Rheumatoid Arthritis: Pathogenesis, Diagnosis, Management and MCQ with Answer

Rheumatoid Arthritis: Pathogenesis, Diagnosis, Management and MCQ with Answer

INTRODUCTION :-

1.) Rheumatoid arthritis [RA] is a chronic systemic inflammatory disorder that may affect many tissues and organs.

2.) Although, the cause of rheumatoid arthritis [RA] remains unknown.

3.) Women are three to five times are more vulnerable towards this disease.

4.) The onset of this disease is insidious ( developing in a gradual and the harmful way ), beginning with prodrome ( an early symptom indicating the onset of a disease or illness ) of fatigue, weakness, joint stiffness, vague arthralagies and myalgias. This is followed by pain and swelling of  joints, especially involving the joints of hands, wrist and feet.

5.) Also, extra – articular manifestations infrequently produces symptoms, but when present complicate the diagnosis.

ETIOPATHOGENESIS :-

1.) It is believed that rheumatoid arthritis is triggered by exposure of an immunogenetically susceptible host to an arthriogenic microbial antigen.

2.) Therefore, causes involved in rheumatoid arthritis are :-

  • Genetic susceptibility.
  • Primary exogenous arthritogen.
  • An autoimmune reaction within synovial membrane.
  • Mediators of the joint damage.

3.) Genetic predisposition is a clearly a major determinant of susceptibility to rheumatoid arthritis.

4.) Moreover, the majority of ( 65 to 80% ) individuals who develop rheumatoid arthritis are HLA – DR4 or DR – 1 or both.

5.) It is generally belived that the initiator of the disease is a microbial agent,  but the identity of microbial agent is always elusive.

6.) An autoimmune reaction in which T cells plays the pivotal role is widely held to be responsible for the chronic destructive nature of rheumatoid arthritis, once an inflammatory synovitis has been initiated by an exogenous agent.

7.) T cells, mainly CD4+ memory cells, appear within the affected area that is in affected joints early in the development of rheumatoid arthritis.

8.) IgM antibodies mostly are generated in the joints. About 80% of individuals with rheumatoid arthritis have auto antibodies to the Fc portion of autologous IgG.

A Closer Look at Rheumatoid Arthritis Symptoms

Fig : 1

CLINICAL COURSE :-

1.) The clinical course of rheumatoid arthritis is extremely variable.

2.) Initially there is a malaise ( feeling of discomfort ), fatigue and generalized musculoskeletal pain.

3.) The involved joints are swollen, warm, painful and particularly stiff on arising or following inactivity.

4.) Symptoms, usually develops in the small joints of the hand ( proximal interphalangeal joint and metacarpophalangeal joint ) and frets, followed by the wrist, knees, ankles and elbows.

5.) Thus, there are no specific laboratory test diagnostic of rheumatoid arthritis.

DIAGNOSIS :-

The diagnosis is made primarily on the clinical features and requires the presence of four of following criteria :-

  • Morning stiffness
  • Arthritis in three or more joint areas.
  • Arthritis of hand joints.
  • Symmetric arthritis.
  • Rheumatoid nodules.
  • Serum rheumatoid factor.
  • Typical radiographic changes.

 

MULTIPLE CHOICE QUESTIONS :-

1.] What are the early signs and symptoms of rheumatoid arthritis ?

a. Joint pain, tenderness, redness and swelling

b. Loss of joint range of motion

c. Limping

d. All of the above

2.] Rheumatoid arthritis [RA] is different from some other forms of arthritis because it ?

a. Is more painful than other forms

b. Occur below the waist

c. Is symmetrical, affecting the right and left side of the body

d. Generally occur above the waist.

3.] Rheumatology is the branch of medicine that involve the study of ?

a. The immune system

b. Musculoskeletal ( muscle and bone ) system

c. Rheumatic disease

d. All of the above

4.] The sudden appearance or worsening of RA symptom is referred to as an ?

a. Outbreak

b. Flare

c. Burst

d. Eruption

5.] The term arthritis refers to ?

a. Stiffness in joint

b. Inflammation of the joints

c. Both (a) and (b)

d. None of the above

6.] Rheumatoid arthritis is more severe in ?

a. Men

b. Women

c. Both (a) and (b)

d. None of the above

7.] People with rheumatoid arthritis experience the most stiffness at night ?

a. True

b. False

8.] Rheumatoid arthritis can be treated by ?

a. Medication

b. Exercise

c. Surgery

d. All of the above

9.] Which test cannot be used to aid in the diagnosis or monitoring of progression of rheumatoid arthritis ?

a. ESR

b. RF Test

c. Anti – CD

d. Heterophile AB

10.] The cause of rheumatoid arthritis is ?

a. Heterophile antibodies

b. EBV

c. IgM

d. IgG

 

SOLUTIONS :-

1.] (d)

2.] (c) is symmetrical, affecting in right and left side of body

3.] (d)

4.] (b) flare

5.] (b) inflammation of the joints

6.] (b) women

7.] (b)

8.] (d)

9.] (d) heterophile AB

10.] (c) IgM

 

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REFERENCE :-

1.] Textbook Of Pathology By Harsh Mohan.

2.] Robbin’s Basic Pathology.

 

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