0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1
1300 Rheumatoid Arthritis■50% are women w/ onset 5 years before or after menopause
■Additional 25% are women in their late 20s
■Remainder spread evenly across age & gender
Signs & Symptoms
■Morning stiffness
■Symmetric joint pain, especially 2nd & 3rd MCPs, wrists
■Joint swelling & tenderness
■Palpable synovium
■Decreased range of motion
■Subcutaneous nodules on extensor surfaces
■Must last 6 weeks to exclude self-limited postviral synovitistests
Laboratory
General
■Urinalysis
■CBC
■Comprehensive metabolic panel as baseline for potentially toxic
drug treatment & to exclude end-organ damage due to other dis-
eases (eg, SLE)
■ESR or C-reactive protein usually elevated, not specific
Specific
■Rheumatoid factor
➣60–80% sensitive
➣Takes up to 10 months to turn positive
➣Not very specific: occurs in other diseases w/ polyclonal B
cell activation: hepatitis C w/ cryoglobulinemia, endocarditis,
Sjogren’s syndrome, other rheumatic diseases (eg, SLE) ̈
■ANA to rule out lupus, especially in African Americans. Antibodies
to cyclic citrullinated peptide (CCP) more specific (80–90%) but less
sensitive (∼55%) than rheumatoid factor
Imaging
■Chest radiograph for sarcoidosis
■Joint radiographs
➣Early: juxtarticular osteopenia
➣Erosions defined by cortical discontinuity on hand & foot are the
most specific, take 6 months to develop
➣Joint space narrowing, indicating cartilage loss, comes later
➣Ultrasound or MRI of joint may be more sensitive, not widely
available