Rheumatoid arthritis—clinical features

2013 ◽  
Author(s):  
Eugen Feist ◽  
Gerd-R. Burmester
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Features ◽  
Clinical Laboratory ◽  
Systemic Disease ◽  
Systemic Autoimmune Disease ◽  
Joint Involvement ◽  
Loss Of Function ◽  
Increased Risk ◽  
Autoantibody Status ◽  
Disease Entities

Rheumatoid arthritis (RA) presents with variable clinical features, making this most frequent chronic systemic autoimmune disease with characteristic joint involvement a diagnostic and therapeutic challenge. This chapter describes in detail the different clinical, laboratory and imaging findings in patients with RA. In addition to the characteristic arthritic involvement, which can lead to severe joint changes with progressive destruction and loss of function, other systemic disease manifestations as well as an increased risk for cardiovascular events and non-Hodgkin's lymphoma with relevance for patients' prognosis are described. Recent approaches to early diagnosis and stratification of patients by predictive factors for a severe course of disease are discussed. These patient profiles include increased inflammatory markers, the presence of autoantibodies, and erosive changes at the time of diagnosis. The novel classification criteria for RA and the significance of autoantibody status, namely seropositivity for antibodies against citrullinated antigens as highly specific diagnostic markers, are highlighted to further promote early differentiation of RA from other arthritic disease entities.

Rheumatoid arthritis—clinical features

2013 ◽  
pp. 858-866
Author(s):  
Eugen Feist ◽  
Gerd-R. Burmester
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Features ◽  
Clinical Laboratory ◽  
Systemic Disease ◽  
Systemic Autoimmune Disease ◽  
Joint Involvement ◽  
Loss Of Function ◽  
Increased Risk ◽  
Autoantibody Status ◽  
Disease Entities

Rheumatoid arthritis (RA) presents with variable clinical features, making this most frequent chronic systemic autoimmune disease with characteristic joint involvement a diagnostic and therapeutic challenge. This chapter describes in detail the different clinical, laboratory and imaging findings in patients with RA. In addition to the characteristic arthritic involvement, which can lead to severe joint changes with progressive destruction and loss of function, other systemic disease manifestations as well as an increased risk for cardiovascular events and non-Hodgkin’s lymphoma with relevance for patients’ prognosis are described. Recent approaches to early diagnosis and stratification of patients by predictive factors for a severe course of disease are discussed. These patient profiles include increased inflammatory markers, the presence of autoantibodies, and erosive changes at the time of diagnosis. The novel classification criteria for RA and the significance of autoantibody status, namely seropositivity for antibodies against citrullinated antigens as highly specific diagnostic markers, are highlighted to further promote early differentiation of RA from other arthritic disease entities.

scholarly journals ROLE OF PANCHAKARMA IN MANAGEMENT OF RHEUMATOID ARTHRITIS

2021 ◽  
Vol 9 (04) ◽  
pp. 122-126
Author(s):  
Panchola Priyanka ◽  
◽  
Joshi Neha ◽  
Deepshikha a ◽  
Garg G.P ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Autoimmune Disease ◽  
Systemic Disease ◽  
Modern Science ◽  
Body Part ◽  
The Body ◽  
Systemic Autoimmune Disease ◽  
Loss Of Function ◽  
Abnormal Immune Response

Rheumatoid arthritis is a systemic autoimmune disease that causes chronic inflammation of the joints.It causes inflammation of the tissue around the joints. As the disease advancement, the inflamed synovium occupies and damages the cartilage and bone of the joint. An autoimmune disease is a condition characterized by an abnormal immune response to a normal body part. Because it can affect various organs of the body, rheumatoid arthritis is referred to as a systemic disease and ultimately called rheumatoid disease. In Ayurvedaamavata is correlated with rheumatoid arthritis. Vitiatedvata and ama plays major role in the manifestation of amavata. Improper digestion of Rasaadidhatu leads to the formation of ama. Vitiated ama leads swelling, pain, stiffness, in many joints along with loss of function. Modern science does not offer any cure of RA, the management aims are limited. This article reviews the line of treatment for the management of amavata described by Acharyachakradatta. It was concluded that rheumatoid arthritis can be completely cured or treated with Ayurveda medication and Panchakarma therapies without any side effects.

