Rheumatoid arthritis
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Rheumatoid arthritis
Musculoskeletal system
Musculoskeletal system
Musculoskeletal system
Musculoskeletal system
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Rheumatoid arthritis
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Rheumatoid arthritis
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USMLE® Step 1 style questions USMLE
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| Laboratory value | Result |
| Sodium | 145 mmol/L |
| Potassium | 3.7 mmol/L |
| Chloride | 102 mmol/L |
| Bicarbonate | 30 mmol/L |
Imaging reveals obstruction of the small intestine. The patient is taken to the operating room, undergoes endotracheal intubation, and surgical adhesiolysis is performed. Three hours later, neurological examination reveals areflexia and impaired sensation in all extremities. Which of the following is the most likely explanation for the neurological defects?
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Amyloidosis
with rheumatoid arthritis p. 476
Anemia of chronic disease p. 429
rheumatoid arthritis p. 476
Carpal tunnel syndrome p. 455
rheumatoid arthritis p. 476
Glucocorticoids
rheumatoid arthritis p. 476
Hydroxychloroquine
rheumatoid arthritis p. 476
Methotrexate p. 446
rheumatoid arthritis p. 476
Neutropenia
rheumatoid arthritis p. 476
Nonsteroidal anti-inflammatory drugs (NSAIDs) p. 499
rheumatoid arthritis p. 476
Obesity
osteoarthritis/rheumatoid arthritis p. 476
Pericarditis
rheumatoid arthritis p. 476
Rheumatoid arthritis p. 476
anemia of chronic disease and p. 429
autoantibody p. 113
azathioprine for p. 448
biliary cirrhosis p. 404
carpal tunnel syndrome and p. 456
celecoxib for p. 499
etanercept for p. 501
HLA-DR4 and p. 98
immunosuppressants p. 118
infliximab/adalimumab for p. 501
labs/findings p. 722
leflunomide for p. 499
methotrexate for p. 448
rituximab for p. 120, 450
uveitis p. 555
Sjögren syndrome p. 478
rheumatoid arthritis p. 476
Splenomegaly
rheumatoid arthritis p. 476
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In rheumatoid arthritis, “arthr-“ refers to joints, “-itis” means inflammation, and “rheumatoid” comes from rheumatism, which more broadly refers to a musculoskeletal illness.
So, rheumatoid arthritis is a chronic, inflammatory disorder that mostly affects the joints, but can also involve other organ systems like the skin and lungs as well.
Alright, so a healthy joint typically has two bones covered with articular cartilage at the ends.
Articular cartilage is a type of connective tissue that acts like a protective cushion - a lubricated surface for bones to smoothly glide against.
One type of joint, like the knee joint is called a synovial joint.
A synovial joint connects two bones with a fibrous joint capsule that is continuous with the periosteum or outer layer of both bones.
The fibrous capsule is lined with a synovial membrane that has cells that produce synovial fluid and remove debris.
The synovial fluid is normally a viscous fluid like the jelly-like part of a chicken egg and it helps lubricate the joint.
To help serve these synovial cells, the synovial membrane also has blood vessels and lymphatics running through it.
Together, the synovial membrane and the articular cartilage form the inner lining of the joint space.
Rheumatoid arthritis is an autoimmune process that is typically triggered by an interaction between a genetic factor and the environment.
For example, a person with a certain gene for an immune protein like human leukocyte antigen, or HLA- DR1 and HLA–DR4, might develop rheumatoid arthritis after getting exposed to something in the environment like cigarette smoke or a specific pathogen like a bacteria that lives in the intestines.
These environmental factors can cause modification of our own antigens, such as IgG antibodies or other proteins like type II collagen or vimentin.
Τype II collagen and vimentin can get modified through a process called citrullination.
Summary
Rheumatoid arthritis (RA) is a systemic inflammatory disorder of autoimmune origin that is primarily characterized by progressive, symmetric joint destruction, especially in the wrists and fingers, but may also affect other joints and many organs, such as the skin, heart, blood vessels, and lungs. Symptoms of RA include fatigue, joint pain, stiffness, and swelling, which can lead to decreased range of motion and joint deformity. RA is a chronic condition and treatment is focused on managing symptoms and preventing further joint damage. Treatment options include medications such as non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs) and biologic agents, physical therapy, and in some cases, surgery.
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