Rheumatoid arthritis

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic disease characterized by joint inflammation. Inflammation presents with joint pain, swelling, rise of joint temperature on palpation (warmth) and decrease in function.

The disease characteristically affects joints of hands and feet symmetrically. Patients often complain of prolonged morning stiffness (hours). The duration of stiffness tends to correlate with a degree of synovial inflammation and decreases when the disease is in remission.

With persistence of disease, the inflamed synovium becomes hyperplastic and is invaded by inflammatory cells. In the process of inflammation molecules such as cytokines are secreted by inflammatory cells and excitate the nerve ends of the pain transducing nerves. The invasive hyperplastic

synovial tissue is called pannus - a characteristic feature of rheumatoid arthritis. The pannus grows aggressively under the cartilage and invades the bone tissue at the junction between cartilage and bone. On X-ray, loss of cartilage (thinning) and bone destruction localized typically at the junction (erosions) is then detectable. Progressive states of the disease are thus associated with joint destruction, joint deformity which can result in disability.

RA is not only a disease of joints but is also a systemic disease associated characteristically with ‘extra-articular’ syndromes such as vasculitis, pulmonary fibrosis, pleuritis, pericarditis, mononeuritis multiplex, Sjögren's syndrome and/or ocular inflammation (scleritis, uveitis).