scholarly journals Osteopontin, Osteoprotegerin and Musculoskeletal Ultrasound findings in First-Degree Relatives of Rheumatoid Arthritis: Potential Markers of Preclinical Disease

2020 ◽  
Author(s):  
Eiman Soliman ◽  
Sarah Ohrndorf ◽  
Magdy Zehairy ◽  
Khaled Matrawy ◽  
Abeer Alhadidy ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Metabolism ◽  
Clinical Laboratory ◽  
Joint Inflammation ◽  
Musculoskeletal Ultrasound ◽  
First Degree Relatives ◽  
Preclinical Phase ◽  
Increased Risk ◽  
Significant Difference ◽  
Clinical Arthritis

Abstract Background: First-degree relatives (FDRs) of rheumatoid arthritis (RA) patients are known to have increased risk of developing the disease. The detection of altered bone metabolism in FDRs could be a predictor of the disease. Preclinical phase of RA is characterized by a state of autoimmunity and inflammation. Musculoskeletal ultrasound (MSUS) is known for its ability to detect subclinical joint inflammation in RA, but changes in FDRs are not yet described.Objectives: To study serum osteopontin (OPN) and osteoprotegerin (OPG) levels in first degree relatives (FDRs) of rheumatoid arthritis (RA) as markers of altered bone metabolism in relation to clinical, laboratory and musculoskeletal ultrasound (MSUS) findings. Methods: Fifty-five individuals were included, 20 had definite RA, 25 were FDRs of RA patients, and 10 healthy controls. Clinical evaluation for joint swelling/tenderness was performed for all. ESR, CRP, rheumatoid factor (RF), anti-citrullinated antibodies (ACPA), OPN, OPG, and MSUS by the US7 score were evaluated.Results: OPG was significantly higher in RA (143.89 pg/ml±365.47) than in FDRs (22.23 pg/ml±65.73; p=0.009) and controls (6.20 pg/ml±12.43; p=0.003). OPN was also higher in RA (3.66 ng/ml±4.20) than in FDRs (1.97 ng/ml±1.04) and controls (2.81 ng/ml±1.31), though not significant (p=0.102). Eight of 25 FDRs (32%) had arthralgia without clinical arthritis and 17/25 (68%) were asymptomatic. FDRs with arthralgia had significantly higher ESR and CRP levels than asymptomatic FDRs (9.82 mm/h±4.13; p=0.003, and 3.93 mg/l±3.58; p=0.003). OPG was higher in FDRs than in controls, and also in those with arthralgia (51.55 pg/ml±114.68) than in those without (8.44 pg/ml±9.67), though without significant difference. OPN was higher in FDRs with arthralgia (2.09 ng/ml±1.19) than in asymptomatics (1.70 ng/ml±0.55), also without significant difference. Pathologic findings by US7 were detected in 10/25 (40%) FDRs, of which three (12%) had arthralgia and seven (28%) were asymptomatic. Conclusions: The raised OPG and lower OPN in FDRs than in controls reflect an altered bone metabolism which could precede clinical disease phase. OPN and OPG could serve as markers of altered preclinical bone metabolism in FDRs of RA. US7 score might be a useful screening tool to identify ‘at-risk’ individuals.

scholarly journals Possible Influence of Resistance to Malaria in Clinical Presentation of Rheumatoid Arthritis: Biological Significance of Natural Selection

Arthritis ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Fabio Bonilla-Abadía ◽  
Gabriel J. Tobón ◽  
Carlos A. Cañas
Keyword(s):  
Rheumatoid Arthritis ◽  
Natural Selection ◽  
Chemokine Receptors ◽  
Biological Significance ◽  
Immunological Response ◽  
Immune Reactivity ◽  
Loss Of Function ◽  
Special Group ◽  
Increased Risk

Rheumatoid arthritis (RA) is a common autoimmune disease that affects all ethnic groups. Genetic factors, mainly HLA alleles, are highly associated with increased risk to develop RA. However, there are few available data about the role of these genetic polymorphisms in the prevalence or severity of RA in the Afrodescendant population, who have evolutionarily and by natural selection developed mutations that allowed them to acquire resistance to infectious diseases like malaria. Some of the mechanisms, by which this resistance was developed as a product of natural selection, are involved in different forms of immunological response, many of them of a well-known importance in the pathophysiology of RA. This paper focuses on presenting the known mechanisms of resistance to malaria and their possible contribution to the pathophysiology of RA, including “loss-of-function” mutations, lack of expression of chemokine receptors, decrease of immune complexes clearance by asplenia, or increase of immune reactivity mediated by B cells, among other mechanisms in this special group of patients.

scholarly journals Dietary Habits and Nutrition in Rheumatoid Arthritis: Can Diet Influence Disease Development and Clinical Manifestations?

