Overview
What is rheumatoid arthritis (RA)?
What are the signs and symptoms of rheumatoid arthritis (RA)?
Which assessments should be included in the physical exam for rheumatoid arthritis (RA)?
Which organizations have published guidelines for the evaluation of rheumatoid arthritis (RA)?
Which lab studies are helpful in the diagnosis of rheumatoid arthritis (RA)?
Which imaging modalities are helpful in the diagnosis of rheumatoid arthritis (RA)?
Is joint aspiration useful in the diagnosis of rheumatoid arthritis (RA)?
Other than medication and surgery, which therapies exist for rheumatoid arthritis (RA)?
Which nonbiologic DMARDS are used to treat rheumatoid arthritis (RA)?
Which biologic non–tumor necrosis factor (TNF) DMARDS are used to treat rheumatoid arthritis (RA)?
What drugs other than DMARDS are used to treat rheumatoid arthritis (RA)?
Which surgical procedures are used to treat rheumatoid arthritis (RA)?
What are the main features of rheumatoid arthritis (RA)?
What lab test results suggest rheumatoid arthritis (RA)?
How is rheumatoid arthritis (RA) treated?
What is macrophage activation syndrome as it relates to juvenile idiopathic arthritis (JIA)?
What are the treatment guidelines for managing rheumatoid arthritis (RA) to therapeutic target?
What is the pathogenesis of rheumatoid arthritis (RA)?
Which cells have a major role in the pathophysiology of rheumatoid arthritis (RA)?
What causes the tissue destruction in rheumatoid arthritis (RA)?
What causes rheumatoid arthritis (RA)?
Is rheumatoid arthritis (RA) genetic?
What is the role of genomic imprinting and epigenetics in the etiology of rheumatoid arthritis (RA)?
Which infectious agents may cause rheumatoid arthritis (RA)?
Do sex hormones increase the risk of developing rheumatoid arthritis (RA)?
What are the life-style risk factors for rheumatoid arthritis (RA)?
What is the role of immunologic factors in the development of rheumatoid arthritis (RA)?
What is the role of T cells in the pathogenesis of rheumatoid arthritis (RA)?
What is the role of B cells in the pathology of rheumatoid arthritis (RA)?
What is the role of synovial membrane in the pathology of rheumatoid arthritis (RA)?
Does rheumatoid arthritis (RA) in first-degree relatives increase risk?
Is rheumatoid arthritis (RA) more common in women or men?
What are the possible clinical outcomes of rheumatoid arthritis (RA)?
How can early treatment improve the prognosis in rheumatoid arthritis (RA)?
What factors correlate with an unfavorable prognosis in rheumatoid arthritis (RA)?
Which lab results suggest a poor prognosis in rheumatoid arthritis (RA)?
How does duration of rheumatoid arthritis (RA) affect prognosis?
What is the prevalence of full employment among patients with rheumatoid arthritis (RA)?
What risk factors contribute to mortality in rheumatoid arthritis (RA)?
What is the mortality rate in rheumatoid arthritis (RA)?
What are the benefits of patient education and counseling in rheumatoid arthritis (RA)?
What is the best way to inform patients about their diagnosis of rheumatoid arthritis (RA)?
What is a common fear in patients with rheumatoid arthritis (RA)?
What is the best approach to supporting patients with severe rheumatoid arthritis (RA)?
Presentation
What are the main features of rheumatoid arthritis (RA)?
What is juvenile idiopathic arthritis (JIA)?
Is the onset of rheumatoid arthritis (RA) insidious or abrupt?
What should be assessed in a physical exam for rheumatoid arthritis (RA)?
How does rheumatoid arthritis (RA) affect the elbow?
How does rheumatoid arthritis (RA) affect the cervical spine?
Which joints are affected by rheumatoid arthritis (RA) and what are the symptoms?
What is a boutonniere deformity in rheumatoid arthritis (RA)?
What is a swan-neck deformity of the finger in rheumatoid arthritis (RA)?
How is tightness of intrinsic muscles due to rheumatoid arthritis (RA) assessed?
What is the prognosis of flexor tenosynovitis/trigger finger due to rheumatoid arthritis (RA)?
What is arthritis mutilans (opera glass hands) due to rheumatoid arthritis (RA)?
How does rheumatoid arthritis (RA) affect metacarpophalangeal (MCP) joints?
