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rheumatoid_arthritis

Rheumatoid arthritis (RA)

Chronic, systemic inflammatory disorder that primarily affects joints.

It may result in deformed and painful joints, which can lead to loss of function. The disease may also have signs and symptoms in organs other than joints.

Etiology

The cause of RA is not completely understood.

Complications

The process involves an inflammatory response of the capsule around the joints (synovium) secondary to swelling (turgescence) of synovial cells, excess synovial fluid, and the development of fibrous tissue (pannus) in the synovium. It also affects the underlying bone(focal erosions) and cartilage(thinning and destruction). RA can also produce diffuse inflammation in the lungs, the membrane around the heart, the membranes of the lung (pleura), and whites of the eye, and also nodular lesions, most common in subcutaneous tissue. It is a clinical diagnosis made primarily on the basis of symptoms and physical examination. X-rays, laboratory testing, and synovial fluid analysis might help support a diagnosis or exclude other diseases with similar symptoms.

Attachement points of the transverse ligament may be weakend.

Treatment

Treatments include both medication and non-pharmacological measures - the goal being to control joint inflammation and prevent joint damage and disability. Non-pharmacological treatment includes physical therapy, splints and braces, occupational therapy and dietary changes but these do not stop the progression of joint destruction. painkillers and anti-inflammatory drugs, including steroids, suppress symptoms, but do not stop the progression either. Disease-modifying antirheumatic drugs (DMARDs) may slow or halt the progress of the disease. Biological DMARDS like anti-TNF agents are effective but usually avoided in persons with active disease or hypersensitivity to these agent. They have been shown to decrease the number of tender or swollen joints and the pain and disability due to the disease but there is little data about side effects. Alternative medicine is not supported by any evidence.

RA affects between 0.5 and 1% of adults in the developed world with between 5 and 50 per 100,000 people newly developing the condition each year. Onset is most frequent during middle age, but people of any age can be affected. The name is based on the term “rheumatic fever”, an illness which includes joint pain and is derived from the Greek word ῥεύμα-rheuma (nom.), ῥεύματος-rheumatos (gen.) (“flow, current”). The suffix -oid (“resembling”) gives the translation as joint inflammation that resembles rheumatic fever. The first recognized description of RA was made in 1800 by Dr. Augustin Jacob Landré-Beauvais (1772–1840) of Paris.


Findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines. 1).

Complications

Rheumatoid patients may develop a retrodental lesion (atlantoaxial rheumatoid pannus) that may cause cervical instability and/or neurological compromise.

A subset of RA patients developed positional Vertebral Artery (VA) occlusion associated with cervical spine involvement 2).

Case series

A total of 201 patients with RA who had been followed up at the outpatient clinic of the authors' institution were enrolled in this study. retro-odontoid soft-tissue (ROST) thickness was evaluated on midsagittal T1-weighted MRI. The correlations between ROST thickness and radiographic findings or clinical data on RA were examined. The independent factors related to ROST thickness were analyzed using stepwise multiple regression analysis.

The average thickness of ROST was 3.0 ± 1.4 mm. ROST thickness showed an inverse correlation with disease duration (r = -0.329, p < 0.01), Steinbrocker stage (r = -0.284, p < 0.01), the atlantodental interval (ADI) in the neutral position (r = -0.326, p < 0.01), the ADI in the flexion position (r = -0.383, p < 0.01), and the ADI in the extension position (r = -0.240, p < 0.01). On stepwise multiple regression analysis, ADI in the flexion position and Steinbrocker stage were independent factors associated with ROST thickness.

Although the correlations were not strong, ROST thickness in patients with RA was inversely correlated with ADI and Steinbrocker stage. In other words, ROST thickness tends to be smaller as atlantoaxial instability and peripheral joint destruction worsen. Clinical trial registration no.: UMIN000000980 (UMIN Clinical Trials Registry) 3).

1)
Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Bak KH, Chun HJ. Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis. Osteoporos Int. 2017 Mar 2. doi: 10.1007/s00198-017-3972-9. [Epub ahead of print] PubMed PMID: 28255666.
2)
Tateishi Y, Tagami A, Baba H, Osaki M, Kawakami A, Akira T. Duplex Ultrasonography-Detected Positional Vertebral Artery Occlusion in Upper Cervical Rheumatoid Arthritis. Spine (Phila Pa 1976). 2016 Jan;41(1):26-31. doi: 10.1097/BRS.0000000000001136. PubMed PMID: 26583470.
3)
Dohzono S, Suzuki A, Koike T, Takahashi S, Yamada K, Yasuda H, Nakamura H. Factors associated with retro-odontoid soft-tissue thickness in rheumatoid arthritis. J Neurosurg Spine. 2016 Nov;25(5):580-585. Epub 2016 Jun 24. PubMed PMID: 27341058.
rheumatoid_arthritis.txt · Last modified: 2017/04/19 10:48 by administrador