includes: patient case example, aetiology and pathogenesis, signs and symptoms, role of cytokines, inflammation as the cause of joint damage, consequences, markers of inflammation, treatment
1
Sunday, 16th January 2022
Week 1
Medicine
The Pathophysiology of Joint Disease 1
Rheumatoid arthritis
Patient
Maria
o 46
o Female
o 3 months of pain and swelling in small joints of hands and feet
o Stiffness in early morning for about 60 minutes
What do we notice?
Relatively young
Short duration over months
Non-specific pain
Swelling implies inflammation
Stiffness in the early morning takes a long time to stop
Inflammatory
Take a history and examine joints
Joint swelling over thumb, index and middle finger
o Cannot see the valleys between MCP joints
Swelling of PIP joints
Test results
CRP 15 ESR 48 moderate inflammatory response
Rf – 40 – positive
CCP 120 – significantly raised
ANA – neg
Diagnosis
History of inflammation of small joints, morning stiffness
Can see swelling on examination and it is symmetrical
Positive antibodies for rheumatoid arthritis
Most likely diagnosis rheumatoid arthritis
Rheumatoid arthritis
1% prevalence
Untreated can cause increased morbidity
o Moderate to severe disability over 10-year period
Significant impact on job prospects
o High job loss in 1st year
Costs are significant
o Population burden
Symptoms and signs
Insidious onset
o Over months
Joint swelling
Prolonged stiffness
o Early morning
o Lasts over 30 minutes
MCPs, MTPs and wrists
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