How does rheumatoid arthritis (RA) affect the wrist?
How does rheumatoid arthritis (RA) affect the shoulders?
How does rheumatoid arthritis (RA) affect the ankles and feet?
How does rheumatoid arthritis (RA) affect the knees?
How does rheumatoid arthritis (RA) affect the hips?
What are clinical manifestations of early cervical spine disease due to rheumatoid arthritis (RA)?
What are symptoms of cervical myelopathy in rheumatoid arthritis (RA)?
How can stiffness caused by rheumatoid arthritis (RA) be determined during physical exam?
How is stiffness in rheumatoid arthritis (RA) relieved?
How are pain and tenderness assessed during physical exam in rheumatoid arthritis (RA)?
How is enlargement of the synovial membrane noted on physical exam in rheumatoid arthritis (RA)?
How is synovial proliferation identified during a physical exam in rheumatoid arthritis (RA)?
How does a Baker cyst form in rheumatoid arthritis (RA)?
Where are Baker cysts most commonly found in rheumatoid arthritis (RA)?
How does rheumatoid arthritis (RA) cause joint deformity?
How does rheumatoid arthritis (RA) cause limitation of motion?
What are the common extra-articular manifestations of rheumatoid arthritis (RA)?
How do rheumatoid nodules affect patients with rheumatoid arthritis (RA)?
Which organ systems are affected by rheumatoid arthritis (RA)?
How does rheumatoid arthritis (RA) affect the heart/cardiovascular system?
How does rheumatoid arthritis (RA) affect the lungs?
How does rheumatoid arthritis (RA) affect the kidneys?
How does rheumatoid arthritis (RA) affect the GI system?
Where do vasculitis lesions develop in rheumatoid arthritis (RA)?
Is anemia a presentation of rheumatoid arthritis (RA)?
Is nerve entrapment a presentation of rheumatoid arthritis (RA)?
How does rheumatoid arthritis (RA) affect the eye?
Is rheumatoid arthritis (RA) fatal?
How can rheumatoid arthritis (RA) affect daily life?
Which parts of the body are affected by rheumatoid arthritis (RA) in addition to joints?
What are the ACR and EULAR diagnostic criteria for rheumatoid arthritis (RA)?
Who should be tested for rheumatoid arthritis (RA), according to 2010 ACR/EULAR criteria?
What is the 2010 ACR/EULAR classification system for rheumatoid arthritis (RA)?
What are the 4 stages of progression of rheumatoid arthritis (RA)?
What are the ACR–recommended rheumatoid arthritis (RA) disease activity cutoffs?
What is the 2011 ACR/EULAR definition of remission in rheumatoid arthritis (RA)?
How is remission in rheumatoid arthritis (RA) predicted?
What are the 4 functional classes of rheumatoid arthritis (RA)?
DDX
How is rheumatoid arthritis (RA) differentiated from other diseases?
How is rheumatic fever differentiated from rheumatoid arthritis (RA)?
How is systemic lupus erythematosus (SLE) differentiated from rheumatoid arthritis (RA)?
How is degenerative joint disease (DJD) differentiated from rheumatoid arthritis (RA)?
How is gouty arthritis differentiated from rheumatoid arthritis (RA)?
How is pyogenic arthritis differentiated from rheumatoid arthritis (RA)?
How is chronic Lyme disease differentiated from rheumatoid arthritis (RA)?
How is polymyalgia rheumatica differentiated from rheumatoid arthritis (RA)?
How are carcinomas differentiated from rheumatoid arthritis (RA)?
What are the differential diagnoses for Rheumatoid Arthritis (RA)?
Workup
How is rheumatoid arthritis (RA) diagnosed?
Which lab studies are useful in the diagnosis of rheumatoid arthritis (RA)?
Which inflammation markers are associated with rheumatoid arthritis (RA)?
What are the hematologic findings consistent with a diagnosis of rheumatoid arthritis (RA)?
What are the immunologic findings consistent with a diagnosis of rheumatoid arthritis (RA)?
Is rheumatoid factor (RF) specific to rheumatoid arthritis (RA)?
What is the significance of antinuclear antibodies (ANAs) in rheumatoid arthritis (RA)?
Can rheumatoid arthritis (RA) biomarkers be used to diagnose early RA?
How does pregnancy affect lab results in rheumatoid arthritis (RA)?
