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Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. It is a disabling and painful inflammatory condition, which can lead to substantial loss of mobility due to pain and joint destruction. RA is a systemic disease, often affecting extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ...
The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ...
// M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14...
// M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14...
The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ...
The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ...
The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ...
The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ...
MedlinePlus (medlineplus. ...
eMedicine is an online clinical medical knowledge base that was founded in 1996. ...
Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ...
An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...
Autoimmunity is the failure of an organism to recognize its own constituent parts (down to the sub-molecular levels) as self, which results in an immune response against its own cells and tissues. ...
A scanning electron microscope image of a single neutrophil (yellow), engulfing anthrax bacteria (orange). ...
This article is about a joint in zootomical anatomy. ...
An abscess on the skin, showing the redness and swelling characteristic of inflammation. ...
Look up Pain in Wiktionary, the free dictionary. ...
A systemic disease is one that affects more than one body system. ...
For other uses, see Skin (disambiguation). ...
f you all The blood vessels are part of the circulatory system and function to transport blood throughout the body. ...
The heart and lungs, from an older edition of Grays Anatomy. ...
For the village in Tibet, see Lung, Tibet. ...
For other uses of Muscles, see Muscles (disambiguation). ...
The name is derived from the Greek rheumatos means "flowing", and this initially gave rise to the term "rheumatic fever", an illness that can follow throat infections and which includes joint pain. The suffix -oid means "resembling", i.e. resembling rheumatic fever. Arthr means "joint" and the suffix -itis, a "condition involving inflammation". Thus rheumatoid arthritis was a form of joint inflammation that resembled rheumatic fever. Rheumatoid arthritis appears to have been described in paintings more than a century before the first detailed medical description of the condition in 1800 by Landre-Beauvais.[1] Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...
Signs and symptoms
Synovitis Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disorder affecting the joints and sometimes other organs as well. It is by definition polyarticular; that is, it affects many joints. Most commonly, small joints (including the hands, feet and cervical spine) are affected, but larger joints (shoulders, knees etc) can also be involved; the pattern of joint involvement can differ from patient to patient.[2]
Rheumatoid arthritis affects women three times more often than men, and it can first develop at any age. The risk of first developing the disease (the disease incidence) appears to be greatest for women between 40 and 50 years of age, and for men somewhat later.[3] RA is a chronic disease, and although a spontaneous remission may occur in a very small number of patients, the natural course is almost invariably one of persistent symptoms, waxing and waning in intensity, and a progressive deterioration of joint structures leading to deformations and disability. In optics one considers angles of incidence. ...
Synovitis affecting synovial joints is the most prominent feature in rheumatoid arthritis. Joint synovitis could evolve in to a chronic arthritis and deformities in rheumatoid arthritis. Rheumatoid arthritis is a systemic disorder due to an abnormal immune reaction associated with constitutional symptoms which can affect the other organ systems as well. However the joint synovitis leading to arthritis affecting multiple joints remains the key clinical feature in rheumatoid arthritis. It was recently noted that there is a strong correlation between RA and cyanosis of the sclera and of the nails, which is thought to be due to the release of cuprified protein C from the synovial fluid.[4] Synovitis is the medical term for inflammation of a synovial membrane, which line those joints which possess cavities. ...
Schematic diagram of the human eye. ...
Inflammation in the joints manifests itself as a soft, "doughy" swelling, pain, tenderness to palpation and movement, local warmth, and functional impairment. Morning stiffness is often a prominent feature and may last for more than an hour. These signs help distinguish rheumatoid and other inflammatory arthritides from non-inflammatory diseases of the joints such as osteoarthritis (sometimes referred to as the "wear-and-tear" of the joints). In RA, the joints are usually affected in a fairly symmetrical fashion although the initial presentation may be asymmetrical. Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease, or in more colloquial terms wear and tear), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints and destruction or...
Rheumatoid arthritis is a systemic disorder mainly affecting synovial joints. Chemical mediators (Cytokines) released as a result of an abnormal immune reaction triggered by yet undetermined agent/ agents, immune system releases cytokines which gives rise to inflammation of joint synovium (Synovitis). Constitutional symptoms such as fever, malaise, loss of appetite and weight loss are also due to cytokines released in to the blood stream due to an abnormal immune reaction. Vasculitis affecting many other organ systems often gives rise to systemic complications. Most common and disabling clinical feature in Rheumatoid arthritis is chronic, deforming, often symmetrical polyarthritis (affecting multiple joints) due to joint Synovitis triggered by an autoimmune reaction in genetically susceptible individuals .[5]
Deformity As the pathology progresses the inflammatory activity leads to erosion and destruction of the joint surface, which impairs their range of movement and leads to deformity. The fingers are typically deviated towards the little finger (ulnar deviation) and can assume unnatural shapes. Classical deformities in rheumatoid arthritis are the Boutonniere deformity (Hyperflexion at the proximal interphalangeal joint with hyperextension at the distal interphalangeal joint), swan neck deformity (Hyperextension at the proximal interphalangeal joint, hyperflexion at the distal interphalangeal joint). The thumb may develop a "Z-Thumb" deformity with fixed flexion and subluxation at the metacarpophalangeal joint, and hyperextension at the IP joint. It is a hand deformity in which the swelling of the metacarpophalangeal joints(the big knuckes at the base of the fingers) causes the fingers to become displaced, tending towards the little finger. ...
The introduction to this article provides insufficient context for those unfamiliar with the subject matter. ...
Grays Fig. ...
Grays Fig. ...
Grays Fig. ...
Grays Fig. ...
A subluxation may refer to: // A subluxation[1] is an incomplete or partial dislocation (Latin: luxatio)[2] of a joint or organ. ...
The Metacarpophalangeal joint (MCP): The Metacarpophalangeal Articulations are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the first phalanges, with the exception of that of the thumb, which presents more of the characters of...
