Rheumatoid Arthritis

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• especially synovial joints

• HLA-DR4

Pathogenesis

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• synovium important for lubrication

• RA: inflammation of synovium

• pannus can erode into cartilage, bone, destroy joint

• pink: thin layer of synovial cells that can be inflammed

• thickens: pannus, eat down into cartilage and bones

Symptoms

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• osteoarthritis: not symmetric

• morning stiffness with arthritis resolves in less than an hour

• osteoarthritis: more you use, more it hurts, no fever

• top: DIP, spared

• middle: PIP

• bottom: MCP

• picture: painful, swollen, redness

• wrist deviate toward ulnar side

• pic: swan neck

Systemic Complications

• outside of joints

• swollen in back of knee

• rupture: pain travel down knee

• pleura around lungs or pericardium around heart

• aka rheumatoid nodules

• central necrosis surrounded by pallisading macrophages/lymphocytes

• secondary sjogren syndrome

• sjogren also association with lupus

Diagnosis

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• citrullinated peptides: peptides with citrulline added

• IgM against IgG

Treatment

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• short term/rapid onset with NSAIDS and steroids

• DMARDS: modern treatment. Protect joints from destruction

Sulfasalazine

• 5 ASA similar to aspirin, similar effect

Leflunomide

Infliximab

• Etanercept looks just like TNF receptors

Association

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• rare complication

• triad: splenomegaly, neutropenia, RA