RA is a chronic autoimmune disease causing symmetrical, deforming polyarthritis with systemic features and extra-articular involvement.
Mnemonic: "R.A. =
Rheumatic Autoimmune disease"
CAUSES & RISK FACTORS
- Autoimmune Disease (Body Attacks Its Own Joints).
- Genetics (HLA-DR4 & HLA-DR1 Increase Risk).
- Female Gender (3:1 Female:Male Ratio, Worse Post-Pregnancy).
- Smoking (Strongest Environmental Risk Factor).
- Infections (May Trigger Autoimmune Response).
Mnemonic: "A.G.F.S.I. =
Autoimmune, Genetics, Female, Smoking, Infections"
PATHOLOGY OF RA
- Synovial Inflammation (Early Feature, Leads to Joint Swelling & Pain).
- Pannus Formation (Granulation Tissue Over Cartilage, Causes Damage).
- Bone Erosion & Joint Deformity (Chronic Stage).
- Extra-Articular Involvement (Lungs, Heart, Skin, Eyes).
Mnemonic: "S.P.B.E. =
Synovitis, Pannus, Bone Erosion, Extra-Articular"
SYMPTOMS OF RA
- Morning Stiffness >1 Hour (Inflammatory Arthritis Feature).
- Symmetrical Joint Pain (Affects Small Joints First – Hands, Feet).
- Swollen, Tender, Warm Joints (Due to Synovitis).
- Deformities (Swan Neck, Boutonnière, Z-Deformity in Hands).
- Fatigue, Weight Loss, Low-Grade Fever (Systemic Symptoms).
Mnemonic: "M.S.S.D.F. =
Morning Stiffness, Symmetrical Pain, Swelling, Deformities, Fatigue"
COMMONLY AFFECTED JOINTS
- Hands → MCP & PIP Joints (Not DIP, Unlike OA).
- Feet → MTP Joints (Forefoot Pain & Deformity).
- Wrist → Ulnar Deviation, Subluxation.
- Knees → Synovitis, Baker’s Cyst.
- Cervical Spine → Atlantoaxial Subluxation (Neck Pain, Neurological Symptoms).
Mnemonic: "H.F.W.K.C. =
Hands, Feet, Wrist, Knees, Cervical Spine"
EXTRA-ARTICULAR MANIFESTATIONS
- Skin → Rheumatoid Nodules, Vasculitis.
- Eyes → Dry Eyes (Sjögren’s Syndrome), Scleritis.
- Lungs → Interstitial Lung Disease, Pleural Effusion.
- Heart → Pericarditis, Myocarditis.
- Nerves → Carpal Tunnel Syndrome, Cervical Myelopathy.
Mnemonic: "S.E.L.H.N. =
Skin, Eyes, Lungs, Heart, Nerves"
DIAGNOSIS OF RA
Clinical Diagnosis Based on
Symptoms & History.
Blood Tests:
- Rheumatoid
Factor (RF) – Positive in 70% (Not Specific).
- Anti-CCP
Antibody – More Specific for RA (>95%).
- CRP &
ESR – Markers of Inflammation.
X-ray (Late-Stage RA) → Periarticular Osteopenia, Joint Erosions.
MRI (Early RA) → Synovitis, Bone Marrow Edema.
Mnemonic: "C.B.X.M. =
Clinical, Blood, X-ray, MRI"
TREATMENT OF RA
1. LIFESTYLE & SUPPORTIVE
CARE
- Physiotherapy (Prevents Deformities, Improves Mobility).
- Joint Protection (Use Splints, Avoid Heavy Lifting).
- Weight Management (Reduces Load on Joints).
Mnemonic: "P.J.W. =
Physiotherapy, Joint Protection, Weight Management"
2. MEDICAL MANAGEMENT
- NSAIDs (Pain Relief, But No Disease Modification).
- DMARDs (Methotrexate, Sulfasalazine, Leflunomide – Slow Disease Progression).
- Biologics (TNF Inhibitors – Infliximab, Etanercept for Severe RA).
- Steroids (For Acute Flares, Low-Dose for Long-Term).
Mnemonic: "N.D.B.S. =
NSAIDs, DMARDs, Biologics, Steroids"
3. SURGICAL MANAGEMENT
- Joint Replacement (For Severe Joint Damage – Knees, Hips).
- Synovectomy (Removes Inflamed Synovium).
Mnemonic: "J.S. = Joint
Replacement, Synovectomy"
HOMOEOPATHIC MANAGEMENT OF RA
- For Joint Pain & Swelling:
- Rhus Tox, Bryonia, Calcarea Fluor, Arnica.
- For Autoimmune & Chronic Cases:
- Causticum, Kali Carb, Medorrhinum, Syphilinum.
- For Rheumatoid Nodules & Deformities:
- Silicea, Calcarea Carb, Lycopodium.
Mnemonic: "R.B.C.A. =
Rhus Tox, Bryonia, Calc Fluor, Arnica for RA Pain"
FINAL REVISION WITH MNEMONICS
- Definition = "R.A. = Rheumatic Autoimmune disease"
- Causes = "A.G.F.S.I." (Autoimmune, Genetics, Female, Smoking, Infections)
- Pathology = "S.P.B.E." (Synovitis, Pannus, Bone Erosion, Extra-Articular)
- Symptoms = "M.S.S.D.F." (Morning Stiffness, Symmetrical Pain, Swelling, Deformities, Fatigue)
- Common Joints = "H.F.W.K.C." (Hands, Feet, Wrist, Knees, Cervical Spine)
- Extra-Articular = "S.E.L.H.N." (Skin, Eyes, Lungs, Heart, Nerves)
- Diagnosis = "C.B.X.M." (Clinical, Blood, X-ray, MRI)
- Lifestyle = "P.J.W." (Physiotherapy, Joint Protection, Weight Management)
- Medical = "N.D.B.S." (NSAIDs, DMARDs, Biologics, Steroids)
- Surgical = "J.S." (Joint Replacement, Synovectomy)
- Homeopathy = "R.B.C.A." (Rhus Tox, Bryonia, Calc Fluor, Arnica for RA Pain)
