Rheumatoid Arthritis

HOW COMMON Affects about 1% of world's population. AGE Peak incidences occur in 30's and 50's, though can affect all ages.

SEX Affects women 3 - 5 times more often than men.

Rheumatoid Arthritis
ANATOMIC LOCATION Joints of feet and hands are nearly always affected. Frequently affected joints include elbows, knee, wrists, ankles, hips, spine and temporomandibular articulations. CLINICAL INFORMATION Typically slow and insiduous onset in more than half of patients. 10% have acute onset. Often family history. 70% are HLA-DR4. Combined features of RA, splenomegaly and neutropenia known as Felty's syndrome.

Rheumatoid Arthritis
HISTOLOGY Earliest changes occur in synovium, hyperemia,
proliferation of synovial lining cells and infiltration by plasma cells and lymphocytes (forming pannus, causing erosion of joint cartilage).

Synovial giant cells and bone and cartilage

fragments also present within synovial membrane. Second phase, synovium and granulation tissue penetrate bone forming erosions, subchondral cysts and osteoporosis, resulting in fractures.

Rheumatoid Arthritis
HISTOLOGY Following cartilage destruction, pannus bridges
apposing bones, forming fibrous ankylosis and eventually bony ankylosis.

Extraarticular manifestations include rheumatoid nodules, composed of necrotic center with fibrin, surrounded by histiocytic inflammatory reaction, often arranged in palisading fashion. Other pathologic findings include necrotizing arteritis and amyloidosis.