Overview

• A chronic, systemic, inflammatory autoimmune disorder that primarily affects the joints
• F>M (3:1), peak incidence 40-60 yrs old
• Risk Factors → genetic predisposition (HLA-DR4 and HLA-DR1), smoking, infection, FH

Making Diagnosis

Clinical Features:

• Symmetrical pain and swelling of affected joints (also at rest) → MCP, PIP, MTP, wrist and knee joints commonly affected (DIP joints spared)
• Morning stiffness (>30 min) that improves with activity
• Rheumatoid Nodules → non-tender, firm, subcutaneous swellings on skin
• Ulnar Deviation, Swan Neck Deformity (MCP flexion, PIP extension, DIP flexion), Boutonniere finger deformity (PIP flexion, DIP extension - like pushing button)
• 25% of patients have Ocular Manifestations → episcleritis (erythema - painless red eye) and scleritis (erythema + pain)
• Pleuritic Chest Pain → pleuritis or pericarditis may occur
• Pleural Effusions
• Carpal Tunnel Syndrome
• Anaemia of Chronic Disease
• Constituitional Symtpoms → fatigue, fever, malaise, weight loss, myalgia