The main affect is on the joints where there is inflammation of synovium which then proceeds toward the breakdown of cartilage and ankylosing of the joints (Robbins et al 2005). The joints which are involved include the joints of the hand, feet, ankles, knees, elbows and the spine (EHRMAN 2008)
Rheumatoid arthritis is a pathology which is believed to be caused by autoimmunity. Te disease is also considered to have a genetic predisposition (Gregerson 2003). The autoimmunity results due to the action of CD4+ T helper cells. These cells lead to the release of factors which cause inflammation which eventually leads to destruction of the joint (Firestein GS 2003 and Lee DM 2001). The autoimmune reaction also involves the formation of rheumatoid factors which are actually auto antibodies against IgG. The triggered autoimmune response leads to accumulation of T cells, plasma cells as well as macrophages in the joints. There is also evidence that the HLA-DR4 gene is found in people who develop rheumatoid arthritis (Levinson 2008).
Rheumatoid arthritis begins with an acute presentation in most patients with pain in the joints. The patient complains of pain in the body, a feeling of being unwell and fatigue. The symptoms begin with the small joints which are the metacarpophalangeal and proximal interphalangeal joints of the hand and the metatarsophalangeal and interphalangeal joints of the feet. Te next sequence is involvement of the wrist, ankle, elbows, knees and finally the cervical spine (Robbins et al 2005).
The diagnosis is based upon certain signs and symptoms which include stiffness in the morning, the involvement of more than 2 joints, inflammation of joints in a symmetrical manner, nodules on the skin which are known as rheumatic nodules and the presence of rheumatic factor in the serum. An X-ray also assists in the diagnosis (Robbins et