Systemic (Rheumatic)
Rheumatoid Arthritis
류마티스 관절염
Chronic symmetric inflammatory small-joint arthritis causing destruction and systemic involvement
- How common
- 0.5–1% of general population
- Typical age
- Onset 30s–50s, female 3:1
What is it?
Autoimmune chronic synovitis forms pannus that destroys cartilage and bone, causing joint deformity.
Commonly affected: Symmetric small joints (MCP, PIP, wrist, MTP); DIP typically spared
How it develops
- Autoantibody ProductionRF and anti-CCP target joints
- SynovitisT-cell/macrophage/TNF/IL-6 mediated inflammation
- Pannus FormationProliferating synovium invades cartilage/bone
- Joint DestructionErosions, subluxation, ulnar deviation
Symptoms
- Symmetric polyarthritisBilateral MCP/PIP/wrist swelling and pain
- Morning stiffness >1 hourGradually improves with activity
- Joint deformitiesUlnar deviation, boutonnière, swan-neck deformities
- Constitutional symptomsFatigue, low fever, weight loss, morning malaise
- Rheumatoid nodulesSubcutaneous nodules over extensor surfaces (20–30%)
How it is examined
- MCP/PIP squeeze testPain on transverse MCP/MTP squeeze — early synovitis
- Joint swelling/warmthBoggy synovial swelling with warmth and tenderness
- RF/anti-CCP positiveAnti-CCP 95% specific; part of ACR/EULAR criteria
- Hand deformities (late)Ulnar deviation, swan-neck, boutonnière, Z-thumb
Imaging
Hand/foot X-ray shows periarticular osteopenia, marginal erosions, joint space narrowing, ulnar deviation, subluxation.
- Periarticular osteopenia
- Marginal erosions
- Symmetric joint space narrowing
- Ulnar deviation/subluxation
MRI detects synovitis, bone marrow edema, and erosions earlier than X-ray.
- Synovitis (contrast enhancement)
- Bone marrow edema (pre-erosive)
- Early erosions
- Tenosynovitis
Non-surgical care
- DMARDs (methotrexate)First-line DMARD, start immediately (treat-to-target)
- BiologicsTNF inhibitors (adalimumab, etanercept), IL-6, JAK inhibitors if MTX inadequate
- NSAIDs + low-dose steroidsBridge therapy for early symptom control
- PT/OTJoint protection, splinting, ROM/strength exercises
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Medical failure, joint destruction, deformity, functional loss
Procedures that may be discussed
- Synovectomy
- Tendon reconstruction
- Joint replacement (hand/wrist/knee/hip)
- Arthrodesis
Outlook
Early DMARD therapy can achieve remission; untreated disease progresses to destruction/disability.