1. RHEUMATOID ARTHRITIS 2. INTRODUCTION A chronic inflammatory disease Unknown aetiology Symmetrical polyarthritis Chronic inflammation resulting in joint damage and physical disability Systemic involvement is common Fatigue/Anemia 3. Extra Articular features Sub cutaneous nodules(on knuckles) Pleural nodules Pericarditis Peripheral neuropathy Vasculitis Kerato conjunctivitis sicca Episcleritis Xerostomia 4. CLINICAL FEATURES Age : 25 to 55 years Sex : Female predominance Early morning joint stiffness lasts for half to one hour, gets eased with activity Earliest joints involved : Small joints of hand and feet Usually monoarticular Oligoarticular Polyarticular Usually symmetrical Results in inflammation of joints tendons and bursae 5. Frequently involved joints MCP DIP PIP Flexor tendon synovitis(Hallmark of RA) Decreased ROM Decreased grip strength Trigger finger Irreversible deformities with destruction of joints and soft tissue 6. Ulnar deviation Subluxation of MCP joints Subluxation of proximal phalynx Subluxation of volar side Z line deformity Piano key movement Flat feet(Pes Plano valgus) Main target of RA are 14 joint groups PIP MCP Wrist Elbow Knees Ankle MTP Does not affect thoracic, lumbar spine and rarely temporo- mandibular joint. 7. Constitutional Loss of body weight Malaise Fever Fatigue Cachexia Depression Temperature >101*F 8. Nodules 30-40% Benign subcutaneous nodules Common sites Forearm, sacral prominence, achilles tendon Lung, Pleura Pericardium Peritoneum Firm, non tender Adherent to periosteum, tendon, bursae Sign of increased disease activity Associated with infection, ulceration and gangrene 9. COMPLICATIONS Sjogrens syndrome: 10% of RA patients Kerratoconjunctivitis sicca Xerostomia Pulmonary Pleuritic chest pain Friction rub Effusion-exudative Nodules Interstitial lung disease Symptoms: cough, SOB, Diagnosis:HRCT, Restrictive pattern in PFT Very poor prognosis Bronchiolitis bronchiectasis 10. Cardiac Pericarditis Cardiomyopathy Myocarditis CAD Amyloid infiltration Vasculitis Rare