Difference between revisions of "Rheumatoid arthritis"
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'''Rheumatoid arthritis''', commonly abbreviated '''RA''', is an autoimmune disorder. | '''Rheumatoid arthritis''', commonly abbreviated '''RA''', is an autoimmune disorder. | ||
== | =Skin= | ||
==Rheumatoid neutrophilic dermatitis== | |||
===General=== | ===General=== | ||
* | *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= | |||
{{Main|Joints}} | |||
==Rheumatic joint disease== | |||
*[[AKA]] ''joint with rheumatic disease''. | |||
===General=== | |||
Clinical: | |||
*Tumour - swelling. | |||
*Rubor - redness. | |||
*Calor - heat. | |||
*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=== | ||
Features: | Features:<ref name=Ref_WMSP660>{{Ref WMSP|660}}</ref> | ||
*Chronic inflammation | *Chronic inflammation, esp. lymphocytes. | ||
**+/-Lymphoid follicles. | |||
*Synovial hyperplasia - with papillary ''or'' polypoid architecture. | |||
**Synoviocytes may show binucleation and mild atypia. | |||
*+/-Fibrin. | |||
*+/-Bone. | |||
*+/-Cartilage. | |||
Note: | |||
*Changes are non-specific - DDx includes other rheumatic diseases ([[systemic lupus erythematosus]], [[psoriatic arthritis]]). | |||
DDx: | |||
*Infected joint. | |||
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=== | |||
====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> | |||
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. | |||
</pre> | |||
====Knee==== | |||
<pre> | |||
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. | |||
</pre> | |||
<pre> | |||
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. | |||
</pre> | |||
==Rheumatoid nodule== | |||
{{Main|Rheumatoid nodule}} | |||
{{Main|Rheumatoid lung nodule}} | |||
=Pleural disease= | |||
:''See [[Rheumatoid pleuritis]]''. | |||
=Lung disease= | |||
:''See [[Medical lung disease]]''. | :''See [[Medical lung disease]]''. | ||
RA may involve the [[lung]]. | RA may involve the [[lung]]. | ||
=Miscellaneous= | |||
==Amyloidosis== | ==Amyloidosis== | ||
:''See [[Amyloidosis]]''. | :''See [[Amyloidosis]]''. | ||
Line 50: | Line 138: | ||
*Neutropenia. | *Neutropenia. | ||
Felty syndrome is | Felty syndrome is associated with ''[[T-cell large granular lymphocytic leukemia|large granular lymphocytic leukemia]]''.<ref name=Ref_PCPBoD8_328>{{Ref PCPBoD8|328}}</ref><ref name=pmid21546829>{{Cite journal | last1 = Liu | first1 = X. | last2 = Loughran | first2 = TP. | title = The spectrum of large granular lymphocyte leukemia and Felty's syndrome. | journal = Curr Opin Hematol | volume = 18 | issue = 4 | pages = 254-9 | month = Jul | year = 2011 | doi = 10.1097/MOH.0b013e32834760fb | PMID = 21546829 }}</ref> | ||
=See also= | |||
*[[Arthritis]]. | |||
**[[Osteoarthritis]]. | |||
*[[Basics]]. | *[[Basics]]. | ||
*[[Joints]]. | |||
=References= | |||
{{Reflist|2}} | {{Reflist|2}} | ||
=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]] |
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:
- Osteoarthritis subchondral cysts are associated with cartilage loss.[3]
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:
- Changes are non-specific - DDx includes other rheumatic diseases (systemic lupus erythematosus, psoriatic arthritis).
DDx:
- Infected joint.
Images:
- RA (med.utah.edu).[6]
- Rheumatoid arthritis (nature.com).
- Synovial inflammation (medpath.info).[4]
- Hyperplastic synovitis (medpath.info).[4]
- RA cartilage loss (bmj.com).
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]
- Rheumatoid arthritis.
- Splenomegaly.
- Neutropenia.
Felty syndrome is associated with large granular lymphocytic leukemia.[7][8]
See also
References
- ↑ 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.
- ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 223. ISBN 978-0443066450.
- ↑ 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.
- ↑ 4.0 4.1 4.2 URL: http://www.medpath.info/MainContent/Skeletal/Joint_02.html. Accessed on: 10 November 2012.
- ↑ 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.
- ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html. Accessed on: 5 December 2010.
- ↑ 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.
- ↑ 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.