Rheumatoid Arthritis ICD-10
Rheumatoid Arthritis ICD-9
- 714.0 (rheumatoid arthritis)
Rheumatoid Arthritis Etiology / Epidemiology / Natural History
- Rheumatoid pannus = inflammed synovial tissue which leads to erosion of articular cartilage, and characteristic periarticular erosions.
- TNF-alpha and interleukin-1B are the major inflammatory cytokines involved in RA. Others=interleukin-2, inferferon gamma,
Rheumatoid Arthritis Anatomy
- Classically involves: wrists, MCP PIP joints in the hand and MTP joints in the foot.
Rheumatoid Arthritis Clinical Evaluation
- Symmetric, erosive and deforming.
- Early morning stiffness, joint swelling.
Rheumatoid Arthritis Xray / Diagnositc Tests
- Xrays demonstrate:
1-symmetric joint space narrowing
- Lateral flexion/extention C-spine xrays are indicated for any RA patient who is undergoing general anesthesia to evaluated for C1-2 instability. Posterior atlanto-dens interval >14mm is predictive of neurologic progression and pt should be considered for fusion (Boden SD, JBJS 1993;75:1282).
- Anticyclic citrullinated antibody: most specific lab finding; present in 2/3 of RA pts.
- Rheumatoid factor: immunoglobulin M antibody against immunoglobulin G. Present in 90% of patients.
- Nonspecific labs: elevated ESR, elevated CRP, decreased Hgb, elevated platelets.
Rheumatoid Arthritis Classification / Treatment
- Diagnosed by symmetric inflammatory polyarthritis affecting small joints of hands, feet and wrists persitting >6months with characteristic lab findings.
- Generally referred to Rheumatologist for disease modifying treatment. Infliximab (targets TNF), etanerceopt(targets TNF), adalimumab(targets TNF), anakinfa(targets IL-1), abatacept, rituximab, corticosteriods, doxycyline, methotrexate, hydroxycloroquine, sulfasalazine leflunomide. (Korpela M, Arthritis Rheum 2004;50:2072). Medications have many sometime severe adverse effects.
- Surgical considerations: 2-4x increased infection risk, RA medications may increase infection risk, delay wound healing; stopping RA meds before surgery remains controversial.
Rheumatoid Arthritis Associated Injuries / Differential Diagnosis
Rheumatoid Arthritis Complications
- Adverse medication reactions: TB reactivation, pneumoxystis carinii, candidiasis, histoplasmosis, listeriosis, nocardiosis, aspergillosis, cytomegalovirus, cryptococcosis, coccidioidmyocosis, demyelinating disease, infusion/injection reactions, malignancy, CHF
Rheumatoid Arthritis Follow-up Care
- Generally refer to rheumatology for medical management.
Rheumatoid Arthritis Review References
- Abdo RV, Iorio LJ. Rheumatoid arthritis of the foot and ankle. J Am Acad Orthop Surg. 1994 Nov;2(6):326-332.
- Jaakkola JI, Mann RA. A review of rheumatoid arthritis affecting the foot and ankle. Foot Ankle Int. 2004 Dec;25(12):866-74.