Nutrients ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1456 ◽  
Author(s):  
Chiara Gioia ◽  
Bruno Lucchino ◽  
Maria Grazia Tarsitano ◽  
Cristina Iannuccelli ◽  
Manuela Di Franco
Keyword(s):  
Rheumatoid Arthritis ◽  
Dietary Habits ◽  
Disease Risk ◽  
Harmful Effect ◽  
Antioxidant Properties ◽  
Clinical Manifestations ◽  
Bone Destruction ◽  
Systemic Autoimmune Disease ◽  
Joint Involvement ◽  
Protective Effects

Rheumatoid arthritis (RA) is a systemic, autoimmune disease characterized by joint involvement, with progressive cartilage and bone destruction. Genetic and environmental factors determine RA susceptibility. In recent years, an increasing number of studies suggested that diet has a central role in disease risk and progression. Several nutrients, such as polyunsaturated fatty acids, present anti-inflammatory and antioxidant properties, featuring a protective role for RA development, while others such as red meat and salt have a harmful effect. Gut microbiota alteration and body composition modifications are indirect mechanisms of how diet influences RA onset and progression. Possible protective effects of some dietary patterns and supplements, such as the Mediterranean Diet (MD), vitamin D and probiotics, could be a possible future adjunctive therapy to standard RA treatment. Therefore, a healthy lifestyle and nutrition have to be encouraged in patients with RA.

scholarly journals Soluble Markers of Antibody Secreting Cell Function as Predictors of Infection Risk in Rheumatoid Arthritis

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Maria J. Gutierrez ◽  
Stephen V. Desiderio ◽  
Nae-Yuh Wang ◽  
Erika Darrah ◽  
Laura Cappelli ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
B Cell ◽  
Serum Protein ◽  
Cell Function ◽  
Systemic Autoimmune Disease ◽  
Secreting Cell ◽  
Soluble Factors ◽  
Antibody Secreting Cell ◽  
Protein Levels ◽  
Increased Risk

Background. Rheumatoid arthritis (RA) is a systemic autoimmune disease associated with immune dysregulation and increased risk of infections. The presence of autoantibodies and immunoglobulin abnormalities indicates B-cell and antibody-secreting cell (ASC) dysfunction. We hypothesize that soluble factors associated with B-cell and ASC activity are decreased in RA patients and that this is linked to higher susceptibility to infections.Methods. Using the Johns Hopkins Arthritis Cohort and Biorepository, we contrasted serum protein levels of soluble factors involved in B-cell activation (CD40, CD40L) and B-cell/ASC homing (CXCL10, CXCL11, and CXCL13) or survival (BAFF, APRIL, TACI, and BCMA) in 10 healthy subjects and 23 adult RA patients (aged 24-65 years). We subdivided RA patients into those with (n=17) and those without infections (n=6) within a 2-year period. In order to reduce the effect of RA treatment, we only included patients receiving methotrexate monotherapy or no RA treatments at baseline. Soluble serum protein levels of B-cell/ASC factors were quantified by multiplex immunoassays.Results. We identified that (1) serum levels of soluble BCMA, APRIL, CD40, and CD40L were significantly decreased in RA patients relative to healthy individuals; (2) serum soluble BCMA, predominantly released by ASC, correlated with serum concentrations of class-switched immunoglobulins, IgG and IgA; and (3) RA patients with a history of infections had significantly lower soluble BCMA levels compared with healthy donors and with RA patients without infections.Conclusions. Our study using soluble factors linked to B-cell/ASC activation and survival suggests that there is a paucity of ASC in a subset of RA patients and that this may be linked to altered antibody production and increased risk of infections. Further delineating the link between ASC and infection susceptibility in RA may optimize disease management and provide novel insights into disease pathogenesis that are susceptible to intervention.

