Rheumatoid arthritis

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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

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:

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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

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

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