Rheumatoid Arthritis
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- especially synovial joints
- HLA-DR4
Pathogenesis
- 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
- 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
- citrullinated peptides: peptides with citrulline added
- IgM against IgG
Treatment
- 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
- rare complication
- triad: splenomegaly, neutropenia, RA
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