How is radiography used to assess rheumatoid arthritis (RA)?
How is MRI used to assess rheumatoid arthritis (RA)?
Is ultrasonography useful in the assessment of patients with rheumatoid arthritis (RA)?
What is the most effective method of hand imaging in rheumatoid arthritis (RA)?
What is the most effective method of spinal imaging in rheumatoid arthritis (RA)?
Which synovial fluid analysis findings suggest rheumatoid arthritis (RA)?
Which histologic findings suggest rheumatoid arthritis (RA)?
Treatment
What is the most effective management approach for rheumatic arthritis (RA)?
What are the nonpharmacological treatment options for rheumatoid arthritis (RA)?
What are the pharmacologic treatment options for rheumatoid arthritis (RA)?
What impact does pregnancy have on the treatment of rheumatoid arthritis (RA)?
What are the surgical options in the treatment of rheumatoid arthritis (RA)?
Which medications are used in the treatment of rheumatoid arthritis (RA)?
Which nonbiologic and biologic DMARDs are used for rheumatoid arthritis (RA)?
What is the role of DMARDs in the management of rheumatoid arthritis (RA)?
What are the benefits of early treatment of rheumatoid arthritis (RA) with DMARDs?
Which DMARDs are most effective in triggering remission of rheumatoid arthritis (RA)?
What is leflunomide and is it effective to treat rheumatoid arthritis (RA)?
Which tumor necrosis factor (TNF) inhibitors are used in the treatment of rheumatoid arthritis (RA)?
When should biologic agents be considered for treatment of rheumatoid arthritis (RA)?
What are the adverse effects of biologic agents used to treat rheumatoid arthritis (RA)?
What are the risks of anti-tumor necrosis factor (TNF) therapy in rheumatoid arthritis (RA)?
What are the effects of certolizumab in rheumatoid arthritis (RA)?
What is golimumab and is it effective in treating rheumatoid arthritis (RA)?
What is the role of rituximab in the treatment of rheumatoid arthritis (RA)?
What is the role of anakinra in the treatment of rheumatoid arthritis (RA)?
What is the role of abatacept in the treatment of rheumatoid arthritis (RA)?
How is abatacept administered in patients with rheumatoid arthritis (RA)?
How is tocilizumab administered in patients with rheumatoid arthritis (RA)?
How is sarilumab administered in patients with rheumatoid arthritis (RA)?
What is the role of janus kinases (JAKs) in the treatment of rheumatoid arthritis (RA)?
When is tofacitinib indicated in the treatment of rheumatoid arthritis (RA)?
How effective is tofacitinib in the treatment of rheumatoid arthritis (RA)?
How effective are DMARDs in the treatment of rheumatoid arthritis (RA)?
How is disease activity reduced in refractory rheumatoid arthritis (RA)?
When should drug combination therapy be considered for the treatment of rheumatoid arthritis (RA)?
What is the role of baricitinib in the treatment of rheumatoid arthritis (RA)?
How are the adverse effects of combination therapy for rheumatoid arthritis (RA) managed?
What are the most common adverse effects of combination therapy for rheumatoid arthritis (RA)?
What are the possible adverse effects of antimalarial agents used for rheumatoid arthritis (RA)?
What is the role of upadacitinib in the treatment of rheumatoid arthritis (RA)?
What are possible adverse effects of DMARDs in rheumatoid arthritis (RA)?
What role do corticosteroids play in the treatment of rheumatoid arthritis (RA)?
What is the role of NSAIDS in the treatment of rheumatoid arthritis (RA)?
What are possible adverse effects of NSAIDS in the treatment of rheumatoid arthritis (RA)?
What is the role of analgesics in the treatment of rheumatoid arthritis (RA)?
What experimental therapies are under investigation for the management of rheumatoid arthritis (RA)?
Which treatments should be considered for acute presentations of rheumatoid arthritis (RA)?
How is Felty syndrome treated in rheumatoid arthritis (RA)?
How are Baker cysts treated in rheumatoid arthritis (RA)?
How is carpal tunnel syndrome (CTS) treated in rheumatoid arthritis (RA)?
How does pregnancy affect the course of rheumatoid arthritis (RA)?
Which rheumatoid arthritis (RA) medications are considered low-risk in pregnant women?
Is contraception required for women treated with DMARD therapy for rheumatoid arthritis (RA)?