scholarly journals Felty’s Syndrome, Insights and Updates

2014 ◽  
Vol 8 (1) ◽  
pp. 129-136 ◽  
Author(s):  
Mohammad Bagher Owlia ◽  
Kam Newman ◽  
Mojtaba Akhtari
Keyword(s):  
Rheumatoid Arthritis ◽  
Lupus Erythematosus ◽  
Clinical Laboratory ◽  
Large Body ◽  
Current Data ◽  
Joint Involvement ◽  
Humoral Immune ◽  
Felty's Syndrome ◽  
Felty’S Syndrome ◽  
Classic Rheumatoid Arthritis

Felty’s syndrome (FS) is characterized by the triad of seropositive rheumatoid arthritis (RA) with destructive joint involvement, splenomegaly and neutropenia. Current data shows that 1-3 % of RA patients are complicated with FS with an estimated prevalence of 10 per 100,000 populations. The complete triad is not an absolute requirement, but persistent neutropenia with an absolute neutrophil count (ANC) generally less than 1500/mm3 is necessary for establishing the diagnosis. Felty’s syndrome may be asymptomatic but serious local or systemic infections may be the first clue to the diagnosis. FS is easily overlooked by parallel diagnoses of Sjӧgren syndrome or systemic lupus erythematosus or lymphohematopoietic malignancies. The role of genetic (HLA DR4) is more prominent in FS in comparison to classic rheumatoid arthritis. There is large body of evidence that in FS patients, both cellular and humoral immune systems participate in neutrophil activation, and apoptosis and its adherence to endothelial cells in the spleen. It has been demonstrated that proinflammatory cytokines may have inhibitory effects on bone marrow granulopoiesis. Binding of IgGs to neutrophil extracellular chromatin traps (NET) leading to neutrophil death plays a crucial role in its pathophysiology. In turn, "Netting" neutrophils may activate auto-reactive B cells leading to further antibody and immune complex formation. In this review we discuss on basic pathophysiology, epidemiology, genetics, clinical, laboratory and treatment updates of Felty’s syndrome.

scholarly journals TRAF1Gene Polymorphism Correlates with the Titre of Gp210 Antibody in Patients with Primary Biliary Cirrhosis

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Agnieszka Kempinska-Podhorodecka ◽  
Zakera Shums ◽  
Michał Wasilewicz ◽  
Ewa Wunsch ◽  
Malgorzata Milkiewicz ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Primary Biliary Cirrhosis ◽  
Clinical Features ◽  
Gene Polymorphisms ◽  
Tumor Necrosis ◽  
Tumor Necrosis Factor Receptor ◽  
Biliary Cirrhosis ◽  
Similar Frequency ◽  
Increased Risk ◽  
Necrosis Factor

Background. Polymorphisms ofTRAF1(Tumor necrosis factor receptor-associated factor 1) are associated with rheumatoid arthritis (RA). WhetherTRAF1polymorphisms confer increased risk for primary biliary cirrhosis (PBC), an autoimmune liver disease which can co-exist with RA, is unknown.Aim of the Study. To assess the frequency of the RA-conferring susceptibilityTRAF1polymorphisms rs3761847 and rs2900180 in a cohort of PBC patients. The association ofTRAF1polymorphisms with clinical features and autoantibody markers was also analyzed.Methods. We studied 179 PBC patients and 300 controls. Samples were genotyped forTRAF1gene polymorphisms by real-time PCR. Autoantibodies were tested by ELISA.Results. The frequency of rs3761847 and rs2900180 polymorphisms did not differ between patients and controls. Laboratory or clinical features were not associated with specific polymorphisms. Gp210 autoantibody titres were conspicuously higher among GG homozygotes of rs3761847 as compared with AA homozygotes (P=0.02). In contrast, antichromatin titers were higher in AA compared to GG rs3761847 homozygotes (P=0.04). Rheumatoid factor IgG titres were significantly higher in rs2900180 TT homozygotes than CC homozygotes (P=0.02).Conclusions.TRAF1polymorphisms occur with the similar frequency in PBC patients and in the general population, but their presence is probably involved in the regulation of specific PBC-related autoantibodies.