Extra-articular (elsewhere) Patients with RA usually exhibit signs of systemic inflammation, that is, the inflammatory process in the joint leaves its marks on other organs as well (and this may also help distinguish it from osteoarthritis). Examples are a general tiredness and lassitude, sometimes low-grade fever, and some abnormalities on blood tests such as an elevated erythrocyte sedimentation rate (ESR), and anemia, which is often seen as a consequence of the disease itself (anaemia of chronic disease) although it may also be caused by gastrointestinal bleeding as a side effect of drugs used in treatment, especially NSAIDs used for analgesia. Extra-articular manifestations (manifestations outside the musculoskeletal system) occur in about 15% of patients with rheumatoid arthritis.[6] Examples are hepatosplenomegaly which may occur with concurrent leukopenia and is then referred to as Felty's syndrome), lymphocytic infiltration affecting the salivary and lacrimal glands (Sjögren's syndrome), pericarditis, pleurisy, alveolitis, scleritis, and subcutaneous nodules. This article discusses the medical condition. ...
Anemia of chronic disease, increasingly referred to as anemia of inflammation, is a form of anemia seen in chronic illness, e. ...
Gastrointestinal bleeding describes every form of hemorrhage (blood loss) in the gastrointestinal tract, from the pharynx to the rectum. ...
Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ...
For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...
Hepatosplenomegaly is the simultaneous enlargement of both the liver (hepatomegaly) and the spleen (splenomegaly). ...
Leukopenia or leukocytopenia refers to a decrease in the number of circulating white blood cells (leukocytes) in the blood. ...
Definition Rheumatoid Arthritis (chronic) & Splenomegaly, ↓ WCC, +++ RhF Complications Recurrent Infection, Hypersplenism → causing 2° anaemia ± thrombocytopenia) Lymphadenopathy Skin hyperpigmentation & cutaneous ulceration Treatment That of RA + Splenectomy may improve neutropenia] ...
Sjögrens syndrome is an autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. ...
Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ...
Pleurisy, also known as pleuritis, is an inflammation of the pleura, the lining of the pleural cavity surrounding the lungs, which can cause painful respiration (also called pleuritic chest pain) and other symptoms. ...
Scleritis is a serious inflammatory disease that affects the white outer coating of the eye, known as the sclera. ...
The subcutis is the layer of tissue directly underlying the cutis. ...
In medicine, a nodule refers to a small aggregation of cells. ...
Cutaneous manifestations - The rheumatoid nodule is the cutaneous (strictly speaking subcutaneous) feature most characteristic of rheumatoid arthritis. The initial pathologic process in nodule formation is unknown but is thought to be related to small-vessel inflammation. The mature lesion is defined by an area of central necrosis surrounded by palisading macrophages and fibroblasts and a cuff of cellular connective tissue and chronic inflammatory cells. The typical rheumatoid nodule may be a few millimetres to a few centimetres in diameter and is usually found over bony prominences, such as the olecranon, the calcaneal tuberosity, the metacarpophalangeal joints, or other areas that sustain repeated mechanical stress. Nodules are associated with a positive RF titer and severe erosive arthritis. They can rarely occur throughout the body in internal organs.
- Several forms of vasculitis are also cutaneous manifestations associated with rheumatoid arthritis. A benign form occurs as microinfarcts around the nailfolds. More severe forms include livedo reticularis, which is a network (reticulum) of erythematous to purplish discoloration of the skin due to the presence of an obliterative cutaneous capillaropathy. (This rash is also otherwise associated with the antiphospholipid-antibody syndrome, a hypercoagulable state linked to antiphospholipid antibodies and characterized by recurrent vascular thrombosis and second trimester miscarriages.)
Other, rather rare, cutaneous features include: Necrosis (in Greek ÎεκÏός = Dead) is the name given to accidental death of cells and living tissue. ...
Macrophages (Greek: big eaters) are cells found in tissues that are responsible for phagocytosis of pathogens, dead cells and cellular debris. ...
A fibroblast is a cell that makes the structural fibers and ground substance of connective tissue. ...
Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue. ...
...
The calcaneus is the large bone making up the heel of the human foot. ...
The Metacarpophalangeal joint (MCP): The Metacarpophalangeal Articulations are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the first phalanges, with the exception of that of the thumb, which presents more of the characters of...
In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ...
Livedoid vasculitis (also known as livedo vasculitis, livedo reticularis, and livedoid vasculopathy) is a vascular disorder mostly affecting women. ...
This article is about biological infectious particles. ...
Erythema nodosum is a form of inflammation of the subcutaneous fatty tissue. ...
Panniculitis is a group of diseases whose hallmark is inflammation of subcutaneous fatty and muscle tissue. ...
Atrophy is the partial or complete wasting away of a part of the body. ...
Palmar erythema is reddening of the palms at the thenar and hypothenar eminences. ...
Other In addition to articular and cutaneous features, rheumatoid arthritis has a multitude of other, rare, features: - Pulmonary
- The lungs may become involved as a part of the primary disease process or as a consequence of therapy. Fibrosis may occur spontaneously or as a consequence of therapy (for example methotrexate). Caplan's syndrome describes lung nodules in patients with rheumatoid arthritis and exposure to coal dust. Pleural effusions are also associated with rheumatoid arthritis.
- Renal
- Amyloidosis can occur. [7]
- Cardiovascular
- Possible complications that may arise include: pericarditis, endocarditis, left ventricular failure, valvulitis and fibrosis. The risk of cardiovascular, specifically myocardial infarction (heart attack) or congestive heart failure are greater in individuals with RA. Over 1/3 of deaths of people with RA are directly attributable to cardiovascular death.
- Ocular
- Keratoconjunctivitis sicca (dry eyes), scleritis, episcleritis and scleromalacia.
- Gastrointestinal and Hematological
- Felty syndrome, anemia
- Neurological
- Peripheral neuropathy and mononeuritis multiplex may occur. The most common problem is carpal tunnel syndrome due to compression of the median nerve by swelling around the wrist. Atlanto-axial subluxation can occur, owing to erosion of the odontoid process and or/transverse ligaments in the cervical spine's connection to the skull. Such an erosion (>3mm) can give rise to vertebrae slipping over one another and compressing the spinal cord. At first the patient experiences clumsiness but without due care this can progress to quadriplegia.
