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*Only for medical professionals to read for reference, can you recognize it? Rheumatoid arthritis (RA) is the most common chronic autoimmune disease involving joints, accounting for about 0.
5%-1.
0% of the total population.
Although the etiology of RA is still unclear, the involvement of dendritic cells and Th17 cells seems to play a key role in maintaining a chronic inflammatory state.
RA is generally characterized by damage to the small joints.
Chronic inflammation leads to joint destruction, tendons and ligaments to relax and disintegrate.
These processes lead to an imbalance of the forces acting on the joints, leading to joint deformities, including swan neck deformities, button fancy joint deformities, mallet finger deformities, telescope deformities, etc.
[1].
In some cases, bone erosion in the course of RA may be life-threatening, such as atlantoaxial subluxation, which may lead to myelopathy and paralysis; skull base depression, which may lead to brainstem damage and even death.
Although RA prefers small joints, the larger joints are not immune.
In a large proportion of RA patients, the elbow, hip, and shoulder joints can also be affected.
The progression and prognosis of RA are variable, depending on the efficacy and response of the treatment modality used.
Inappropriate treatment can lead to disease progression, ultimately leading to joint erosion, destruction, deformity, and a substantial decline in the quality of life functions.
The basic structure of joints Synovial joints are the most common type of joints in the human body and are characterized by the synovial cavity.
The joint capsule is a type of fibrous connective tissue that attaches to the bone around the joint and wraps the synovial membrane inside.
Unlike other types of joints, the bones in synovial joints are protected by articular cartilage to avoid direct contact.
Articular cartilage provides a lubricating surface for the joint and promotes free movement.
The joint capsule is mainly composed of two layers, which are continuous with the periosteum around the joint.
The outer fibrous connective tissue is formed by the interwoven collagen fiber bundles that wrap the joints.
The inner layer of the joint capsule is the synovial membrane, whose function is to secrete synovial fluid, lubricate the joints and act as a medium for the passage of nutrients.
The synovium of healthy patients has a unique cell lining.
Synovial cells arranged on the synovial membrane are called synovial cells, which are responsible for producing and absorbing synovial fluid and exchanging with blood.
Joint deformities in RA ▌ Hand joint deformity 75% of RA patients have hand joints and tendons involved.
Wrist joint involvement is common in RA and can cause major complaints such as pain, joint swelling, and limited mobility.
Radiocarpal joint: Involvement of the radiocarpal joint leads to unstable rotation of the scaphoid bone, which in turn leads to a reduction in the height of the wrist bone and collapse of the wrist, which results in displacement of the wrist bone relative to the ulnar and volar sides of the radius.
As RA progresses, the ulnar styloid process gradually bulges up on the dorsal side.
Flexion deformity is also a feature of advanced RA wrist disease.
These patients can show pain and paresthesia during median nerve innervation, as well as characteristic nocturnal pain and positive signs of Tinel and Phalen.
In some RA patients, carpal tunnel syndrome may be the first symptom.
Figure 1 The dorsal uplift of the ulnar styloid process of the wrist joint: Metacarpophalangeal joint involvement in RA patients results in swelling of the hand and limited mobility.
As RA progresses, flexion deformities of the metacarpophalangeal joints appear.
Generally speaking, the lumbroid and interosseous muscles are responsible for the flexion of the metacarpophalangeal joints and the extension of the interphalangeal joints.
The involvement of the RA tendon leads to fibrosis and spasm, which exaggerates its normal flexion function.
In addition to the observed increased flexion of the metacarpophalangeal joints, ulnar deflection of the fingers may also occur due to many factors, including the tension of the lumbroid muscles.
Figure 2 Metacarpophalangeal joint ulnar deflection Interphalangeal joint: Interphalangeal joint involvement can cause various deformities.
Swan neck deformity usually refers to hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint.
Button fancy deformity is manifested by flexion of the proximal interphalangeal joints and hyperextension of the distal interphalangeal joints.
On the contrary, the hammer finger refers to the incomplete extension of the distal phalanx due to weak attachment of the extensor tendon.
The deformity of the telescope is that the affected fingers can be lengthened or shortened, like an old telescope.
Figure 3 Interphalangeal joint involvement ▌ Cervical spine involvement RA, which is characterized by erosive synovitis, has a tendency to affect the cervical spine; RA is considered to be the most common cause of spinal inflammation.
Evidence shows that cervical spondylosis begins in the early stages of the disease process, and its progression is related to the progression of peripheral joint diseases.
According to reports, in RA patients, the incidence of neck pain is about 40%-88%.
According to imaging records, 43%-88% of patients have cervical subluxation [2].
The most vulnerable joints in the cervical spine are the occipital-C1 and C1-C2 joints [3].
There are three main manifestations of cervical spine involvement: atlantoaxial subluxation (65%), skull base depression (20%), and lower cervical spine subluxation (15%).
Atlantoaxial subluxation is also called C1-C2 instability.
