Difference between revisions of "Rheumatoid arthritis"

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Rheumatoid arthritis (view source)

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==Rheumatoid neutrophilic dermatitis==
==Rheumatoid neutrophilic dermatitis==
===General===
===General===
*May manifest as ''rheumatoid neutrophilic dermatitis'' - super rare.<ref name=pmid9197831>{{Cite journal  | last1 = Mashek | first1 = HA. | last2 = Pham | first2 = CT. | last3 = Helm | first3 = TN. | last4 = Klaus | first4 = M. | title = Rheumatoid neutrophilic dermatitis. | journal = Arch Dermatol | volume = 133 | issue = 6 | pages = 757-60 | month = Jun | year = 1997 | doi =  | PMID = 9197831 }}</ref>
*Case report rare manifestation of rheumatoid arthritis.<ref name=pmid9197831>{{Cite journal  | last1 = Mashek | first1 = HA. | last2 = Pham | first2 = CT. | last3 = Helm | first3 = TN. | last4 = Klaus | first4 = M. | title = Rheumatoid neutrophilic dermatitis. | journal = Arch Dermatol | volume = 133 | issue = 6 | pages = 757-60 | month = Jun | year = 1997 | doi =  | PMID = 9197831 }}</ref>


===Microscopic===
===Microscopic===
Features:
Features:
*Nodular and diffuse pattern.
*Nodular and diffuse pattern.
*[[Neutrophil]]s.
*[[Neutrophil]]s - perivascular (without vessel wall injury).<ref name=pmid9197831/>
 
DDx:
*[[Vasculitis]].


=Joints=
=Joints=
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*Calor - heat.
*Calor - heat.
*Dolor - pain.
*Dolor - pain.
===Gross===
Features:
*Pannus<ref name=Ref_Lester223>{{Ref Lester|223}}</ref> - fibrovascular tissue or granulation tissue.
*Irregular surface - synovial hyperplasia.
*Subchondral cysts - involve the entire femoral head (late stage of disease).<ref name=pmid404905/>
Note:
*[[Osteoarthritis]] subchondral cysts are associated with cartilage loss.<ref name=pmid404905>{{Cite journal  | last1 = Resnick | first1 = D. | last2 = Niwayama | first2 = G. | last3 = Coutts | first3 = RD. | title = Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint. | journal = AJR Am J Roentgenol | volume = 128 | issue = 5 | pages = 799-806 | month = May | year = 1977 | doi =  | PMID = 404905 }}</ref>
Image:
*[http://www.medpath.info/MainContent/Skeletal/732.GIF Gross image of RA (medpath.info)].<ref name=medpath>URL: [http://www.medpath.info/MainContent/Skeletal/Joint_02.html http://www.medpath.info/MainContent/Skeletal/Joint_02.html]. Accessed on: 10 November 2012.</ref>
*[http://www.tumorlibrary.com/case/detail.jsp?image_id=3907 RA mimicking chondrosarcoma (tumorlibrary.com)].


===Microscopic===
===Microscopic===
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*Chronic inflammation, esp. lymphocytes.
*Chronic inflammation, esp. lymphocytes.
**+/-Lymphoid follicles.
**+/-Lymphoid follicles.
*Synovial hyperplasia - with papillary ''or'' polyoid architecture.  
*Synovial hyperplasia - with papillary ''or'' polypoid architecture.  
**Synoviocytes may show binucleation and mild atypia.
**Synoviocytes may show binucleation and mild atypia.
*+/-Fibrin.
*+/-Fibrin.
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Images:
Images:
*[http://library.med.utah.edu/WebPath/jpeg3/BONE044.jpg RA (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html]. Accessed on: 5 December 2010.</ref>
*[http://library.med.utah.edu/WebPath/jpeg3/BONE044.jpg RA (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html]. Accessed on: 5 December 2010.</ref>
*[http://www.nature.com/nature/journal/v423/n6937/fig_tab/nature01661_F1.html Rheumatoid arthritis (nature.com)].
*[http://www.medpath.info/MainContent/Skeletal/3100.GIF Synovial inflammation (medpath.info)].<ref name=medpath/>
*[http://www.medpath.info/MainContent/Skeletal/3109.GIF Hyperplastic synovitis (medpath.info)].<ref name=medpath/>
*[http://ard.bmj.com/content/58/3.cover-expansion RA cartilage loss (bmj.com)].