- Vasculitis
- Vasculitis in rheumatoid arthritis is common. It typically presents as vasculitic nailfold infarcts.
- Osteoporosis
- Osteoporosis classically occurs in RA around inflamed joints. It is postulated to be partially caused by inflammatory cytokines.
- Lymphoma
- The incidence of lymphoma is increased in RA as it is in most autoimmune conditions.
The heart and lungs (from an older edition of Grays Anatomy) The lung is an organ belonging to the respiratory system and interfacing to the circulatory system of air-breathing vertebrates. ...
Fibrosis is the formation or development of excess fibrous connective tissue in an organ or tissue as a reparative or reactive process, as opposed to a formation of fibrous tissue as a normal constituent of an organ or tissue. ...
Amethopterin redirects here. ...
Caplans syndrome (or Caplans disease) is a form of rheumatoid arthritis presenting with pneumoconiosis. ...
Coal Example chemical structure of coal Coal is a fossil fuel formed in ecosystems where plant remains were saved by water and mud from oxidization and biodegradation. ...
Pleural effusion Chest x-ray of a pleural effusion. ...
Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ...
Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ...
Fibrosis is the formation or development of excess fibrous connective tissue in an organ or tissue as a reparative or reactive process, as opposed to a formation of fibrous tissue as a normal constituent of an organ or tissue. ...
Heart attack redirects here. ...
Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ...
Scleritis is a serious inflammatory disease that affects the white outer coating of the eye, known as the sclera. ...
This article or section does not cite its references or sources. ...
Feltys syndrome is a condition characterized by the triad of rheumatoid arthritis, splenomegaly and granulocytopenia. ...
This article discusses the medical condition. ...
Mononeuritis multiplex is the clinical picture that arises from problems with multiple individual nerves serially or almost simultaneously. ...
Quadriplegia, also known as tetraplegia, is a symptom in which a human experiences paralysis of all four limbs, although not necessarily total paralysis. ...
In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ...
Osteoporosis is a disease of bone - leading to an increased risk of fracture. ...
This article is about lymphoma in humans. ...
Diagnosis
Diagnostic criteria The American College of Rheumatology has defined (1987) the following criteria for the classification of rheumatoid arthritis:[8] Year 1987 (MCMLXXXVII) was a common year starting on Thursday (link displays 1987 Gregorian calendar). ...
- Morning stiffness of >1 hour most mornings for at least 6 weeks.
- Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups, present for at least 6 weeks
- Arthritis of hand joints, present for at least 6 weeks
- Symmetric arthritis, present for at least 6 weeks
- Subcutaneous nodules in specific places
- Rheumatoid factor at a level above the 95th percentile
- Radiological changes suggestive of joint erosion
At least four criteria have to be met for classification as RA. Rheumatoid factor (RF) is a blood test performed in patients with suspected rheumatoid arthritis (RA). ...
It is important to note that these criteria are not intended for the diagnosis of patients for routine clinical care. They were primarily intended to categorize patients for research. For example: one of the criteria is the presence of bone erosion on X-Ray. Prevention of bone erosion is one of the main aims of treatment because it is generally irreversible. To wait until all of the ACR criteria for rheumatoid arthritis are met may sometimes result in a worse outcome for the patient. Most patients and rheumatologists would agree that it would be better to treat the patient as early as possible and prevent bone erosion from occurring, even if this means treating patients who don't fulfill the ACR criteria. The ACR criteria are, however, very useful for categorising patients with established rheumatoid arthritis, for example for epidemiological purposes.
Blood tests When RA is being clinically suspected, immunological studies are required, such as rheumatoid factor (RF, a specific antibody).[9] A negative RF does not rule out RA; rather, the arthritis is called seronegative. During the first year of illness, rheumatoid factor is frequently negative. 80% of patients eventually convert to seropositive status. RF is also seen in other illnesses, like Sjögren's syndrome, and in approximately 10% of the healthy population, therefore the test is not very specific. Immunology is a broad branch of biomedical science that covers the study of all aspects of the immune system in all organisms. ...
Rheumatoid factor (RF) is a blood test performed in patients with suspected rheumatoid arthritis (RA). ...
Each antibody binds to a specific antigen; an interaction similar to a lock and key. ...
Seronegative is a general term that means absent from the blood. More specifically, it almost always is used to refer to antibodies being absent from the blood. ...
Sjögrens syndrome is an autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. ...
Because of this low specificity, a new serological test has been developed in recent years, which tests for the presence of so called anti-citrullinated protein antibodies (ACPA). Like RF, this test can detect approximately 80% of all RA patients, but is rarely positive in non-RA patients, giving it a specificity of around 98%. In addition, ACP antibodies can be often detected in early stages of the disease, or even before disease onset. Currently, the most common test for ACP antibodies is the anti-CCP (cyclic citrullinated peptide) test. [10] The specificity is a statistical measure of how well a binary classification test correctly identifies the negative cases, or those cases that do not meet the condition under study. ...
Also, several other blood tests are usually done to allow for other causes of arthritis, such as lupus erythematosus. The erythrocyte sedimentation rate (ESR), C-reactive protein,[11] full blood count, renal function, liver enzymes and other immunological tests (e.g. antinuclear antibody/ANA)[12] are all performed at this stage. Ferritin can reveal hemochromatosis, which can mimic RA. Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ...
Systemic Lupus Erythematosus (SLE or lupus) is a chronic autoimmune disease that can be fatal, though with recent medical advances, fatalities are becoming increasingly rare. ...
The erythrocyte sedimentation rate (ESR), also called a sedimentation rate, sed rate or Biernacki Reaction, is a non-specific measure of inflammation that is commonly used as a medical screening test. ...
C-reactive protein (CRP) is a plasma protein, an acute phase protein produced by the liver. ...
A full blood count (FBC) or complete blood count (CBC) is a test requested by a doctor or other medical professional that gives information about the cells in a patients blood. ...
