Rheumatology And Immunology Online Medical Reference — covering Definition through Treatment. Arthritis pathophysiology rheumatoid of the Cleveland Clinic.
Measures of disease activity, such as the Disease Activity Index, and measures of outcome, such as the Health Assessment Questionnaire, should be recorded at every outpatient visit. Your complete Medical Education portal. Although most readily recognized by its articular manifestations, RA can affect any organ system. The presentation and disease course are distinct for any individual patient, making diagnosis and management a thoughtful, complex, and dynamic process. Whether disease expression is confined to mild articular manifestations or manifests as severe, multisystem disease, our current understanding demands that patients receive early and aggressive therapy. Achieving prompt control of local and systemic inflammatory processes minimizes damage of articular structures, preserves function, and reduces early mortality. Its incidence is two to three times greater in women, and this disparity is most pronounced in patients younger than 50 years.
The incidence of RA continues to increase with age until about the seventh decade of life. The cause of RA is unknown. However, the association of HLA-DR with RA is well established. There is an increased relative risk of RA of about 4 to 5 in patients with this allele. Whether shared alleles contribute to disease severity is controversial. More data are needed to establish the precise role of genetic factors.
Infectious agents have long been suspected as potential triggers of RA. Although investigations have failed to identify any one organism in synovial tissue or fluid, polymerase chain reaction techniques have detected bacterial nucleotide sequences in synovial tissues in RA patients. RA patients have been found to have higher levels of virus-infected B cells and higher levels of EBV antibody titers than the general population. In addition, the ability of the virus to activate B cells to produce RF has generated interest in this virus as a potential trigger.