Rheumatoid Arthritis
Max Field, Gillian Hosie, Gillian A C Hosie in Shared Care for Rheumatology, 2002
Rheumatoid arthritis is a symmetrical peripheral polyarthritis classically involving metacarpophalangeal and proximal interphalangeal joints (Figure 6.1), but equally affecting metatarsophalangeal joints in the feet. Specific criteria for the diagnosis of rheumatoid arthritis have been defined by the American Rheumatology Association (Table 6.1). However any synovial joint can be involved, including wrists, elbows, shoulders, ankles, knees, hips, cervical spine and temporo-mandibular joints (Figure 6.2). Symptoms include stiffness occurring early in the morning, improving as the day progresses, and pain is often described as toothache-like. Early in disease process the joint swelling is predominantly soft tissue with synovitis and/ or effusion, with heat because of joint inflammation. Deformity usually develops over years with joint destruction in the hands leading to ulnar deviation, volar subluxation of the metacarpophalangeal joints, Table 6.1American Rheumatology Association criteria for diagnosis of rheumatoid arthritis RA is diagnosed when four or more of the following criteria are met.
Rheumatoid arthritis
Gill Wakley, Ruth Chambers, Paul Dieppe in Musculoskeletal Matters in Primary Care, 2018
Most health professionals in primary care have experience of new presentations of rheumatoid arthritis, so it is important that suspect it and refer to a specialist team. However, because it is a chronic disease wee need to be involved in the continuing management and aware of the problems that may arise. Non-steroidal anti-inflammatory drugs (NSAIDs) are extremely useful for reducing pain, swelling and inflammation in rheumatoid arthritis. All patients should start on NSAIDs and be given pain relief while they are awaiting their appointment for evaluation for second-line disease-modifying drugs which should normally be started within three months of diagnosis. Active rheumatoid arthritis may result in irreversible joint damage even months of the disease. Although NSAIDs may improve symptoms, disease-modifying anti-rheumatic drugs (DMARDs) have the potential to reduce or prevent joint damage. Press claims of a 'new cure for rheumatoid arthritis' were, as usual, much exaggerated.
Chrysotherapy
Ronald Eisler in Biogeochemical, Health, and Ecotoxicological Perspectives on Gold and Gold Mining, 2010
About 100 million individuals are afflicted with rheumatoid arthritis (RA), including 8 million Americans. This painful disease is associated with high morbidity and mortality. The causes of RA are unknown and there is no known cure. Chrysotherapy, or the treatment of RA by monovalent gold thiol drugs, has been practiced since 1929, although the mechanisms of action are not known with certainty. In general, the gold drugs were most efficacious — and toxic — during the first 2 years of treatment. This chapter synthesizes information on (1) the history of gold drugs used in the treatment of RA; (2) proposed modes of action of gold drugs; and (3) chrysotherapy treatment regimes, adverse effects, and case histories, as modified from Eisler (2003).
Depression and health-related quality of life in patients with rheumatoid arthritis
Published in Expert Review of Pharmacoeconomics & Outcomes Research, 2005
Rheumatoid arthritis is a chronic inflammatory musculoskeletal disease with a prevalence rate of 1–3% in Western countries. In addition to limited physical function, rheumatoid arthritis patients also suffer from psychologic comorbidities. Depression in rheumatoid arthritis patients has been linked to disease outcomes such as increased healthcare service utilization and poor adherence to medication. This review focuses on the impact of depression on rheumatoid arthritis patient’s quality of life and how quality of life can be improved through the management of depression. Both generic and disease-specific instruments have been used to assess health-related quality of life in rheumatoid arthritis research. Commonly used instruments include the generic Short Form-36, the Nottingham Health Profile, the disease-specific Arthritis Impact Measurement Scale and the Rheumatoid Arthritis Quality of Life. Studies have shown that depression in rheumatoid arthritis patients may exert an important impact on multiple domains of health-related quality of life. Currently, depression in rheumatoid arthritis has been managed by both psychoeducation and antidepressant treatment. They are generally effective in improving clinical outcomes. However, future studies are needed to clarify whether they can improve patient reported quality of life. As depression is a prevalent comorbidity in rheumatoid arthritis, clinicians should pay more attention to the rheumatoid arthritis patient’s psychologic wellbeing. Screening for depression and other psychologic distress should be recognized as an important process in the routine clinical care of patients with rheumatoid arthritis.
A Study on the Hereditary Disposition to Rheumatoid Arthritis
Published in Acta Rheumatologica Scandinavica, 1957
Summary In an attempt to study the hereditary disposition to rheumatoid arthritis the 854 siblings of 177 patients suffering from rheumatoid arthritis were examined as well as a control series comprising the 203 siblings of 40 victims of various accidents. The difference between the two series is almost significant (96.5%), which would indicate that rheumatoid arthritis may be a disease of hereditary disposition. There is further support for the assumption in the observation that the rheumatoid arthritis series contains considerably more cases where symptoms similar to those of rheumatoid arthritis have occurred. Rheumatic fever and osteo-arthritis occur similarly in both series. Allergic symptoms were found to be very significantly more frequent in the rheumatoid arthritis series. Therefore, a constitution inclined to allergic manifestations might possibly constitute a noteworthy factor. Tuberculosis, infectious diseases, other internal diseases, occupation and place of domicile did not seem to have any significance with regard to the occurrence of rheumatoid arthritis. The occurrence of rheumatoid arthritis shows a ratio of 3:1 between women and men, and it is obvious that the first outbreak of rheumatoid arthritis occurs at a considerably earlier age in Finland than elsewhere.
Lymphocytic Sialadenitis in the Buccal Mucosa, in Sjögren's Disease, Rheumatoid Arthritis and other Arthritides: A Clinical and Laboratory Study
Published in Acta Rheumatologica Scandinavica, 1968
K. Whaley, D. M. Chisholm, W. W. Downie, W. C. Dick, J. Williamson
Summary The buccal mucous membrane biopsy has been examined histologically for focal lymphocytic sialadenitis, in patients with Sjögren's syndrome, Sjögren's syndrome with rheumatoid arthritis, rheumatoid arthritis alone, and other arthritides. Focal lymphocytic sialadenitis was found in approximately 60 % of all patients with Sjögren's syndrome — with or without rheumatoid arthritis — and in 27.5 % of patients with rheumatoid arthritis. In rheumatoid arthritis, this did not correlate with symptomatic xerostomia, or possible keratoconjunctivitis sicca, both of which may be manifestations of a mild form of Sjögren's syndrome.