In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ...
Liver function tests (LFTs or LFs), are groups of clinical biochemistry laboratory blood assays designed to give a doctor or other health professional information about the state of a patients liver. ...
Antinuclear antibodies (ANAs, also known as antinuclear factor or ANF) are detected in a large group of autoimmune disorders. ...
Ferritin is a globular protein found mainly in the liver, which can store about 4500 iron (Fe3+)ions in a hollow protein shell made of 24 subunits. ...
Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ...
Differential diagnosis Several other medical conditions can resemble RA, and usually need to be distinguished from it at the time of diagnosis:[13] - Crystal induced arthritis (gout, and pseudogout) - usually involves particular joints and can be distinguished with aspiration of joint fluid if in doubt
- Osteoarthritis - distinguished with X-rays of the affected joints and blood tests
- Systemic lupus erythematosus (SLE) - distinguished by specific clinical symptoms and blood tests (antibodies against double-stranded DNA)
- One of the several types of psoriatic arthritis resembles RA - nail changes and skin symptoms distinguish between them
- Lyme disease causes erosive arthritis and may closely resemble RA - it may be distinguished by blood test in endemic areas
- Reactive arthritis (previously Reiter's disease) - asymetrically involves heel, sacroiliac joints, and large joints of the leg. It is usually associated with urethritis, conjunctivitis, iritis, painless buccal ulcers, and keratoderma blennorrhagica.
- Ankylosing spondylitis - this involves the spine and is usually diagnosed in males, although a RA-like symmetrical small-joint polyarthritis may occur in the context of this condition.
Rarer causes that usually behave differently but may cause joint pains:[13] It has been suggested that this article or section be merged with Calcium pyrophosphate deposition disease. ...
Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease, or in more colloquial terms wear and tear), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints and destruction or...
In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz...
Psoriatic arthritis (or Arthropathic psoriasis) is a type of inflammatory arthritis that affects around 20% of people suffering from the chronic skin condition Psoriasis. ...
Lyme disease, or borreliosis, is an emerging infectious disease caused by bacteria from the genus Borrelia. ...
This article does not adequately cite its references or sources. ...
The sacroiliac joint is the joint between the sacrum, at the base of the spine, and the ilium of the pelvis, which are joined by ligaments. ...
Urethritis is inflammation of the urethra. ...
Iritis is a form of anterior uveitis and refers to the inflammation of the iris of the eye. ...
Keratoderma blennorrhagica are skin lesions commonly found on the palms and soles but which may spread to the scrotum scalp and trunk also. ...
- Sarcoidosis, amyloidosis, and Whipple's disease can also resemble RA.
- Hemochromatosis may cause hand joint arthritis.
- Acute rheumatic fever can be differentiated from RA by a migratory pattern of joint involvement and evidence of antecedent streptococcal infection. Bacterial arthritis (such as streptococcus) is usually asymmetric, while RA usually involves both sides of the body symmetrically.
- Gonococcal arthritis (another bacterial arthritis) is also initially migratory and can involve tendons around the wrists and ankles.
Whipples disease is a rare disease caused by the bacteria Thropheryma whipplei. ...
Haemochromatosis, also spelled hemochromatosis, is a hereditary disease characterized by improper processing by the body of dietary iron which causes iron to accumulate in a number of body tissues, eventually causing organ dysfunction. ...
Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...
Species S. agalactiae S. bovis S. faecalis S. pneumoniae S. pyogenes S. suis S. viridans S. salivarius Streptococcus is a genus of spherical, Gram-positive bacteria of the phylum Firmicutes. ...
Binomial name Zopf, 1885 Neisseria gonorrhoeae (also known as Gonococci) is a species of Gram-negative bacteria responsible for the sexually transmitted disease gonorrhoea. ...
A tendon or sinew is a tough band of fibrous connective tissue, attached on one end to a muscle and on the other to a bone. ...
Pathophysiology
 Joint abnormalities in rheumatoid arthritis Image File history File links Image taken from http://www. ...
Image File history File links Image taken from http://www. ...
Causes The cause of RA is still unknown to this day. In considering possible causes, it is important to distinguish between the cause(s) that trigger the inflammatory process, and those that may permit it to persist and even progress from milder to more severe forms of inflammation. Thus, it has long been suspected that certain infections could be triggers for this disease. As in other autoimmune diseases, the "mistaken identity" theory suggests that an offending organism causes an immune response that leaves behind antibodies that are specific to that organism. The antibodies are not specific enough, though. They begin an immune attack against, in this case, the synovium, because some molecule in the synovium "looks like" a molecule on the offending organism that created the initial immune reaction - this phenomenon is called molecular mimicry. Some infectious organisms mentioned in this context have been Mycoplasma, Erysipelothrix, parvovirus B19 and rubella, but these associations have never been supported in epidemiological studies. Nor has convincing evidence been presented for other types of triggers such as food allergies. There is also no clear evidence that physical and emotional effects, stress and improper diet could be a trigger for the disease. The many negative findings suggest that either the trigger is different from patient to patient, or that the trigger might in fact be a chance event, as suggested by Edwards et al [14]. Synovium means with egg, because the (synovial) fluid in joints that have a cavity between the bearing surfaces is like egg-white. ...
Molecular mimicry is defined as the theoretical possibility that sequence similarities between foreign and self-peptides are sufficient enough to result in the cross-activation of autoreactive T or B cells by pathogen-derived peptides. ...
Species M. genitalium M. hominis M. pneumoniae etc. ...
...
Species Canine minute virus Canine parvovirus Chicken parvovirus Feline panleukopenia virus Feline parvovirus HB virus H-1 virus Kilham rat virus Lapine parvovirus LUIII virus Mice minute virus Mink enteritis virus Mouse parvovirus 1 Porcine parvovirus Raccoon parvovirus RT parvovirus Tumor virus X Parvovirus, commonly called parvo, is a genus...
Rubella, commonly known as German measles, is a disease caused by the rubella virus. ...
