Difference between revisions of "Rheumatoid arthritis"

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 '''Rheumatoid arthritis''', commonly abbreviated '''RA''', is an autoimmune disorder.
-==Joints==
+=Skin=
+==Rheumatoid neutrophilic dermatitis==
+===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===
 Features:
-*Chronic inflammation (e.g. lymphocytes).
+*Nodular and diffuse pattern.
+*[[Neutrophil]]s - perivascular (without vessel wall injury).<ref name=pmid9197831/>
-Images:
+DDx:
-*[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>
+*[[Vasculitis]].
-==Rheumatoid nodule==
+=Joints=
+{{Main|Joints}}
+==Rheumatic joint disease==
+*[[AKA]] ''joint with rheumatic disease''.
 ===General===
-*Usually only in seropositive cases.<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref>
+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===
-Features:<ref name=Ref_DCHH299>{{Ref DCHH|299}}</ref>
+Features:<ref name=Ref_WMSP660>{{Ref WMSP|660}}</ref>
-*Necrobiotic collagen surrounded by:
+*Chronic inflammation, esp. lymphocytes.
-**Plasma cells.
+**+/-Lymphoid follicles.
-**Palisading macrophages.
+*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]]).
-Notes:
+DDx:
-*Histomorphologically identical to ''Granuloma annulare''.
+*Infected joint.
 Images:
-*[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://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://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://www.nature.com/nature/journal/v423/n6937/fig_tab/nature01661_F1.html Rheumatoid arthritis (nature.com)].
-*[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>
+*[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)].
-==Lung disease==
+===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]]''.
 RA may involve the [[lung]].
+=Miscellaneous=
 ==Amyloidosis==
 :''See [[Amyloidosis]]''.
@@ Line 36: / Line 133: @@
 ==Felty syndrome==
-RA may occur in ''Felty syndrome'' - the triad of:<ref name=Ref_PCPBoD8_328>{{Ref PCPBoD8|328}}</ref>
+RA may occur in ''Felty syndrome'' -- the triad:<ref name=Ref_PCPBoD8_328>{{Ref PCPBoD8|328}}</ref>
 *Rheumatoid arthritis.
 *[[Splenomegaly]].
 *Neutropenia.
-Felty syndrome is assoc. with ''large granular lymphocytic leukemia''.<ref name=Ref_PCPBoD8_328>{{Ref PCPBoD8|328}}</ref>
+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==
+=See also=
+*[[Arthritis]].
+**[[Osteoarthritis]].
 *[[Basics]].
+*[[Joints]].
-==References==
+=References=
 {{Reflist|2}}
-==External links==
+=External links=
 *[http://www.pathguy.com/lectures/joints.htm Joint disease (pathguy.com)].
 [[Category:Weird stuff]]
+[[Category:Diagnosis]]

Difference between revisions of "Rheumatoid arthritis"

Rheumatoid arthritis (view source)

Revision as of 15:53, 10 April 2023

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