Rheumatoid Arthritis Clinical Scenario Question

Question

A 30-year-old woman recently diagnosed with rheumatoid arthritis (RA) complains of general fatigue and weight loss along with symmetrical joint swelling, stiffness, and pain. The stiffness is more prominent in the morning and subsides during the day. Laboratory measures reveal an elevated rheumatoid factor.  

1. Describe the immunopathogenesis of the joint changes that occur with RA. 
2. How do these changes relate to this woman’s symptoms?

Answer 1

1. Describe the immunopathogenesis of the joint changes that occur with RA.
2. RA is an autoimmune disease that causes inflammation of the joints and induces pannus formation. A pannus is defined as proliferative granulation tissue that erodes cartilage and bone. In someone with RA you will have an elevated rheum factor which is a marker for tissue damage and disease activity. The rheum factor is an IgM autoantibody against the Fc portion of IgG. These joint changes can cause joint space narrowing, subchondral cysts, erosions, and osteopenia. Classical findings in RA are ulnar finger deviation, swan neck, and boutonniere deformity. RA involves the MCP, PIP, and wrist NOT the DIPs. Remember this is associated with HLA-DR4 and anti-citrullinated peptide antibody.