Arthritis, Rheumatoid (RA)

Arthritis, Rheumatoid (RA) is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or .

5-Minute Clinical Consult (5MCC) app and website powered by Unbound Medicine helps you diagnose and manage 900+ medical conditions. Exclusive bonus features include Diagnosaurus DDx, 200 pediatrics topics, and medical news feeds. Explore these free sample topics:

-- The first section of this topic is shown below --

Basics

Description

  • Rheumatoid arthritis (RA) is a chronic autoimmune systemic inflammatory disease (1).
  • RA primarily involves synovial inflammation and proliferation leading to destruction of juxta-articular bone and articular cartilage (1).
  • Along with articular manifestation, RA also causes various extra-articular manifestations like vasculitis, nodule, or accelerated atherosclerosis.
  • Classification:
    • Based on the duration of disease (1)
      • Early: Disease symptoms less than 6 months
      • Established: Disease symptoms more than 6 months or meeting 1987 American College of Rheumatology classification criteria
    • Based on the disease activity (calculated by validated disease activity scale
      • Remission
      • Low activity
      • Moderate activity
      • High activity

Epidemiology

Incidence
  • Annual incidence in North America is 38 (range 31 to 45) cases per 100,000.
  • Incidence rates around the world
  • Lifetime risk in U.S. males 1.7% females 3.6.

Prevalence
  • RA is one of the most commonly present inflammatory arthritis and is prevalent in 0.5% to 1% of the general population worldwide.
  • More prevalent in females (female: male, 2:1 to 3:1)

Etiology and Pathophysiology

  • The cause of RA remains uncertain.
  • Often precipitated by some sort of stress or insult (e.g., infection, smoking, trauma)

Genetics
  • More than 100 genes have been associated with an increased risk of RA.
  • Allelic variant HLA-DRB1 has been linked to RA associated with antibodies to citrullinated protein epitopes.
  • Antibodies to citrullinated protein epitopes found in more than 70% of patients of RA
  • Evidence of altered immunity can be present years before the onset of clinical arthritis.
  • Cytokine networks involving tumor necrosis factor (TNF), interleukin-6, and many other factors participate in disease progression and can be targeted by therapeutic agents.

Risk Factors

  • Female gender
  • Occurs in females at a younger age (5th to 6th decade) than male (7th to 8th decade)
  • Family history
  • Some Native American tribes
  • Smoking
  • Obesity
  • Exposure to silica

Commonly Associated Conditions

Accelerated atherosclerosis, pericarditis, amyloidosis, Felty syndrome (RA, splenomegaly, neutropenia), interstitial lung disease, pulmonary nodules, rheumatoid nodules, vasculitis, lymphomas, carpal tunnel syndrome

-- To view the remaining sections of this topic, please or --

Basics

Description

  • Rheumatoid arthritis (RA) is a chronic autoimmune systemic inflammatory disease (1).
  • RA primarily involves synovial inflammation and proliferation leading to destruction of juxta-articular bone and articular cartilage (1).
  • Along with articular manifestation, RA also causes various extra-articular manifestations like vasculitis, nodule, or accelerated atherosclerosis.
  • Classification:
    • Based on the duration of disease (1)
      • Early: Disease symptoms less than 6 months
      • Established: Disease symptoms more than 6 months or meeting 1987 American College of Rheumatology classification criteria
    • Based on the disease activity (calculated by validated disease activity scale
      • Remission
      • Low activity
      • Moderate activity
      • High activity

Epidemiology

Incidence
  • Annual incidence in North America is 38 (range 31 to 45) cases per 100,000.
  • Incidence rates around the world
  • Lifetime risk in U.S. males 1.7% females 3.6.

Prevalence
  • RA is one of the most commonly present inflammatory arthritis and is prevalent in 0.5% to 1% of the general population worldwide.
  • More prevalent in females (female: male, 2:1 to 3:1)

Etiology and Pathophysiology

  • The cause of RA remains uncertain.
  • Often precipitated by some sort of stress or insult (e.g., infection, smoking, trauma)

Genetics
  • More than 100 genes have been associated with an increased risk of RA.
  • Allelic variant HLA-DRB1 has been linked to RA associated with antibodies to citrullinated protein epitopes.
  • Antibodies to citrullinated protein epitopes found in more than 70% of patients of RA
  • Evidence of altered immunity can be present years before the onset of clinical arthritis.
  • Cytokine networks involving tumor necrosis factor (TNF), interleukin-6, and many other factors participate in disease progression and can be targeted by therapeutic agents.

Risk Factors

  • Female gender
  • Occurs in females at a younger age (5th to 6th decade) than male (7th to 8th decade)
  • Family history
  • Some Native American tribes
  • Smoking
  • Obesity
  • Exposure to silica

Commonly Associated Conditions

Accelerated atherosclerosis, pericarditis, amyloidosis, Felty syndrome (RA, splenomegaly, neutropenia), interstitial lung disease, pulmonary nodules, rheumatoid nodules, vasculitis, lymphomas, carpal tunnel syndrome

There's more to see -- the rest of this entry is available only to subscribers.