Rheumatoid Arthritis

Rheumatoid Arthritis

1. anatomy of the hand

   • arterial, venous and nerve supplies
     • arterial supply
       • The ulnar artery enters the hand anteriorly to the flexor retinaculum and laterally to the ulnar nerve.
         • It gives rise to the deep palmar branch and continues laterally across the palm as the superficial palmar arch.
       • superficial and deep palmar arches
       • The dorsal branch of the radial artery passes between the two heads of the first dorsal interosseous muscle to enter the palm.
         • Before passing through this muscle, it gives rise to the first dorsal metacarpal artery and a transverse branch, which forms the dorsal arch of the carpus (the dorsal proximal metacarpal arch).
       • 4 dorsal metacarpal arteries
     • venous supply
       • The dorsal venous network of the hand is a network of veins in the superficial fascia on the dorsum of hand formed by the dorsal metacarpal veins. It is found on the back of the hand and gives rise to veins such as the cephalic vein and the basilic vein.
       • dorsal venous network
     • nerve supply
       • median, ulnar and radial nerves
       • ulnar nerve supplies all muscles of the hand except thenars ,1st & 2nd lumbricals (supplied by median nerve)
   • bones and joints
     • bones: carpals, metacarpals and phalanges
     • joints: carpometacarpal, metacarpophalanges, interphalanges (proximal and distal)
   • muscles of the hand
     • group 1
       • thenars
         • abductor pollicis brevis, flexor pollicis brevis and opponens pollicis
       • hypothenars
         • flexor digiti minimi brevis, abductor digiti minimi and opponens digiti minimi
       • adductor pollicis
     • group 2
       • pads and dabs
         • 4 palmar interossei
         • 4 dorsal interossei
     • group 3
       • 4 lumbricals
       • palmaris brevis

2. anatomy of the wrist joint

   • Radiocarpal joint is an ellipsoid biaxial synovial type of joint.
     • the large concave facet located on the distal end of radius directly articulates with the scaphoid and lunate bones

3. synovial fluid

   • Synovial tissue is a vascularized connective tissue consisting of 2 cells: Type A=phagocytes. Type B=fibroblast-like cells
   • function
     • Reducing friction/Lubrication/Shock absorption/Supply O2 and nutrient/Waste transportation

4. clinical features of arthritis

   • arthritis is inflammation of the joints. it can affect more than 1 joint. it has many types
   • signs and symptoms
     • Tender, warm, swollen joints. Joint stiffness that is usually worse in the mornings and after inactivity. Fatigue, fever and loss of appetite

5. examination of the hand

   • 1. introduction
     • 2. inspection
       • 3. palpation
         • 4. movement
           • 5. special tests
             • 6. closure
             • Phalen's test: Carpal tunnel syndrome. Tinel’s sign: Nerve compression or injury. Finkelstein Test: De Quervain tenosynovitis

6. autoimmunity

   • A condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue
     • Failure to maintain self- tolerance in B cells, T cells, or both.
   • classification

7. what is it?

   • an autoimmune and inflammatory disease that mainly attacks the joints, usually many joints at once.

8. RA clinical features

   • signs and symptoms include

9. RA investigations

   • blood test
     • To check for rheumatoid factor, C-reactive protein and anti-CCP antibodies
   • ESR
     • High ESR indicates presence of inflammatory reaction in the body
   • Latex test
     • Checking the presence of rheumatoid factor using latex agglutination

10. radiographic changes

    • The hallmark feature of RA is persistent symmetric polyarthritis (synovitis) that affects the hands and feet, though any joint lined by a synovial membrane may be involved.

11. RA prognosis

    • can reduce a person's life expectancy by as much as 10 to 15 years
      • Factors affecting RA prognosis include a person's age, disease progression, and lifestyle factors, such as smoking and being overweight

12. RA diagnosis

    • People with RA often have an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), which may indicate the presence of an inflammatory process in the body.
      • Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies.

13. RA treatment

    • NSAIDs, DMARDs, biological therapies and glucocorticoids
    • physiotherapy

14. Pathological changes of RA

    • The joints become fixed in place by thick and hardened pannus, which also may cause displacement and deformity of the joints. The skin, bones, and muscles adjacent to the joints atrophy from disuse and destruction. Painful nodules over bony prominences may persist or regress.

15. effects of RA on patient's belief

    • People who attributed more symptoms to RA, believe in a long illness duration, and held stronger beliefs that it would have negative consequences also presented greater disability on disease-specific measures of functioning
      • on the other side, stronger beliefs of personal control were associated with lower levels of disability, as were stronger beliefs in the ability of treatment to control RA

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