Subluxation can occur in multiple planes, so anterior, posterior, lateral, and rotational subluxations are possible, but most subluxations occur anteriorly.
The indentation of the skull base is due to the erosion of the occipital bones C1 and C1-C2, which reduces the vertical distance between the dentate and the brainstem.
This can cause severe nerve damage.
Subluxation of the lower cervical spine (below C2) refers to various deformities that may occur in different planes of the cervical spinal cord.
In some cases, it can cause spondylolisthesis, stair deformity, or cervical kyphosis.
Figure 4 Cervical spine involvement▌ Foot joint involvement RA patients may initially have foot and ankle symptoms similar to upper limb joint involvement.
During RA, the proportion of foot and ankle joint involvement is estimated to be about 94% [4].
The dorsal subluxation of the proximal phalanx hinders the normal extension of the interosseous muscles, resulting in excessively flexed little toe deformities, including claw toe deformity and hammer toe deformity.
Posterior tibial tendinitis may cause valgus and flat feet common in RA [5].
Figure 5 Foot joint involvement ▌ Large joint involvement RA is characterized by involving small joints, but in many cases, RA will involve large joints including elbow joints, shoulder joints, and hip joints.
All in all, RA is a chronic joint disease that can cause irreversible and irreversible joint deformities, and sometimes even life-threatening.
Advances in immunopathogenesis help to understand the pathogenesis of RA.
However, there are still many problems to be solved.
Patients should be strictly controlled and actively treated to slow the progression of the disease, avoid joint deformities and severe cervical spine involvement, so as to improve the quality of life and increase the survival rate.
References: 1.
Sharif,K.
,et al.
,Rheumatoid arthritis in review:Clinical,anatomical,cellular and molecular points of view.
Clin Anat,2018.
31(2):p.
216-223.
2.
Reiter,MFand SDBoden,Inflammatory Disorders of the cervical spine.
Spine(Phila Pa 1976),1998.
23(24):p.
2755-66.
3.
Kim,HJ,et al.
,Cervical spine disease in rheumatoid arthritis:incidence,manifestations,and therapy.
Curr Rheumatol Rep, 2015.
17(2):p.
9.
4.
Borman,P.
,et al.
,Foot problems in a group of patients with rheumatoid arthritis:an unmet need for foot care.
Open Rheumatol J,2012.
6:p.
290-5.
5.
Louwerens, JWand JC Schrier, Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options.
Int Orthop, 2013.
37(9): p.
1719-29.
5%-1.
0% of the total population.
Although the etiology of RA is still unclear, the involvement of dendritic cells and Th17 cells seems to play a key role in maintaining a chronic inflammatory state.
RA is generally characterized by damage to the small joints.
Chronic inflammation leads to joint destruction, tendons and ligaments to relax and disintegrate.
These processes lead to an imbalance of the forces acting on the joints, leading to joint deformities, including swan neck deformities, button fancy joint deformities, mallet finger deformities, telescope deformities, etc.
[1].
In some cases, bone erosion in the course of RA may be life-threatening, such as atlantoaxial subluxation, which may lead to myelopathy and paralysis; skull base depression, which may lead to brainstem damage and even death.
Although RA prefers small joints, the larger joints are not immune.
In a large proportion of RA patients, the elbow, hip, and shoulder joints can also be affected.
The progression and prognosis of RA are variable, depending on the efficacy and response of the treatment modality used.
Inappropriate treatment can lead to disease progression, ultimately leading to joint erosion, destruction, deformity, and a substantial decline in the quality of life functions.
The basic structure of joints Synovial joints are the most common type of joints in the human body and are characterized by the synovial cavity.
The joint capsule is a type of fibrous connective tissue that attaches to the bone around the joint and wraps the synovial membrane inside.
Unlike other types of joints, the bones in synovial joints are protected by articular cartilage to avoid direct contact.
Articular cartilage provides a lubricating surface for the joint and promotes free movement.
The joint capsule is mainly composed of two layers, which are continuous with the periosteum around the joint.
The outer fibrous connective tissue is formed by the interwoven collagen fiber bundles that wrap the joints.
The inner layer of the joint capsule is the synovial membrane, whose function is to secrete synovial fluid, lubricate the joints and act as a medium for the passage of nutrients.
The synovium of healthy patients has a unique cell lining.
Synovial cells arranged on the synovial membrane are called synovial cells, which are responsible for producing and absorbing synovial fluid and exchanging with blood.
Joint deformities in RA ▌ Hand joint deformity 75% of RA patients have hand joints and tendons involved.
Wrist joint involvement is common in RA and can cause major complaints such as pain, joint swelling, and limited mobility.
Radiocarpal joint: Involvement of the radiocarpal joint leads to unstable rotation of the scaphoid bone, which in turn leads to a reduction in the height of the wrist bone and collapse of the wrist, which results in displacement of the wrist bone relative to the ulnar and volar sides of the radius.
