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.