ABSTRACT
Rheumatoid arthritis is a symmetrical peripheral polyarthritis classically involving metacarpophalangeal and proximal interphalangeal joints (Figure 6.1), but equally affecting metatarsophalangeal joints in the feet. Specific criteria for the diagnosis of rheumatoid arthritis have been defined by the American Rheumatology Association (Table 6.1). However any synovial joint can be involved, including wrists, elbows, shoulders, ankles, knees, hips, cervical spine and temporo-mandibular joints (Figure 6.2). Symptoms include stiffness occurring early in the morning, improving as the day progresses, and pain is often described as toothache-like. Early in disease process the joint swelling is predominantly soft tissue with synovitis and/ or effusion, with heat because of joint inflammation. Deformity usually develops over years with joint destruction in the hands leading to ulnar deviation, volar subluxation of the metacarpophalangeal joints,
Table 6.1American Rheumatology Association criteria for diagnosis of rheumatoid arthritis
RA is diagnosed when four or more of the following criteria are met.