As RA progresses, the ulnar styloid process gradually bulges up on the dorsal side.
Flexion deformity is also a feature of advanced RA wrist disease.
These patients can show pain and paresthesia during median nerve innervation, as well as characteristic nocturnal pain and positive signs of Tinel and Phalen.
In some RA patients, carpal tunnel syndrome may be the first symptom.
Figure 1 The dorsal uplift of the ulnar styloid process of the wrist joint: Metacarpophalangeal joint involvement in RA patients results in swelling of the hand and limited mobility.
As RA progresses, flexion deformities of the metacarpophalangeal joints appear.
Generally speaking, the lumbroid and interosseous muscles are responsible for the flexion of the metacarpophalangeal joints and the extension of the interphalangeal joints.
The involvement of the RA tendon leads to fibrosis and spasm, which exaggerates its normal flexion function.
In addition to the observed increased flexion of the metacarpophalangeal joints, ulnar deflection of the fingers may also occur due to many factors, including the tension of the lumbroid muscles.
Figure 2 Metacarpophalangeal joint ulnar deflection Interphalangeal joint: Interphalangeal joint involvement can cause various deformities.
Swan neck deformity usually refers to hyperextension of the proximal interphalangeal joint and flexion of the distal interphalangeal joint.
Button fancy deformity is manifested by flexion of the proximal interphalangeal joints and hyperextension of the distal interphalangeal joints.
On the contrary, the hammer finger refers to the incomplete extension of the distal phalanx due to weak attachment of the extensor tendon.
The deformity of the telescope is that the affected fingers can be lengthened or shortened, like an old telescope.
Figure 3 Interphalangeal joint involvement ▌ Cervical spine involvement RA, which is characterized by erosive synovitis, has a tendency to affect the cervical spine; RA is considered to be the most common cause of spinal inflammation.
Evidence shows that cervical spondylosis begins in the early stages of the disease process, and its progression is related to the progression of peripheral joint diseases.
According to reports, in RA patients, the incidence of neck pain is about 40%-88%.
According to imaging records, 43%-88% of patients have cervical subluxation [2].
The most vulnerable joints in the cervical spine are the occipital-C1 and C1-C2 joints [3].
There are three main manifestations of cervical spine involvement: atlantoaxial subluxation (65%), skull base depression (20%), and lower cervical spine subluxation (15%).
Atlantoaxial subluxation is also called C1-C2 instability.
Subluxation can occur in multiple planes, so anterior, posterior, lateral, and rotational subluxations are possible, but most subluxations occur anteriorly.
The indentation of the skull base is due to the erosion of the occipital bones C1 and C1-C2, which reduces the vertical distance between the dentate and the brainstem.
This can cause severe nerve damage.
Subluxation of the lower cervical spine (below C2) refers to various deformities that may occur in different planes of the cervical spinal cord.
In some cases, it can cause spondylolisthesis, stair deformity, or cervical kyphosis.
Figure 4 Cervical spine involvement▌ Foot joint involvement RA patients may initially have foot and ankle symptoms similar to upper limb joint involvement.
During RA, the proportion of foot and ankle joint involvement is estimated to be about 94% [4].
The dorsal subluxation of the proximal phalanx hinders the normal extension of the interosseous muscles, resulting in excessively flexed little toe deformities, including claw toe deformity and hammer toe deformity.
Posterior tibial tendinitis may cause valgus and flat feet common in RA [5].
Figure 5 Foot joint involvement ▌ Large joint involvement RA is characterized by involving small joints, but in many cases, RA will involve large joints including elbow joints, shoulder joints, and hip joints.
All in all, RA is a chronic joint disease that can cause irreversible and irreversible joint deformities, and sometimes even life-threatening.
Advances in immunopathogenesis help to understand the pathogenesis of RA.
However, there are still many problems to be solved.
Patients should be strictly controlled and actively treated to slow the progression of the disease, avoid joint deformities and severe cervical spine involvement, so as to improve the quality of life and increase the survival rate.
References: 1.
Sharif,K.
,et al.
,Rheumatoid arthritis in review:Clinical,anatomical,cellular and molecular points of view.
Clin Anat,2018.
31(2):p.
216-223.
2.
Reiter,MFand SDBoden,Inflammatory Disorders of the cervical spine.
Spine(Phila Pa 1976),1998.
23(24):p.
2755-66.
3.
Kim,HJ,et al.
,Cervical spine disease in rheumatoid arthritis:incidence,manifestations,and therapy.
Curr Rheumatol Rep, 2015.
17(2):p.
9.
4.
Borman,P.
,et al.
,Foot problems in a group of patients with rheumatoid arthritis:an unmet need for foot care.
Open Rheumatol J,2012.
6:p.
290-5.
5.
Louwerens, JWand JC Schrier, Rheumatoid forefoot deformity: pathophysiology, evaluation and operative treatment options.
Int Orthop, 2013.
37(9): p.
1719-29.
