Resident Report 11/9 – Rheumatoid Arthritis

Teaching Pearls:

  • Average Age 30-55 years old; F:M ratio 3:1
  • Symmetric polyarthritis
  • Morning stiffness >1 hour that improves with activity
    • OA worsens with activity
  • Joint Involvement:
    • Almost always involves MCP, PIP, wrist, MTP
    • Spares the DIP and lumbar spine
      • Think of OA with DIP involvement
    • Can occasionally affect large joints
    • Swan Neck Deformity
    • Boutonniere deformity
    • Ulnar Deviation
    • C1-C2 subluxation (Atlanto-axial instability)
      • This specifically can also be seen in Downs syndrome
    • Peri-articular osteopenia
  • RA is an independent risk factor for pre-mature coronary artery disease
  • RA + pancytopenia + splenomegaly = Felty Syndrome
  • RA is a systemic disease that can affect multiple organs. Can be a cause for secondary amyloidosis.
  • Amyloidosis – deposition disease that clinically affects the kidneys, liver, and heart.
    • Kidney – can lead to nephrotic syndrome
    • Hepatomegaly
    • Restrictive cardiomyopathy
    • Thickening of tongue – lateral scalloping seen on exam
    • Waxy skin
    • Coagulopathy – amyloid protein causes binding to factor X
    • Neuropathy
    • GI – causing a malabsorptive syndrome
  • Diagnosis requires abdominal fat pad biopsy with Congo red stain to check for apple-green birefringence.

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