Rhuematoid rhematoid rheumotoid reumatoid rhuemetoid rhumitoid rheumtoid rhumatiod rhuematiod rhemotoid arthritis

These are all the spellings that people use when referring to the most common inflammatory form of arthritis.

Rheumatoid arthritis (this is the correct spelling) is a chronic progressive systemic inflammatory disorder in which the joints are the primary target.

This disease affects about 1% of the population. While it affects women more often than men, it affects people of all ages.

In its more severe forms... and prior to the advent of the more effective medications we have now, it had a higher mortality rate than diabetes, 3-vessel coronary disease, cigarette smoking, and advanced Hodgkin’s disease.

The cause of rheumatoid arthritis remains unknown. The most characteristic pathologic changes occur in the joints. RA affects diarthrodial joints (joints having cartilage overlying bone, and a joint cavity lined by a synovial membrane that contains synovial fluid). When arthritis develops, the normally thin synovial layer becomes infiltrated with inflammatory cells. Large amounts of immunoglobulins are produced. Blood vessels proliferate and cells undergo changes. The result is a hypertrophied synovium that erodes into cartilage and bone and leads to destruction of elements within the joint as well as destruction of other components near the joint such as ligaments and tendons... A complex interaction among cells such as T cells, macrophages, monocytes, and neutrophils along with the production of destructive cellular messengers called cytokines also takes place.

Cardinal findings include morning stiffness, swollen, and tender joints. Warmth, loss of range of motion, loss of function, and pain predominate.

Criteria for the diagnosis of rheumatoid arthritis established by the American College of Rheumatology include morning stiffness lasting one hour or more, arthritis involving three or more joints, arthritis involving the small joints of the hand, symmetric arthritis, rheumatoid nodules, a positive rheumatoid factor, an x-ray changes characteristic of RA. The presence of 4 or more criteria helps establish the diagnosis.

Damage to joints leads to deformity.

RA may also cause damage to organs besides the joints. These include pleuritis (inflammation of the lining of the lung), pericarditis (inflammation of the lining of the heart), scleritis/episcleritis (inflammation of the eye), rheumatoid nodules, and vasculitis (inflammation of blood vessels) are complications.

Involvement of the spine can lead to dislocation of the vertebrae in the neck with spinal cord compression.

Features of RA associated with aggressive disease are: high titers of rheumatoid factor, elevated erythrocyte sedimentation rate or C reactive protein, x-ray evidence of erosions (damage), arthritis involving more than 20 joints, functional disability, rheumatoid nodules or other non-joint problems, lower socioeconomic status.

Laboratory findings such as an elevation of erythrocyte sedimentation rate (ESR) and rheumatoid factor positivity (occurring in about 75% of patients) is helpful for diagnosis.

While radiographs are helpful in the late stages of RA., they are not helpful for early disease. Magnetic resonance imaging (MRI) is much more useful for finding early changes.

The diagnosis of RA is not always easy. Many diseases mimic RA and a careful diagnostic approach is required.

More information on the approach to diagnosis and treatment may be found elsewhere on this website.

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