Stages

Pathologic process

sx

Physical signs

x-ray

(+) antigen to
lymphocyte
t-cell proliferation
in synovial
membrane
1. Accumulation of
neutrophils
2. Synoviocytes
proliferation
3. WBC invasion in
cartilage

(-)

(-)

(-)

1.
2.
3.
1.
2.

Malaise
Mild jt stiffness
Swelling
Jt swelling
Morning
stiffness > 4hrs
3. Diminished
pain when
submerged in
hot h2o
4. Malaise
5. weakness
^ sam

Swelling or pain of
small jts

(-)

^ same
But c pronounced
swelling

Periarticular
osteopenia
*MRI
proliferative
pannus

^ same
+ Loss of fxn
+ early dfo (Z-dfo)

^ same c stage 3
+ jt instability
+ flexor
contracture
+ ROM
+ extraarticular
complications

Early erosion and

narrowing of jt
space

1. polarization of
synovitis into a
centripetal
invasion of
pannus
2. activation of
chondrocyte
3. initiation of
proteinase
cartilage
degradation
1. erosion of
subchondral
bone
2. invasion of
pannus to
cartilage
3. chondrocyte
proliferation
4. stretched
ligaments

Warms
Swollen jt
Excess synovial
fluid
Synovial prolif
Pain LOM
Nodules

Specific manifestaions
1. cervical
2. TMJ
3. shoulder

4. Elbow
5. Wrist

C1 C2
Rotn
C2 and mid cervical: MC of inflamm
(N) ~ is altered
N/A to open mouth
GH, AC, SC
Degen, pain, LOM
Complication: bursitis and tenidinitis
Unstable jt
Irreg / catching movt
Flxn contracture d/t pain
Flxn contracture d/t synovitis
Volar subluxation of carpas on radius d/t erosion of RC jt

6. Hand
7. PIP
8. DIP
9. thumb
10.Hip
11.Knees
12.Ankle

13.Tenosynoviti
s
14.Lag
phenomeno
n

(+) Piano key sign

power grasp and ligamentous support
Ab(N) radial dev of MCP
Ulnard drift
MCP soft tissue swelling
Bowstring effect
Zigzag
Swan neck
Boutonniere
Bouchards
Heberdens
mallet
mutilans dfo
transverse fold of skin of the thumb
Less common
Protusio acetabuli
Most freq affected
Hindfoot pronation
Heel spurs: d/t calcaneus erosion
Splay foot
Hallux valgus
Hammer toes
Cock-up/claw toes
Mm involvement
Tendon sheaths

Difference PROM vs AROM

Criteria for classification

Possible
Probable
Definite
Classic

2 for 3 mos
3 for 6 wks
5 for 6 wks
7/11 for 6 wks

Stills
20 %
F=M
(-) RF ANA
Intermittent fever
Rashes
Lymphadenopathy
Hepatomegaly
Leukocytosis
Anemia
Inc ESR and WBCC
Marked anemua
Most severe
Causes of long
term steroid use

a.
b.
c.
d.
e.
f.

Morning stiffness
Tenderness/pain in motion
Swelling
Nodules
Elevated ESR/ c-reactive protein
iritis

Polyarticular
40%
F
No extraarticular
Malaise
Low fever
Organomegaly
Adenopathy
Anemia
GR
Weight loss
Symmetric

Pauciarticular
40%
F
Oligo c 4 mos
Jts commonly
affected:
Knee
Ankle
Elbow

Significant growth
retardation
Flex position and
refuse to walk