USMLE (Fach) / Bones, Joints, and Soft Tissue Tumors (Lektion)

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- chronic inflammatory disorder of autoimmune origin that principally attacks the joints producing synovitis

- F:M = 3:1

- positive for: rheumatoid factor, anti-CCP (citrullinated peptides) antibodies

- HLA-DR1 association

Joint- symmetric arthritis principally affecting small joints of the hand/feet- fibrous/bony ankylosisSkin- rheumatoid subcutaneous nodules (also in lungs & other organs) which resemble necrotizing granulomas

Clinical course:- begins with malaise, fatigue, musculoskeletal pain- symmetrical joint involvement- metacarpophalangeal and PIP joints, wrists, ankles, elbows, knees, upper spine (lumbosacral region & hips spared!)- swollen, warm, painful joints- stiff in the morning- decreased range of motion evolving to complete ankylosis- swan-neck deformity, boutonnière deformity- Baker cyst (herniation of the synovium)

Therapy: TNF-Antagonists

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