Should women with rheumatoid arthritis (RA) be monitored during the postpartum period?
What are the goals of rheumatoid arthritis (RA) rehabilitation?
What treatments are available to a physiatrist working with patients with rheumatoid arthritis (RA)?
Do heat and cold therapies relieve the symptoms of rheumatoid arthritis (RA)?
Are orthotic devices and splints beneficial in the treatment of rheumatoid arthritis (RA)?
What is the role of therapeutic exercise in the management of rheumatoid arthritis (RA)?
What are the benefits of aerobic conditioning in rheumatoid arthritis (RA)?
What interventions have been shown to increase activity levels in rheumatoid arthritis (RA)?
Which exercises are beneficial in rheumatoid arthritis (RA) and muscle atrophy?
Do strengthening hand exercises improve hand function in rheumatoid arthritis (RA)?
What are the goals of occupational therapy in rheumatoid arthritis (RA)?
What is the role of an occupational therapist in the management of rheumatoid arthritis (RA)?
What is the role of splints used to treat upper-extremity orthoses in rheumatoid arthritis (RA)?
Are there assistive devices for patients with rheumatoid arthritis (RA)?
What are the components of a joint-protection program in rheumatoid arthritis (RA)?
Is an energy conservation program beneficial in rheumatoid arthritis (RA)?
What is the purpose of surgical intervention in rheumatoid arthritis (RA)?
What are the surgical options for rheumatoid arthritis (RA) of the hand and wrist?
What causes cervical spine instability in rheumatoid arthritis (RA)?
Are biologic agents recommended in rheumatoid arthritis (RA) with chronic heart failure?
What are the EULAR guidelines on the use of DMARDs for the treatment of rheumatoid arthritis (RA)?
Is the use of biologic agents recommended in rheumatoid arthritis (RA) and hepatitis?
Is the use of biologic agents safe in patients with rheumatoid arthritis (RA) who have had cancer?
Guidelines
Who should be tested for rheumatoid arthritis (RA), according to ACR/EULAR criteria?
What is the ACR/EULAR classification system for rheumatoid arthritis (RA)?
What are the ACR recommendations for the measurement of rheumatoid arthritis (RA) disease activity?
What are the ACR guidelines on the measurement of disease remission for rheumatoid arthritis (RA)?
What are the guidelines for treating rheumatoid arthritis (RA) to therapeutic target?
What are the EULAR treatment guidelines for early rheumatoid arthritis (RA)?
What are the ACR treatment guidelines for early rheumatoid arthritis (RA)?
What are the EULAR guidelines for pharmacologic therapy in rheumatoid arthritis (RA)?
What are the ACR treatment guidelines for established rheumatoid arthritis (RA)?
Medications
Which medications are used in the treatment of rheumatoid arthritis (RA)?
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Juvenile rheumatoid arthritis. Ankylosis in the cervical spine at several levels due to long-standing juvenile rheumatoid arthritis (also known as juvenile idiopathic arthritis).
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Juvenile rheumatoid arthritis. Widespread osteopenia, carpal crowding (due to cartilage loss), and several erosions affecting the carpal bones and metacarpal heads in particular in a child with advanced juvenile rheumatoid arthritis (also known as juvenile idiopathic arthritis).
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Rheumatoid arthritis. Rheumatoid changes in the hand. Photograph by David Effron MD, FACEP.
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Rheumatoid arthritis. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP.
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Rheumatoid arthritis. Soft-tissue swelling and early erosions in the proximal interphalangeal joints in a patient with rheumatoid arthritis of the hands.
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Rheumatoid arthritis. Subluxation in the metacarpophalangeal joints, with ulnar deviation, in a patient with rheumatoid arthritis of the hands.
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Rheumatoid arthritis. Coronal, T1-weighted magnetic resonance imaging scan shows characteristic pannus and erosive changes in the wrist in a patient with active rheumatoid arthritis. Courtesy of J. Tehranzadeh, MD, University of California at Irvine.
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Rheumatoid arthritis. Lateral view of the cervical spine in a patient with rheumatoid arthritis shows erosion of the odontoid process.
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Boutonniere deformity.
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Rheumatoid arthritis. Anteroposterior radiograph of the knee shows uniform joint-space loss in the medial and lateral knee compartments without osteophytosis. A Baker cyst is seen medially (arrowhead).
