Rheumatoid Arthritis

› Rheumatoid arthritis (RA) affects all ethnic groups.
Women are nearly three times more likely than men to
develop the disease.
› The pattern of arthritis typically favors distal and symmetrical
involvement.
› The most commonly involved joints are the wrists,
metacarpophalangeal, proximal interphalangeal, and
metatarsophalangeal joints. However, many other joints
can also be involved. Shoulder, elbow, hip, knee, or neck
disease (particularly at the atlanto-axial joint, C1–C2)
are frequently observed.
› Most presentations are subacute in nature, with the
insidious onset of fatigue, morning stiffness, and arthritis.
More explosive onsets of disease are also described.
› If untreated, RA is a chronic, progressive disorder that
leads to joint damage, disability, and early mortality.
› A variety of extraarticular features are typical of “seropositive”
RA (RA associated with the presence of rheumatoid
factor in the serum). These include rheumatoid
nodules, secondary Sjögren’s syndrome, interstitial
lung disease, scleritis, and rheumatoid vasculitis.
› Approximately 70% of patients with RA are rheumatoid
factor positive. An approximately equal percentage
has antibodies directed against cyclic citrullinated
peptides (i.e., anti-CCP antibodies). There is substantial
but not complete overlap between groups of
patients who are rheumatoid factor positive and those
who have anti-CCP antibodies.
› Some patients have RA that appears in every way to be
typical disease yet do not have either rheumatoid factor
or anti-CCP antibodies. These patients are said to
have “seronegative RA.”
› Radiographic studies in RA reveal joint space narrowing,
erosions, deformities, and periarticular osteopenia.
› Treatment approaches now emphasize early interventions
designed to suppress joint infl ammation entirely
as soon as possible after the onset of clinical disease.