Answer: One study revealed that patients treated conservatively (putting off disease-modifying anti-rheumatic drugs [DMARDs] until trials of NSAIDs, low-dose steroids, physical therapy, splinting, and other modalities had failed) suffered a moderate loss of function with 2 years, a severe loss of function with 6 years, and a very severe loss by 10 years. If ability [...]

Answer: RA is now recognized to be profoundly disabling in most patients. The disability is related to the structural damage to the joint that can come very early in the course of the disease. This structural damage produces mechanical derangements in the joint leading inexorably to deformity and thus to profoundly reduced joint function. Reference:  [...]

Answer: Antibodies directed against the citrullinated portion of certain molecules (filaggrin and fibrin among others) have been found in the sera of patients with RA and are called anti-cyclic citrullinated peptide antibodies. They are present in about 66% of RA patients and in fewer than 5% of control subjects making them quite specific for RA. [...]

Answer: The presence of RF is not specific for RA. Patients with other conditions that have rheumatic features, including sarcoidosis, interstitial lung disease, cryoglobulinemia, SLE, and Sjögren’s syndrome, may have circulating RFs. Viral, parasitic, and other infectious diseases, including mononucleosis, hepatitis, malaria, tuberculosis, and bacterial endocarditis, may be associated with RFs. Up to 70% of [...]

Answer: Inflammation of the MTP joints in RA often leads to subluxation of the metatarsal heads and collapse of the arch of the foot. A claw-like or cocking-up appearance of the toes follows. Reference: McCarty DJ: Clinical picture of RA. In McCarty DJ, Koopman WJ (eds): Arthritis and Allied Conditions, 12th ed. Philadelphia, Lea & [...]

Answer: Flexion contracture at the PIP with extension of the DIP is referred to as the boutonnière deformity. The pathogenesis of this deformity is thought to be related to injury of the extensor tendon. If it becomes lengthened or torn, the flexor tendons are unopposed. The altered mechanics and location of the joint lead to [...]

Answer: The swan neck deformity describes flexion at the MCP and DIP joints with extension at the PIP joints. This deformity results from inflammation and subsequent contraction of interosseous and flexor muscles and tendons. Other contributing factors include tenosynovitis and destruction leading to MCP subluxation. Flexion at the MCP leads to exaggerated pull on the [...]