Epidemiological studies have confirmed a potential association between RA and two herpesvirus infections: Epstein-Barr virus (EBV) and Human Herpes Virus 6 (HHV-6). [15] Individuals with RA are more likely to exhibit an abnormal immune response to the Epstein-Barr virus. [16] [17] The allele HLA-DRB1*0404 is associated with low frequencies of T cells specific for the EBV glycoprotein 110 and predisposes one to develop RA. [18] Genera Subfamily Alphaherpesvirinae Simplexvirus Varicellovirus Mardivirus Iltovirus Subfamily Betaherpesvirinae Cytomegalovirus Muromegalovirus Roseolovirus Subfamily Gammaherpesvirinae Lymphocryptovirus Rhadinovirus Unassigned Ictalurivirus The Herpesviridae are a family of DNA viruses that cause diseases in humans and animals. ...
The Epstein-Barr virus (EBV), also called Human herpesvirus 4 (HHV-4), is a virus of the herpes family (which includes Herpes simplex virus and Cytomegalovirus), and is one of the most common viruses in humans. ...
Human Herpesvirus Six (HHV6) is one of the eight known members of the human herpesvirus family. ...
T cells are a subset of lymphocytes that play a large role in the immune response. ...
N-linked protein glycosylation (N-glycosylation of N-glycans) at Asn residues (Asn-x-Ser/Thr motifs) in glycoproteins[1]. Glycoproteins are proteins that contain oligosaccharide chains (glycans) covalently attached to their polypeptide backbones. ...
The factors that allow the inflammation, once initiated, to become permanent and chronic, are much more clearly understood. The genetic association with HLA-DR4 is believed to play a major role in this, as well as the newly discovered associations with the gene PTPN22 and with two additional genes [19], all involved in regulating immune responses. It has also become clear from recent studies that these genetic factors may interact with the most clearly defined environmental risk factor for rheumatoid arthritis, namely cigarette smoking [20] Other environmental factors also appear to modulate the risk of acquiring RA, and hormonal factors in the individual patients may explain some features of the disease, such as the higher occurrence in women, the not-infrequent onset after child-birth, and the (slight) modulation of disease risk by hormonal medications.
Autoimmune diseases require that the affected individual have a defect in the ability to distinguish foreign molecules from the body's own. There are markers on many cells that confer this self-identifying feature. However, some classes of markers allow for RA to happen. 90% of patients with RA have the cluster of markers known as the HLA-DR4/DR1 cluster, whereas only 40% of unaffected controls do. Thus, in theory, RA requires susceptibility to the disease through genetic endowment with specific markers and an infectious event that triggers an autoimmune response. A scientific control augments integrity in experiments by isolating variables as dictated by the scientific method in order to make a conclusion about such variables. ...
Once triggered, B lymphocytes produce immunoglobins, and rheumatoid factors of the IgG and IgM classes that are deposited in the tissue, this subsequently leads to the activation of the serum complement cascade and the recruitment of the phagocytic arm of the immune response, which further exacerbates the inflammation of the synovium, leading to edema, vasodilation and infiltration by activated T-cells (mainly CD4 in nodular aggregates and CD8 in diffuse infiltrates). Early and intermediate molecular mediators of inflammation include tumor necrosis factor alpha (TNF-α), interleukins IL-1, IL-6, IL-8 and IL-15, transforming growth factor beta, fibroblast growth factor and platelet-derived growth factor. Synovial macrophages and dendritic cells further function as antigen presenting cells by expressing MHC class II molecules, leading to an established local immune reaction in the tissue. The disease progresses in concert with formation of granulation tissue at the edges of the synovial lining (pannus) with extensive angiogenesis and production of enzymes that cause tissue damage. Modern pharmacological treatments of RA target these mediators. Once the inflammatory reaction is established, the synovium thickens, the cartilage and the underlying bone begins to disintegrate and evidence of joint destruction accrues. Tumor necrosis factors (or the TNF-family) refers to a group of cytokines family which can cause apoptosis. ...
Interleukins are a group of cytokines that were first seen to be expressed by white blood cells (leukocytes, hence the -leukin) as a means of communication (inter-). The name is sort of a relic though; it has since been found that interleukins are produced by a wide variety of bodily...
Interleukin-1 (IL-1) is secreted by the macrophages, monocytes and dendritic cells. ...
Interleukin-6 (IL-6) is a pro-inflammatory cytokine secreted by T cells and macrophages to stimulate immune response to trauma, especially burns or other tissue damage leading to inflammation. ...
Interleukin-8 (IL-8) is a chemokine produced by macrophages and other cell types such as epithelial cells. ...
Interleukin 15 (IL-15) is a cytokine with structural similarity to IL-2 that is secreted by mononuclear phagocytes (and some other cells) following infection by virus(es). ...
Transforming growth factor (TGF) is one of many characterized growth factors that exist in nature. ...
Fibroblast growth factors, or FGFs, are a family of growth factors involved in wound healing and embryonic development. ...
This article or section is in need of attention from an expert on the subject. ...
Pannus is a medical term for a hanging flap of skin. ...
Treatment There is no known cure for rheumatoid arthritis. However, many different types of treatment can be used to alleviate symptoms and/or to modify the disease process.
The goal of treatment in this chronic disease must be two-fold: to alleviate the suffering of the patient here and now, and to prevent the future destruction of the joints and resulting handicap if the disease is left unchecked. These two goals may not always coincide: while pain relievers may achieve the first goal, they do not have any impact on the long-term consequences. For these reasons, most authorities believe that RA should be treated, in the vast majority of patients, by at least one specific anti-rheumatic medication, also named DMARD (see below), to which other medications and non-medical interventions can be added as needed.
Cortisone therapy has offered relief to many patients in the past, but its long-term effects have been deemed undesirable.[21]. However, cortisone injections can be valuable adjuncts to a long-term treatment plan, and using low dosages of daily cortisone (e.g., prednisone or prednisolone, 5-7.5 mg daily) can also have an important benefit if added to a proper specific anti-rheumatic treatment. Cortisone (IPA:ˈkôrtəˌsÅn) is a steroid hormone. ...
