Rhaumatoid Arthritis

- Chronic systemic inflammatory disorder involving the joints

- Peripheral symmetrical non-suppurative arthritis

- Unknown cause (autoimmune)

- Onset : 30-50 years old

- F:M = 3:1

- Mnemonic for diagnosing RA: RF RISES

Ø Rheumatoid factor

Ø Finger / hand joints involved (>6weeks)

Ø Rheumatoid nodules

Ø Involvement of 3 or more joint areas

Ø Stiffness (morning) > 1 hour > 6 weeks

Ø Erosions on X-ray

Ø Symmetrical arthritis > 6weeks

Revised Criteria for the Classification of RA

1. Guidelines for classification a. 4 of 7 criteria are required to classify a patient as having rheumatoid arthritis (RA). b. Patients with two or more clinical diagnoses are not excluded. 2. Criteriaav a. Morning stiffness: Stiffness in and around the joints lasting 1 h before maximal improvement. b. Arthritis of 3 or more joint areas: At least 3 joint areas, observed by a physician simultaneously, have soft tissue swelling or joint effusions, not just bony overgrowth. The 14 possible joint areas involved are right or left proximal interphalangeal, metacarpophalangeal, wrist, elbow, knee, ankle, and metatarsophalangeal joints. c. Arthritis of hand joints: Arthritis of wrist, metacarpophalangeal joint, or proximal interphalangeal joint. d. Symmetric arthritis: Simultaneous involvement of the same joint areas on both sides of the body. e. Rheumatoid nodules: Subcutaneous nodules over bony prominences, extensor surfaces, or juxtaarticular regions observed by a physician. f. Serum rheumatoid factor: Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in less than 5% of normal control subjects. g. Radiographic(X-ray) changes: Typical changes of RA on posteroanterior hand and wrist radiographs that must include erosions or unequivocal bony decalcification localized in or most marked adjacent to the involved joints.

- ^av Criteria a–d must be present for at least 6 weeks. Criteria b–e must be observed by a physician.