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Rheumatoid arthritis Health Article

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Table of Contents
Definition Alternative Names Causes, incidence, and risk factors Symptoms Signs and tests Treatment Support Groups Expectations (prognosis) Complications Calling your health care provider Prevention References
Reviewer Info: Ariel D. Teitel, MD, MBA, Chief, Division of Rheumatology, St. Vincent?s Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.; ADAM Health Illustrated Encyclopedia, 02/22/2009
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Prevention

Rheumatoid arthritis has no known prevention. However, it is often possible to prevent further damage of the joints with proper early treatment.

Stop smoking. Research shows that the risk of developing RA is nearly double for current smokers compared with non-smokers.

Because RA may cause eye complications, patients should be have regular eye exams.

References

Harris ED Jr., Budd RC, Genovese MC, Firestein GS, Sargent JS, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005

Smolen JS, Aletaha D, Koeller M, Weisman MH, Emery P. New therapies for treatment of rheumatoid arthritis. Lancet. 2007;370(9602):1861-74.

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Rheumatoid arthritis
Rheumatoid arthritis 		Rheumatoid arthritis
Rheumatoid arthritis 		Rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis 		Synovial fluid
Synovial fluid 		Girl with juvenile rheumatoid arthritis. The disease affects children under the age of 16 and lasts for at least three to six months. (c John Moss/Photo Researchers Inc. Reproduced by permission.)
Girl with juvenile ...
A close-up of a hand deformed by rheumatoid arthritis; the knuckles are swollen and reddened and the fingers curve away from the thumb. The ends of the middle fingers are swollen with cartilage accretion (called Heberden's nodes) that are an indication of osteoarthritis. (Photo Researchers, Inc. Reproduced by permission.)
A close-up of a han... 		Colored x ray of hands with severe rheumatoid arthritis (RA). Yellow indicates swelling and bone deformation. Most of the joints are ragged because of bone erosion. (SPL / Photo Researchers, Inc.)
Colored x ray of ha... 		False-color x ray of hands with extreme rheumatoid arthritis affecting the joints of all the fingers in both hands. (CNRI / Photo Researchers, Inc.)
False-color x ray o...
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Table 278-1 		Table 278-2
Table 278-2
Table 278-3
Table 278-3 		Table 278-4
Table 278-4 		Table 278-5
Table 278-5
Table 278-6
Table 278-6 		Figure 278-1. Rheumatoid arthritis (RA): Initiation.
Figure 278-1. Rheum... 		Figure 278-9. Rheumatoid nodules. In this patient large rheumatoid nodules are seen in a classic location along the extensor surface of the forearm and in the olecranon bursa.
Figure 278-9. Rheum...
Figure 278-11. Left and Right, Rheumatoid vasculitis with small brown infarcts of palms and fingers in chronic rheumatoid arthritis.
Figure 278-11. Left... 		Figure 278-12. Chest radiograph demonstrates discrete rheumatoid nodules in both the right and left lower lobes of the lungs.
Figure 278-12. Ches... 		Figure 278-10. Rheumatoid nodulosis. In this patient multiple rheumatoid nodules are present over joints. In some cases, the nodules may dominate the clinical picture. Rarely, this may be seen as a side effect of methotrexate therapy.
Figure 278-10. Rheu...
Figure 278-3. The joint distribution of the two most common forms of arthritis—rheumatoid arthritis and osteoarthritis—are compared and contrasted. Joints involved in these arthritides are noted by the black circles over the involved joint areas.
Figure 278-3. The j... 		Figure 278-2. Events involved in the pathogenesis of rheumatoid synovitis progress from left to right. M = macrophage; T = T lymphocyte; B = B lymphocyte; P = plasma cell; IL = interleukin; TNF-a = tumor necrosis factor-a TGF-s = transforming growth factor-s GM-CSF = granulocyte-macrophage colony-stimulating factor; RF = rheumatoid factor; PGE 2 = prostaglandin E 2 ; C = complement.
Figure 278-2. Event... 		Figure 278-5. Distribution of pain and/or paresthesias (shaded area) when the median nerve is compressed by swelling in the wrist (carpal tunnel).
Figure 278-5. Distr...
Figure 278-4. Early rheumatoid arthritis manifested as soft tissue swelling of the proximal interphalangeal and metacarpophalangeal joints of the hand. Radiographs at this time would show soft tissue swelling and juxta-articular osteoporosis and occasionally even may show early marginal erosions.
Figure 278-4. Early... 		Figure. Arthrogram with a radiocontrast agent injected into the knee. The dye flows into the popliteal space and through a narrow channel into a large synovial cyst (Baker's cyst) that has dissected into the soft tissue of the calf.
Figure. Arthrogram ... 		Figure 278-6. Radiographs of the knees in the two most common forms of arthritis—rheumatoid arthritis and osteoarthritis—are compared and contrasted. A, Severe involvement in rheumatoid arthritis, with almost complete symmetrical loss of joint space in both the medial and lateral compartment, with little subchondral sclerosis or osteophyte formation. B, Typical osteoarthritis, with severe, near-total loss of joint space of one compartment and a normal or actually increased joint space of the other compartment. Note also the significant subchondral sclerosis in the involved area typical of osteoarthritis.
Figure 278-6. Radio...
Figure 278-8. Lateral radiograph and lateral pathologic specimen of the cervical spine in patients with rheumatoid arthritis are shown. A, The body of C2 and its odontoid process are outlined by the broken lines, and the posterior aspect of the anterior segment of C1 is indicated by a solid line. Normally a space of only 2 to 3 cm separates C1 from C2. The space between C1 and the odontoid of C2 is markedly increased, indicative of subluxation of C1 and C2. B, A pathologic specimen from a patient who died from C1-C2 subluxation. The horizontal arrow shows the odontoid process that subluxed posteriorly, severely compressing and almost severing the cord. The vertical arrow shows a bone graft that had been put in place posteriorly to try and keep this patient from subluxing. Below the arrow you can see a nonhealing area through the bone graft, and inferior to that a wire fixation suture is still in place.
Figure 278-8. Later... 		Table 1
Table 1 		Table 2
Table 2
Figure 1. A patient self-injecting etanercept subcutaneously into the abdomen. This man's hands had improved substantially on this anti-TNF drug so that no active synovitis is evident.
Figure 1. A patient... 		Table 3
Table 3 		Table 4
Table 4

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