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RHEUMATOID ARTHRITIS

What is Rheumatoid Arthritis?

Rheumatoid is a medical inflammatory disease of the lining of the joint rather than a wear and tear problem.

A typical joint in the body is made up of 2 bones that move against each other. These two bones are held together by ligaments and a sheath that surrounds the entire joint like the walls of a balloon or bag. This sheath or wall is called the capsule of the joint. The inner lining of this joint wall or capsule is called the synovium and is made of a special tissue that does many things including producing a special joint-lubricating nutrient fluid called synovial fluid.

In rheumatoid arthritis, the synovium of the joint becomes aggressive and inflamed. It enlarges and erodes (eats into) the neighboring bones, ligaments and joint cartilage coating damaging the joint's smooth surfaces. The end result is similar to osteoarthritis in that the joint surfaces are destroyed and painful, although rheumatoid arthritis starts differently and has additional problems both in the joint and elsewhere in the body.

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LABORATORY FINDINGS

Synovial Fluid

  • Yellow to white;  turbidity reflects increased WBC; fibrin clot indicates chronicity
  • Mucin clot may be fair or poor;  a poor clot and decreased viscosity indicates that hyaluronic acid is decreasd.
  • WBC - usually 5,000/ul - 50,000/ul - reflects the degree of inflammation
  • Differential WBC - usually 65% neutrophils, which increase along with the total WBC
  • Glucose - normal or low - there is interference with normal glucose transport
  • *Positive rheumatoid factor - usually present in higher concentration than in serum; inversely related to the synovial-fluid complement level
  • Decreased complement - reflects consumption in immunologic reaction
  • Increased IgG and immune complexes
  • Ragocytes - neutrophils with ingested immune complexes
Peripheral Blood
  • WBC are usually normal or slightly elevated (<12,000/ul).  WBC are decreased in the presence of splenomegaly;  this suggests Felty's syndrome.
  • Normocytic or microcytic anaemia - chronic disease type
Other Laboratory Findings
  • *Positive rheumatoid factor (IgM) - 75% of patients; occurs in 95% of patients with subcutaneous nodules
  • Presence of antinuclear antibodies (10%-50% of patients) - titres are lower than in SLE
  • Negative anti-DNA antibodies
  • Increased C-reactive protein, fibrinogen, and sedimentation rate - reflect disease activity
  • Increased alpha1 and alpha2 - globulins - acute phase reactants
  • Increased y-globulin - reflects accelerated protein breakdown in chronic disease
  • Normal serum complement;  decreased complement in the presence of severe extra-articular disease, such as vasculitis
  • Presence of circulating immune complexes - frequent when there are systemic manifestations
*This finding is of diagnostic significance


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