Pharmacological treatment of RA can be divided into disease-modifying antirheumatic drugs (DMARDs), anti-inflammatory agents and analgesics.[22][23] DMARDs have been found to produce durable remissions and delay or halt disease progression. In particular they prevent bone and joint damage from occurring secondary to the uncontrolled inflammation. This is important as such damage is usually irreversible. Anti-inflammatories and analgesics improve pain and stiffness but do not prevent joint damage or slow the disease progression. Pharmacology (in Greek: pharmakon (φάÏμακον) meaning drug, and lego (λÎγω) to tell (about)) is the study of how drugs interact with living organisms to produce a change in function. ...
Disease-modifying antirheumatic drugs is a category of drugs used in many autoimmune diseases to slow down disease progression. ...
Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. ...
An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ...
There is an increasing recognition amongst rheumatologists that permanent damage to the joints occurs at a very early stage in the disease. In the past the strategy used was to start with just an anti-inflammatory drug, and assess progression clinically and using X-rays. If there was evidence that joint damage was starting to occur then a more potent DMARD would be prescribed. Tools such as ultrasound and MRI are more sensitive methods of imaging the joints and have demonstrated that joint damage occurs much earlier and in more patients than was previously thought. Patients with normal X-rays will often have erosions detectable by ultrasound that X ray could not demonstrate.
There may be other reasons why starting DMARDs early is beneficial as well as prevention of structural joint damage. In the early stage of the disease, the joints are increasingly infiltrated by cells of the immune system that signal to one another and are thought to set up self-perpetuating chronic inflammation. Interrupting this process as early as possible with an effective DMARD (such as methotrexate) appears to improve the outcome from the RA for years afterwards. Delaying therapy for as little as a few months after the onset of symptoms can result in worse outcomes in the long term. There is therefore considerable interest in establishing the most effective therapy in patients with early arthritis, when they are most responsive to therapy and have the most to gain.[24]
Treatment also includes rest and physical activity. Regular exercise is important for maintaining joint mobility and making the joint muscles stronger. Swimming is especially good, as it allows for exercise with a minimum of stress on the joints. Heat and cold applications are modalities that can ease symptoms before and after exercise. Pain in the joints is sometimes alleviated by oral acetaminophen (paracetamol). Other areas of the body, such as the eyes and lining of the heart, are treated individually. However, there is no diet that has been shown to alleviate rheumatoid arthritis, although fish oil may have anti-inflammatory effects. Acetaminophen (USAN) or paracetamol (INN), is a popular analgesic and antipyretic drug that is used for the relief of fever, headaches, and other minor aches and pains. ...
Disease modifying anti-rheumatic drugs (DMARDs) The term Disease Modifying Anti-Rheumatic Agent was originally introduced to indicate a drug that reduced evidence of processes thought to underly the disease, such as a raised erythrocyte sedimentation rate, reduced haemoglobin level, raised rheumatoid factor level and more recently, raised C-reactive protein level. More recently, the term has been used to indicate a drug that reduces the rate of damage to bone and cartilage. DMARDs can be further subdivided into traditional small molecular mass drugs synthesised chemically and newer 'biological' agents produced through genetic engineering.
Traditional small molecular mass drugs:
Cytotoxic drugs: Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ...
Ciclosporin (INN), cyclosporine or cyclosporin (former BAN), is an immunosuppressant drug. ...
Penicillamine is a pharmaceutical of the chelator class. ...
Gold salts are primarily used in medicine, to reduce inflammation and to slow disease progression in patients with rheumatoid arthritis, and for some industrial purposes. ...
Hydroxychloroquine is an antimalarial drug, sold under the trade name Plaquenil®, also used to reduce inflammation in the treatment of Rheumatoid arthritis (see Disease-modifying antirheumatic drugs) and lupus. ...
// Basic Chemical, Pharmacological, and Marketing Data Leflunomide is a pyrimidine synthesis inhibitor belonging to the DMARD class of drugs, which are chemically and pharmacologically very heterogen. ...
Amethopterin redirects here. ...
Minocycline hydrochloride, also known as minocycline, is a member of the broad spectrum tetracycline antibiotics, and has a broader spectrum than the other members. ...
Sulfasalazine is a sulfa drug, a derivative of Mesalazine (5-aminosalicylic acid abbreviated as 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. ...
The most important and most common adverse events relate to liver and bone marrow toxicity (MTX, SSZ, leflunomide, azathioprine, gold compounds, D-penicillamine), renal toxicity (cyclosporine A, parenteral gold salts, D-penicillamine), pneumonitis (MTX), allergic skin reactions (gold compounds, SSZ), autoimmunity (D-penicillamine, SSZ, minocycline) and infections (azathioprine, cyclosporine A). Hydroxychloroquine may cause ocular toxicity, although this is rare, and because hydroxychloroquine does not affect the bone marrow or liver it is often considered to be the DMARD with the least toxicity. Unfortunately hydroxychloroquine is not very potent, and for most patients hydroxychloroquine alone is insufficient to control symptoms. Cyclophosphamide (the generic name for Cytoxan, Neosar) is a nitrogen mustard alkylating agent, used to treat various types of cancer and some autoimmune disorders. ...
The liver is the largest internal organ in the human body, and is an organ present in vertebrates and some other animals. ...
For the Dir en grey album, see The Marrow of a Bone. ...
For other uses, see Skin (disambiguation). ...
Many rheumatologists consider methotrexate to be the most important and useful DMARD, largely because of lower rates of stopping the drug through toxicity. Nevertheless, methotrexate is often considered by patients and even other doctors as a very "toxic" drug. This reputation is not entirely justified, and at times can result in patients being denied the most effective treatment for their arthritis. Although methotrexate does indeed have the potential to suppress the bone marrow or cause hepatitis, these effects can be monitored using regular blood tests, and the drug withdrawn at an early stage if the tests are abnormal, before any serious harm is done (typically the blood tests return to normal after stopping the drug). In clinical trials in which patients with RA were treated with one of a range of different DMARDs, patients who were prescribed methotrexate were those who stayed on their medication the longest (the others stopped theirs because of either side-effects or failure of the drug to control the arthritis). Lastly, methotrexate is often preferred by rheumatologists because if it does not control arthritis on its own then it works well in combination with many other drugs, especially the biological agents. Other DMARDs may not be as effective or safe in combination with biological agents.