===Sign out===
===Sign out===
====Femoral head====
<pre>
FEMORAL HEAD, LEFT, HIP ARTHROPLASTY:
- CHRONIC SYNOVITIS WITH SYNOVIAL HYPERPLASIA AND LOSS OF CARTILAGE.
- BONE WITHOUT APPARENT PATHOLOGY.
- SEE COMMENT.
COMMENT:
The findings are compatible with rheumatoid arthritis.
</pre>
====Hand====
<pre>
Right Hand - Metacarpal Heads of Index Finger, Middle Finger and Ring Finger, Excision:
- Benign bone and cartilage focally associated with fibrous tissue and erosions.
- Fatty marrow space.
- NEGATIVE for significant inflammation.
- NEGATIVE for malignancy.
Comment:
The history of rheumatoid arthritis and deformities is noted.
</pre>
<pre>
<pre>
SYNOVIUM, LEFT HAND, EXCISION:
SYNOVIUM, LEFT HAND, EXCISION:
- SYNOVIAL HYPERPLASIA.
- SYNOVIAL HYPERPLASIA.
- CHRONIC AND FOCAL ACUTE SYNOVITIS.
- CHRONIC AND FOCAL ACUTE SYNOVITIS.
- FIBRINOUS EXUDATE.
- GRANULATION TISSUE AND HEMOSIDERIN-LADEN MACROPHAGES.
- GRANULATION TISSUE AND HEMOSIDERIN-LADEN MACROPHAGES.
- SEE COMMENT.
- SEE COMMENT.


COMMENT:
COMMENT:
The findings are consistent with rheumatoid arthritis.
The findings are compatible with rheumatoid arthritis.
</pre>
</pre>


==Rheumatoid nodule==
====Knee====
===General===
<pre>
*Usually only in seropositive cases.<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref>
KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
*Typically close to a joint.{{fact}}
- CHRONIC SYNOVITIS WITH SYNOVIAL HYPERPLASIA AND LOSS OF CARTILAGE.
- BONE WITHOUT APPARENT PATHOLOGY.


===Microscopic===
COMMENT:
Features:<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref><ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
The findings are compatible with rheumatoid arthritis.
*Necrotic collagen bundles with fibrin surrounded by:
</pre>
**Palisading [[granuloma]].
*+/-Eosinophils.


Notes:
<pre>
*Histomorphologically very similar to ''[[Granuloma annulare]]''.  
KNEE - BONE AND SOFT TISSUE, LEFT, KNEE ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH CHRONIC SYNOVITIS AND SYNOVIAL HYPERPLASIA.
- BONE WITHOUT APPARENT PATHOLOGY.


DDx:
COMMENT:
*[[Granuloma annulare]] - has mucin in the core of the granuloma.<ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
The findings are compatible with rheumatoid arthritis.
*[[Necrobiosis lipoidica]].
</pre>


Images:
==Rheumatoid nodule==
*www:
{{Main|Rheumatoid nodule}}
**[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-1.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref>
{{Main|Rheumatoid lung nodule}}
**[http://granuloma.homestead.com/rheumatoid_nod_S89-2617-5.jpg Rheumatoid nodule (granuloma.homestead.com)].<ref name=ghc>URL: [http://granuloma.homestead.com/palisading.html http://granuloma.homestead.com/palisading.html]. Accessed on: 1 November 2010.</ref>
**[http://library.med.utah.edu/WebPath/jpeg3/BONE045.jpg Rheumatoid nodule (utah.edu)].<ref>URL: [http://www.pathguy.com/lectures/joints.htm http://www.pathguy.com/lectures/joints.htm]. Accessed on: 1 November 2010.</ref>
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Rheumatoid_nodule_-_low_mag.jpg Rheumatoid nodule - low mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Rheumatoid_nodule_-_intermed_mag_2.jpg Rheumatoid nodule - intermed. mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Rheumatoid_nodule_-_high_mag.jpg Rheumatoid nodule - high mag. (WC)].


=Pleural disease=
=Pleural disease=
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=See also=
=See also=
*[[Arthritis]].
*[[Arthritis]].
**[[Osteoarthritis]].
*[[Basics]].
*[[Joints]].
*[[Joints]].
*[[Basics]].


=References=
=References=
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=External links=
=External links=
*[http://www.pathguy.com/lectures/joints.htm Joint disease (pathguy.com)].
*[http://www.pathguy.com/lectures/joints.htm Joint disease (pathguy.com)].
[[Category:Weird stuff]]
[[Category:Weird stuff]]
[[Category:Diagnosis]]
Michael
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