Signs and Symptoms of Rheumatoid Arthritis
المؤلف:
Mary Louise Turgeon
المصدر:
Immunology & Serology in Laboratory Medicine
الجزء والصفحة:
5th E, P425-426
2025-09-30
131
The term rheumatic disease does not have a clear boundary; more than 100 different conditions are labeled as rheumatic diseases, including RA, osteoarthritis, autoimmune disorders such as systemic lupus erythematosus (SLE) and scleroderma, osteoporosis, back pain, gout, fibromyalgia, and tendinitis.
Rheumatoid arthritis is a chronic, multisystemic, autoimmune disorder and a progressive inflammatory disorder of the joints (Fig. 1). It is, however, a highly variable disease that ranges from a mild illness of brief duration to a progressive destructive polyarthritis associated with a systemic vasculitis (Fig 2).The pathogenesis of RA has the following three distinct stages:
1. Initiation of synovitis by the primary causative factor
2. Subsequent immunologic events that perpetuate the initial inflammatory reaction
3. Transition of an inflammatory reaction in the synovium to a proliferative, destructive tissue process
Fig1. Inflammation in the rheumatoid joint. (Adapted from Olsen NJ, Stein CM: N Engl J Med 350:2167–2179, 2004.)
Fig2. Characteristics of rheumatoid arthritis. Shown are swan-neck deformity, ulnar deviation, dorsal interosseous atrophy, and swelling of wrist. (From Kaye D, Rose LF: Fundamentals of internal medicine, St Louis, 1983, Mosby.)
Rheumatoid arthritis often begins with prodromal symptoms such as fatigue, anorexia, weakness, and generalized aching and stiffness not localized to articular structures. Joint symptoms usually appear gradually over weeks to months. The patient may display a wide variety of extra-articular manifestations (Box 1).
Box1. Extra-Articular Manifestations of Rheumatoid Arthritis
The revised American Rheumatism Association’s criteria for diagnosis of RA are presented in Table 1. If these conditions are present for at least 6 weeks, the patient is designated as having classic RA. Prognostic markers such as a persistently high number of swollen joints, high serum levels of acute-phase reactants of immunoglobulin M (IgM) rheumatoid factor, early radiographic and functional abnormalities, and the presence of certain HLA class II alleles may help identify patients with more severe RA who are still in the early stages of the disease.
Table1. 2010 ACR-EULAR Classification Criteria For Rheumatoid Arthritis*
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