Biological agents Biological agents (biologics include: Biologics or biologic therapies are a new class of drugs produced through genetic manipulation. ...
Etanercept (Enbrel®, co-marketed by Amgen and Wyeth) is a human recombinant, soluble tumor necrosis factor-alpha (TNFα) receptor. ...
Infliximab (brand name Remicade®) is a drug used to treat auto-immune disorders. ...
Adalimumab (Humira®) is the third TNF antagonist (after infliximab and etanercept) to be approved in the US. Like infliximab and etanercept, adalimumab binds to TNFα, preventing it from activating TNF receptors; adalimumab was constructed from a fully human monoclonal antibody, while infliximab is a mouse-human chimeric antibody and etanercept...
Interleukin-1 (IL-1) is secreted by the macrophages, monocytes and dendritic cells. ...
// Basic chemical, pharmacological and marketing data Anakinra is an IL-1 receptor antagonist. ...
Monoclonal antibodies (mAb) are antibodies that are identical because they were produced by one type of immune cell, all clones of a single parent cell. ...
B cells are lymphocytes that play a large role in the humoral immune response (as opposed to the cell-mediated immune response). ...
Rituximab, sold under the trade names Rituxan® and MabThera®, is a monoclonal antibody used in the treatment of B cell non-Hodgkins lymphoma, B cell leukemia, and some autoimmune disorders. ...
Abatacept (Orencia) is a first-generation hybrid protein composed of an immunoglobulin and CTLA-4, which is a molecule crucial for T-cell costimulation. ...
Anti-inflammatory agents and analgesics Anti-inflammatory agents include: Analgesics include: The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ...
Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ...
The Prosorba column blood filtering device was approved by the FDA for treatment of RA in 1999 [26] However, in most patients the results have been very modest. Acetaminophen (USAN) or paracetamol (INN), is a popular analgesic and antipyretic drug that is used for the relief of fever, headaches, and other minor aches and pains. ...
An opioid is any agent that binds to opioid receptors found principally in the central nervous system and gastrointestinal tract. ...
Diproqualone is an analogue of methaqualone developed in the 1980s and marketed mainly in France and some other european countries. ...
Lidocaine (INN) (IPA: ) or lignocaine (former BAN) (IPA: ) is a common local anesthetic and antiarrhythmic drug. ...
There are very few or no other articles that link to this one. ...
Historic treatments for RA have also included: RICE, acupuncture, apple diet, nutmeg, some light exercise every now and then, nettles, bee venom, copper bracelets, rhubarb diet, rest, extractions of teeth, fasting, honey, vitamins, insulin, magnets, and electroconvulsive therapy (ECT).[27]. Most of these have either had no effect at all, or their effects have been modest and transient in some individual patients, while not being generalizable. Acupuncture chart from Hua Shou (fl. ...
This article is about the fruit. ...
For other uses, see Nutmeg (disambiguation). ...
Nettles redirects here. ...
For other uses, see Western honey bee and Bee (disambiguation). ...
For other uses, see Copper (disambiguation). ...
Fasting is primarily the act of willingly abstaining from some or all food, drink, or both, for a period of time. ...
For other uses, see Honey (disambiguation). ...
Retinol (one vitamer of Vitamin A) A vitamin is an organic compound required as a nutrient in tiny amounts by an organism. ...
Not to be confused with inulin. ...
For other uses, see Magnet (disambiguation). ...
Electroconvulsive therapy (ECT), also known as electroshock, is a controversial psychiatric treatment in which seizures are induced with electricity for therapeutic effect. ...
Epidemiology The incidence of RA is in the region of 3 cases per 10,000 population per annum. Onset is uncommon under the age of 15 and from then on the incidence rises with age until the age of 80. The prevalence rate is 1%, with women affected three to five times as often as men. It is 4 times more common in smokers than non-smokers. Some Native American groups have higher prevalence rates (5-6%) and black persons from the Caribbean region have lower prevalence rates. First-degree relatives prevalence rate is 2-3% and disease genetic concordance in monozygotic twins is approximately 15-20%. Incidence is a measure of the risk of developing some new condition within a specified period of time. ...
In epidemiology, the prevalence of a disease in a statistical population is defined as the total number of cases of the disease in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population. ...
For other uses, see Native Americans (disambiguation). ...
West Indies redirects here. ...
For other uses, see Twin (disambiguation). ...
It is strongly associated with the inherited tissue type Major histocompatibility complex (MHC) antigen HLA-DR4 (most specifically DR0401 and 0404) — hence family history is an important risk factor. Protein images comparing the MHC I (1hsa) and MHC II (1dlh) molecules. ...
HLA region of Chromosome 6 The human leukocyte antigen system (HLA) is the name of the human major histocompatibility complex (MHC). ...
Research
Pain relief Recent research indicates that cytokines, a group of chemicals that are produced by various cells in the body, may be responsible for generating the response of chronic pain associated with Rheumatoid Arthritis. Medications that affect the release of cytokines or block the action of cytokines may reduce the response of chronic pain. Various anti-cytokine medications are now being used to treat painful disease states such as Rheumatoid Arthritis, and Crohn's Disease. In addition, research using the anti-cytokine medication, Thalidomide, is being evaluated for its effect in treating chronic pain associated with Arachnoiditis. Cytokines are small protein molecules that are the core of communication between immune system cells, and even between immune system cells and cells belonging to other tissue types. ...
Look up Pain in Wiktionary, the free dictionary. ...
Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining between). ...
This article is about the drug. ...
Arachnoiditis describes a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. ...