Genetic Variations in Genes Encoding RANK, RANKL, and OPG in Rheumatoid Arthritis: A Case-Control Study

2010 ◽  
Vol 37 (5) ◽  
pp. 900-904 ◽  
Author(s):  
GUNTER ASSMANN ◽  
JOCHEM KOENIG ◽  
MICHAEL PFREUNDSCHUH ◽  
JOERG T. EPPLEN ◽  
JOERN KEKOW ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Structural Damage ◽  
Case Control Study ◽  
Case Control ◽  
Genetic Variations ◽  
Minor Allele ◽  
Taqman Assay ◽  
Systemic Autoimmune Disease ◽  
Increased Risk ◽  
Control Study

Objective.Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation of the joints, which may lead to structural damage of the cartilage and bone. The receptor activator of nuclear factor-κB (RANK) and the osteoprotegerin (OPG) cascade system have been reported to be essential in osteoclastogenesis. Genetic variations in the genes coding for RANK, RANK ligand (RANKL), and OPG are thought to play roles in the susceptibility to RA.Methods.In our case-control study, genomic DNA was obtained from 534 patients with RA who fulfilled the American College of Rheumatology 1987 criteria and 516 healthy control blood donors (HC). We studied 7 single-nucleotide polymorphisms (SNP) in the genes of RANK (2 SNP: rs1805034, rs35211496), OPG (2 SNP: rs3102735, rs2073618), and RANKL (3 SNP: rs9533156, rs2277438, rs1054016) using TaqMan assay-guided polymerase chain reaction. Genotype and allelic frequencies comparing RA patients with HC were analyzed by chi-square test for 2 × 3 and 2 × 2 tables, respectively.Results.Genotype distributions of the SNP rs35211496 in the RANK gene as well as the SNP rs2277438 in the RANKL gene differed significantly between patients with RA and HC. The frequency of the minor allele of rs9533156 of RANKL was significantly higher in patients with RA than in HC (OR 0.84, 95% CI 0.71–0.99, p = 0.047). Multivariate analysis adjusted to sex and investigating SNP demonstrated a significantly elevated risk for RA associated with the major allele in the RANK SNP rs35211496 (p = 0.0231) and with the minor allele in the RANKL SNP rs2277438 (p = 0.0092). No significantly increased risk was detected in the other SNP.Conclusion.The minor allele of the RANK SNP rs35211496 may be protective against RA, while the minor alleles of the RANKL SNP rs2277438 may increase susceptibility to RA.

scholarly journals Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis

2010 ◽  
Vol 70 (3) ◽  
pp. 500-507 ◽  
Author(s):  
Andrew Filer ◽  
Paola de Pablo ◽  
Gina Allen ◽  
Peter Nightingale ◽  
Alison Jordan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Laboratory ◽  
Power Doppler ◽  
Predictive Ability ◽  
Joint Involvement ◽  
Symptom Duration ◽  
Early Therapy ◽  
Large Joint ◽  
Metatarsophalangeal Joints ◽  
Early Synovitis

ObjectivesEarly therapy improves outcomes in rheumatoid arthritis (RA). It is therefore important to improve predictive algorithms for RA in early disease. This study evaluated musculoskeletal ultrasound, a sensitive tool for the detection of synovitis and erosions, as a predictor of outcome in very early synovitis.Methods58 patients with clinically apparent synovitis of at least one joint and symptom duration of ≤3 months underwent clinical, laboratory, radiographic and 38 joint ultrasound assessments and were followed prospectively for 18 months, determining outcome by 1987 American College of Rheumatology (ACR) and 2010 ACR/European League Against Rheumatism criteria. Sensitivity and specificity for 1987 RA criteria were determined for ultrasound variables and logistic regression models were then fitted to evaluate predictive ability over and above the Leiden rule.Results16 patients resolved, 13 developed non-RA persistent disease and 29 developed RA by 1987 criteria. Ultrasound demonstrated subclinical wrist, elbow, knee, ankle and metatarsophalangeal joint involvement in patients developing RA. Large joint and proximal interphalangeal joint ultrasound variables had poor predictive ability, whereas ultrasound erosions lacked specificity. Regression analysis demonstrated that greyscale wrist and metacarpophalangeal joint involvement, and power Doppler involvement of metatarsophalangeal joints provided independently predictive data. Global ultrasound counts were inferior to minimal power Doppler counts, which significantly improved area under the curve values from 0.905 to 0.962 combined with the Leiden rule.ConclusionIn a longitudinal study, extended ultrasound joint evaluation significantly increased detection of joint involvement in all regions and outcome groups. Greyscale and power Doppler scanning of metacarpophalangeal joints, wrists and metatarsophalangeal joints provides the optimum minimal ultrasound data to improve on clinical predictive models for RA.

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