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