Difference between revisions of "Rheumatoid arthritis"

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====Hand====
====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:
Line 106: Line 117:


==Rheumatoid nodule==
==Rheumatoid nodule==
{{ Infobox external links
{{Main|Rheumatoid nodule}}
| Name          = Rheumatoid nodule
{{Main|Rheumatoid lung nodule}}
| EHVSC          = 10182
| pathprotocols  =
| wikipedia      =
| pathoutlines  =
}}
*Abbreviated ''RN''.
===General===
*Seen in [[rheumatoid arthritis]] - usually only in seropositive cases, i.e. ''rheumatoid factor'' (RF) positive.<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref>
**Exceptions are reported.<ref name=pmid6364806>{{Cite journal  | last1 = Kaye | first1 = BR. | last2 = Kaye | first2 = RL. | last3 = Bobrove | first3 = A. | title = Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases. | journal = Am J Med | volume = 76 | issue = 2 | pages = 279-92 | month = Feb | year = 1984 | doi =  | PMID = 6364806 }}</ref>
 
===Gross===
*Usually on the extensor aspect of the extremities, e.g. dorsal aspect of elbow.<ref name=Ref_Derm53>{{Ref Derm|53}}</ref>
*Typically close to a joint.{{fact}}
 
===Microscopic===
Features:<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref><ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
*Necrotic collagen bundles with fibrin surrounded by:
**Palisading [[granuloma]].
*+/-Eosinophils.
 
Notes:
*Histomorphologically very similar to ''[[Granuloma annulare]]''.
 
DDx:
*[[Granuloma annulare]] - has mucin in the core of the granuloma.<ref name=Ref_Derm52>{{Ref Derm|52}}</ref>
*[[Necrobiosis lipoidica]].
 
===Images===
www:
*[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>
*[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>
<gallery>
Image:Rheumatoid_nodule_-_low_mag.jpg |Rheumatoid nodule - low mag. (WC)
Image:Rheumatoid_nodule_-_intermed_mag_2.jpg |Rheumatoid nodule - intermed. mag. (WC)
Image:Rheumatoid_nodule_-_high_mag.jpg |Rheumatoid nodule - high mag. (WC)
</gallery>
 
===Stains===
*[[Alcian blue stain|Alcian blue]] (pH 2.5) -ve.
**Positive staining of mucin in [[granuloma annulare]].<ref name=pmid20523767>{{Cite journal  | last1 = Yun | first1 = JH. | last2 = Lee | first2 = JY. | last3 = Kim | first3 = MK. | last4 = Seo | first4 = YJ. | last5 = Kim | first5 = MH. | last6 = Cho | first6 = KH. | last7 = Kim | first7 = MB. | last8 = Lee | first8 = WS. | last9 = Lee | first9 = KH. | title = Clinical and pathological features of generalized granuloma annulare with their correlation: a retrospective multicenter study in Korea. | journal = Ann Dermatol | volume = 21 | issue = 2 | pages = 113-9 | month = May | year = 2009 | doi = 10.5021/ad.2009.21.2.113 | PMID = 20523767 | PMC = 2861218 }}</ref>
 
===Sign out===
<pre>
Lesion (subcutaneous), right index finger, excision:
- Palisading granulomas with cores of necrobiotic collagen, consistent with rheumatoid nodule.
</pre>
 
====Micro====
The sections show foci with strands of necrobiotic collagen surrounded by palisading granulomas. Rare Neutrophils are seen in the core of the granulomas. Multinucleated cells are not apparent.
 
Benign fibroadipose tissue and dense connective tissue are also present.


=Pleural disease=
=Pleural disease=

Latest revision as of 15:53, 10 April 2023

Rheumatoid arthritis, commonly abbreviated RA, is an autoimmune disorder.

Skin

Rheumatoid neutrophilic dermatitis

General

  • Case report rare manifestation of rheumatoid arthritis.[1]

Microscopic

Features:

  • Nodular and diffuse pattern.
  • Neutrophils - perivascular (without vessel wall injury).[1]

DDx:

Joints

Main article: Joints

Rheumatic joint disease

  • AKA joint with rheumatic disease.

General

Clinical:

  • Tumour - swelling.
  • Rubor - redness.
  • Calor - heat.
  • Dolor - pain.

Gross

Features:

  • Pannus[2] - fibrovascular tissue or granulation tissue.
  • Irregular surface - synovial hyperplasia.
  • Subchondral cysts - involve the entire femoral head (late stage of disease).[3]

Note:

Image:

Microscopic

Features:[5]

  • Chronic inflammation, esp. lymphocytes.
    • +/-Lymphoid follicles.
  • Synovial hyperplasia - with papillary or polypoid architecture.
    • Synoviocytes may show binucleation and mild atypia.
  • +/-Fibrin.
  • +/-Bone.
  • +/-Cartilage.

Note:

DDx:

  • Infected joint.

Images:

Sign out

Femoral head

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.

Hand

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.

SYNOVIUM, LEFT HAND, EXCISION:
- SYNOVIAL HYPERPLASIA.
- CHRONIC AND FOCAL ACUTE SYNOVITIS.
- FIBRINOUS EXUDATE.
- GRANULATION TISSUE AND HEMOSIDERIN-LADEN MACROPHAGES.
- SEE COMMENT.

COMMENT:
The findings are compatible with rheumatoid arthritis.

Knee

KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
- CHRONIC SYNOVITIS WITH SYNOVIAL HYPERPLASIA AND LOSS OF CARTILAGE.
- BONE WITHOUT APPARENT PATHOLOGY.

COMMENT:
The findings are compatible with rheumatoid arthritis.

KNEE - BONE AND SOFT TISSUE, LEFT, KNEE ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH CHRONIC SYNOVITIS AND SYNOVIAL HYPERPLASIA.
- BONE WITHOUT APPARENT PATHOLOGY.

COMMENT:
The findings are compatible with rheumatoid arthritis.

Rheumatoid nodule

Main article: Rheumatoid nodule
Main article: Rheumatoid lung nodule

Pleural disease

See Rheumatoid pleuritis.

Lung disease

See Medical lung disease.

RA may involve the lung.

Miscellaneous

Amyloidosis

See Amyloidosis.

Amyloidosis may be due to RA.

Felty syndrome

RA may occur in Felty syndrome -- the triad:[7]

Felty syndrome is associated with large granular lymphocytic leukemia.[7][8]

See also

References

  1. ↑ 1.0 1.1 Mashek, HA.; Pham, CT.; Helm, TN.; Klaus, M. (Jun 1997). "Rheumatoid neutrophilic dermatitis.". Arch Dermatol 133 (6): 757-60. PMID 9197831.
  2. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 223. ISBN 978-0443066450.
  3. ↑ 3.0 3.1 Resnick, D.; Niwayama, G.; Coutts, RD. (May 1977). "Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint.". AJR Am J Roentgenol 128 (5): 799-806. PMID 404905.
  4. ↑ 4.0 4.1 4.2 URL: http://www.medpath.info/MainContent/Skeletal/Joint_02.html. Accessed on: 10 November 2012.
  5. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 660. ISBN 978-0781765275.
  6. ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html. Accessed on: 5 December 2010.
  7. ↑ 7.0 7.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 328. ISBN 978-1416054542.
  8. ↑ Liu, X.; Loughran, TP. (Jul 2011). "The spectrum of large granular lymphocyte leukemia and Felty's syndrome.". Curr Opin Hematol 18 (4): 254-9. doi:10.1097/MOH.0b013e32834760fb. PMID 21546829.

External links

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