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Rheumatoid arthritis. Ultrasonography-guided synovial biopsy of the second metacarpophalangeal joint of the right hand in a patient with rheumatoid arthritis of the hands. The biopsy needle is seen as a straight echogenic line on the left side of the image in an oblique orientation.
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Plain lateral radiograph of the normal cervical spine taken in extension shows measurement of anterior atlantodental interval (yellow line) and posterior atlantodental interval (red line).
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Rheumatoid arthritis. Lateral flexion view of the cervical spine shows atlantoaxial subluxation.
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Rheumatoid arthritis. Lateral view of the cervical spine in a patient with rheumatoid arthritis shows erosion of the odontoid process.
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Rheumatoid arthritis. T1-weighted sagittal magnetic resonance image of the cervical spine shows basilar invagination with cranial migration of an eroded odontoid peg. There is minimal pannus. The tip of the peg indents the medulla, and there is narrowing of the foramen magnum due to the presence of the peg. Inflammatory fusion of several cervical vertebral bodies is shown.
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Sagittal T2-weighted magnetic resonance image of cervical spine in same patient as in previous image. Compromised foramen magnum is easily appreciated, and there is increased signal intensity within upper cord; this is consistent with compressive myelomalacia. Further narrowing of canal is seen at multiple levels.
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Rheumatoid arthritis. Lateral radiograph of the same patient as in Images 4-5. Midcervical vertebral-body fusions are shown. The eroded peg is difficult to visualize, but inferior subluxation of the anterior arch of C1 is shown.
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Lateral radiograph of a normal cervical spine shows the McGregor line. The odontoid tip should not protrude more than 4.5 mm above the line, which is drawn from the posterior edge of the hard palate to the most caudal point of the occiput.
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Normal lateral magnified radiograph of the cervical spine shows the Ranawat method of detection of cranial settling. This method is used to measure the distance from the center of the pedicles (sclerotic ring) of C2 to a line drawn connecting the midpoints of the anterior and posterior arches of C1. (Normal values are 15 mm or greater for males and 13 mm or greater for females.)
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Lateral radiograph of the cervical spine shows how the cervical height index (CHI) is calculated. The distance from the center of the sclerotic ring of C2 to the tip of the spinous process of C2 (dotted line) is measured. This is then divided into the distance from the center of the sclerotic ring of C2 to the midpoint of the inferior border of the body of C7. A CHI of less than 2 mm is a sensitive predictor of neurologic deficit.
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X-ray shows total hip replacement, with prosthesis, in patient with osteoarthritis.
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Rheumatoid arthritis. This gross photo shows destruction of the cartilage and erosion of the underlying bone with pannus from a patient with rheumatoid arthritis.
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Rheumatoid arthritis. The hallmark of rheumatoid arthritis is a perivascular mononuclear cell infiltrate in the synovium (pictured here). The early stages are noted to have plasma cells as well, and syphilis needs to be part of the differential diagnosis.
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Rheumatoid arthritis. The inflammation involved in rheumatoid arthritis can be intense. It is composed of mononuclear cells and can resemble a pseudosarcoma.
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Rheumatoid arthritis. A 72-year-old man with long-standing rheumatoid arthritis developed blue-grayish discoloration of his skin. He had been on hydroxychloroquine for approximately 15 years. The diagnosis was hydroxychloroquine-related hyperpigmentation. Image courtesy of Jason Kolfenbach, MD, and Kevin Deane, MD, Division of Rheumatology, University of Colorado Denver School of Medicine.
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Rheumatoid arthritis. A 64-year-old woman with rheumatoid arthritis has developed nodules on the dorsal and volar aspect of her fingers, as well as the posterior aspect of her heels. The diagnosis is rheumatoid nodules with methotrexate-induced accelerated nodulosis. Image courtesy of Jason Kolfenbach, MD, and Kevin Deane, MD, Division of Rheumatology, University of Colorado Denver School of Medicine.
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Rheumatoid arthritis. A 64-year-old woman with rheumatoid arthritis has developed nodules on the dorsal and volar aspect of her fingers, as well as the posterior aspect of her heels. The diagnosis is rheumatoid nodules with methotrexate-induced accelerated nodulosis. Image courtesy of Jason Kolfenbach, MD, and Kevin Deane, MD, Division of Rheumatology, University of Colorado Denver School of Medicine.