Specific desensitization An experimental treatment known as enzyme potentiated desensitization (EPD) is now under development for the treatment of rheumatoid arthritis and other autoimmune diseases. EPD uses dilutions of allergen (in this case type 2 collagen) and an enzyme, β-glucuronidase, to which T-regulatory lymphocytes respond by favouring desensitization, rather than sensitization. Initial results are encouraging [28] but the treatment is still at an early stage of development. Enzyme potentiated desensitization, or EPD, is a treatment for allergies developed in the 1960s by Dr. Len McEwen in the United Kingdom. ...
Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ...
Tropocollagen triple helix. ...
Glucuronidases are glycoside hydrolases that cleave glucuronic acid glycosides (glucuronides). ...
Other therapies Other therapies are weight loss, occupational therapy, podiatry, physiotherapy, joint injections, and special tools to improve hard movements (e.g. special tin-openers). Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ...
Occupational therapy refers to the use of meaningful occupation to assist people who have difficulty in achieving healthy and balanced life; and to enable an inclusive society so that all people can participate to their potential in daily occupations of life. ...
Podiatry, more appropriately podiatric medicine is a field of healthcare devoted to the study and treatment of disorders of the foot, ankle, and the knee, leg and hip (collectively known as the lower extremity). ...
Physical therapy can help restore lost functionality in many people. ...
In medicine, a joint injection is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendonitis, bursitis and occasionally osteoarthritis. ...
Severely affected joints may require joint replacement surgery, such as knee replacement. ...
Prognosis The course of the disease varies greatly from patient to patient. Some patients have mild short-term symptoms, but in most the disease is progressive for life. Around 20%-30% will have subcutaneous nodules (known as rheumatoid nodules); this is associated with a poor prognosis.
Disability - Daily living activities are impaired in most patients.
- After 5 years of disease, approximately 33% of patients will not be working
- After 10 years, approximately half will have substantial functional disability.
Prognostic factors - Poor prognostic factors include persistent synovitis, early erosive disease, extra-articular findings (including subcutaneous rheumatoid nodules), positive serum RF findings, positive serum anti-CCP autoantibodies, carriership of HLA-DR4 "Shared Epitope" alleles, family history of RA, poor functional status, socioeconomic factors, elevated acute phase response (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and increased clinical severity.
Mortality Estimates of the life-shortening effect of RA vary; most sources cite a lifespan reduction of 5 to 10 years. According to the UK's National Rheumatoid Arthritis Society, "Young age at onset, long disease duration, the concurrent presence of other health problems (called co-morbidity), and characteristics of severe RA – such as poor functional ability or overall health status, a lot of joint damage on x-rays, the need for hospitalisation or involvement of organs other than the joints – have been shown to associate with higher mortality".[29] Positive responses to treatment may indicate a better prognosis. A 2005 study by the Mayo Clinic noted that RA patients suffer a doubled risk of heart disease,[30] independent of other risk factors such as diabetes, alcohol abuse, and elevated cholesterol, blood pressure and body mass index. The mechanism by which RA causes this increased risk remains unknown; the presence of chronic inflammation has been proposed as a contributing factor.[31] The United Kingdom of Great Britain and Northern Ireland is a country in western Europe, and member of the Commonwealth of Nations, the G8, the European Union, and NATO. Usually known simply as the United Kingdom, the UK, or (inaccurately) as Great Britain or Britain, the UK has four constituent...
Main campus in downtown Rochester, Minnesota. ...
This article is about the disease that features high blood sugar. ...
Cholesterol is a sterol (a combination steroid and alcohol). ...
A graph of body mass index is shown above. ...
History To delineate the history of rheumatoid arthritis a researcher must rely on scanty and ambiguous data from old medical literature and buried skeletons. The current consensus is too speculative for the taste of some scholars. Nevertheless a tentative best guess has emerged.
The first known traces of arthritis date back at least as far as 4500 BC. A text dated 123 AD first describes symptoms very similar to rheumatoid arthritis. It was noted in skeletal remains of Native Americans found in Tennessee.[32] In the Old World the disease is vanishingly rare before the 1600s.[33] and on this basis investigators believe it spread across the Atlantic during the Age of Exploration. In 1859 the disease acquired its current name. (6th millennium BC – 5th millennium BC – 4th millennium BC – other millennia) Events 4860 BC - Mount Mazama in Oregon collapses, forming a caldera that later fills with water and becomes Crater Lake, the deepest lake in the United States. ...
Events Roman Emperor Hadrians villa at Tivoli was built. ...
A symptom is a manifestation of a disease, indicating the nature of the disease, which is noticed by the patient. ...
For other uses, see Native Americans (disambiguation). ...
This article is about the U.S. state of Tennessee. ...
The so-called Age of Exploration was a period from the early 15th century and continuing into the early 17th century, during which European ships were traveled around the world to search for new trading routes and partners to feed burgeoning capitalism in Europe. ...
Year 1859 (MDCCCLIX) was a common year starting on Saturday (link will display the full calendar) of the Gregorian calendar (or a common year starting on Thursday of the 12-day slower Julian calendar). ...
An anomaly has been noticed from investigation of Precolumbian bones. The bones from the Tennessee site show no signs of tuberculosis even though it was prevalent at the time throughout the Americas.[34] Jim Mobley, at Pfizer, has discovered a historical pattern of epidemics of tuberculosis followed by a surge in the number of rheumatoid arthritis cases a few generations later.[35] Mobley attributes the spikes in arthritis to selective pressure caused by tuberculosis. A hypervigilant immune system is protective against tuberculosis at the cost of an increased risk of autoimmune disease.
The art of Peter Paul Rubens may depict the effects of rheumatoid arthritis, for it is presumed that he used his own hands as a model. In his later paintings, his rendered hands show increasing deformity consistent with the symptoms of the disease.[36][37] Peter Paul Rubens (June 28, 1577 – May 30, 1640) was a prolific seventeenth-century Flemish and European painter, and a proponent of an exuberant Baroque style that emphasized movement, color, and sensuality. ...
Notable cases |
