RheumatoidArthritis in afya

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''Epidemiology''
    peak onset = 30-50 years, although occurs in all age groups
    F:M ratio = 3:1
    prevalence = 1%
    some ethnic differences e.g. high in Native Americans
    associated with HLA-DR4 (especially Felty's syndrome)

''wide variety of extra-articular complications''
    respiratory: pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy
    ocular: keratoconjunctivitis sicca (most common), episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, chloroquine retinopathy
    osteoporosis
    ischaemic heart disease: RA carries a similar risk to type 2 diabetes mellitus
    increased risk of infections
    depression

''Less common''
    Felty's syndrome (RA + splenomegaly + low white cell count)
    amyloidosis

''Xray changes''
//Early//
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
//Late//
periarticular erosions
subluxation

''Diagnosis''
Americans look at numbers of joints, raised inflamm markers, raised serology (RhF or ACPA) and duration
ACPA = Anti-cyclic citrullinated peptide antibody
NICE look more clinically - negative blood tests may still be RA

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