Rheumatoid arthritis is a chronic and systemic inflammatory disorder characterized predominantly by synovitis, which exerts its influence across a spectrum of joints. Its prevalence approximates 1%, exhibiting a discernible predilection for females over males, with a female-to-male ratio of 3:1. Although rheumatoid arthritis can manifest at any chronological juncture, its onset typically aligns with the fourth or fifth decade among women and the sixth to eighth decades among men. The etiological underpinnings of this ailment remain shrouded in intricacy, yet genetic predispositions orchestrated by a confluence of multiple genes play a pivotal role. Particularly salient is the inheritance of specific HLA-DRB1 alleles, housing a unique pentameric sequence, colloquially known as the "shared epitope," which confers a well-established genetic proclivity.
In the absence of therapeutic intervention, rheumatoid arthritis ushers in a progression of joint deterioration, ultimately culminating in marked debilitation and curtailed longevity. Nurturing an early and proactive therapeutic approach stands as the cornerstone of established medical practice. Microscopic scrutiny of affected joint tissues unveils the persistence of chronic synovitis, culminating in the development of a pannus. This pathologically evolved structure orchestrates the erosion of vital components including cartilage, bone, ligaments, and tendons. Evidentiary hallmarks of heightened inflammatory activity, including synovial effusion, converge to typify this intricate clinical tableau.
Symptoms:
- Morning stiffness that persists for more than 30 minutes.
- Swelling, tenderness, and pain in the joints.
- Generalized weakness and fatigue.
- Decreased appetite.
- Mild fever.
Joint Involvement:
- Symmetrical joint impact.
- Primarily affects smaller joints, such as hands, wrists,
feet, and ankles.
- Inflamed joints feel warm upon touch.
- Limited joint mobility due to inflammation.
Systemic Symptoms:
- Fatigue and overall feeling of unwellness.
- Mild fever.
- Unintentional weight loss.
Extra-articular Manifestations:
- Formation of subcutaneous nodules.
- Occurrence of interstitial lung disease.
- Presence of pleural effusion.
- Development of pericarditis.
- Enlargement of the spleen.
- Inflammation of the sclera (scleritis).
- Manifestation of vasculitis (blood vessel inflammation).
Laboratory Findings:
- Elevated levels of C-reactive protein (CRP) and
erythrocyte sedimentation rate (ESR).
- Presence of Rheumatoid factor (RF) in blood.
- Detection of antibodies targeting cyclic citrullinated
peptides (anti-CCP antibodies).
- Elevated white blood cell count (leukocytosis) during
active disease phases.
Joint Examination:
- Joint swelling due to synovial inflammation.
- Tenderness and pain in the joints upon palpation.
- Reduced range of joint motion.
- Development of deformities like swan-neck or boutonniere
deformities.
Radiographic Findings:
- Osteoporosis near joints (juxta-articular).
- Erosion of joint structures.
- Narrowing of joint spaces.
It's important to note that the presentation of Rheumatoid
Arthritis can vary from person to person, and not all individuals will
experience all the mentioned symptoms or manifestations.
Summary of Rheumatoid Arthritis:
- Typically characterized by a gradual and subtle beginning marked by morning stiffness and joint discomfort.
- Demonstrates a symmetrical pattern of polyarthritis, often affecting the smaller joints in the hands and feet; progressive disease frequently leads to joint deformities.
- Radiological observations commonly include peri-joint bone density loss, erosion of joints, and a narrowing of joint spaces.
- Rheumatoid factor and antibodies targeting cyclic citrullinated peptides (anti-CCP) are detectable in approximately 70-80% of cases.
- Beyond joint involvement, potential extra-articular manifestations encompass subcutaneous nodules, interstitial lung ailments, pleural effusion, pericarditis, spleen enlargement, scleritis, and vasculitis.
