Difference between revisions of "Rheumatoid arthritis"

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*[http://library.med.utah.edu/WebPath/jpeg3/BONE044.jpg RA (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html]. Accessed on: 5 December 2010.</ref>
*[http://library.med.utah.edu/WebPath/jpeg3/BONE044.jpg RA (med.utah.edu)].<ref>URL: [http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html]. Accessed on: 5 December 2010.</ref>
*[http://www.nature.com/nature/journal/v423/n6937/fig_tab/nature01661_F1.html Rheumatoid arthritis (nature.com)].
*[http://www.nature.com/nature/journal/v423/n6937/fig_tab/nature01661_F1.html Rheumatoid arthritis (nature.com)].
*[http://www.medpath.info/MainContent/Skeletal/3100.GIF Synovial hyperplasia and inflammation (medpath.info)].<ref name=medpath/>
*[http://www.medpath.info/MainContent/Skeletal/3100.GIF Synovial inflammation (medpath.info)].<ref name=medpath/>
*[http://www.medpath.info/MainContent/Skeletal/3109.GIF Hyperplastic synovitis (medpath.info)].<ref name=medpath/>
*[http://ard.bmj.com/content/58/3.cover-expansion RA cartilage loss (bmj.com)].
*[http://ard.bmj.com/content/58/3.cover-expansion RA cartilage loss (bmj.com)].


Revision as of 17:50, 22 April 2014

Rheumatoid arthritis, commonly abbreviated RA, is an autoimmune disorder.

Skin

Rheumatoid neutrophilic dermatitis

General

  • Case report rare manifestation of rheumatoid arthritis.[1]

Microscopic

Features:

  • Nodular and diffuse pattern.
  • Neutrophils - perivascular (without vessel wall injury).[1]

DDx:

Joints

Main article: Joints

Rheumatic joint disease

  • AKA joint with rheumatic disease.

General

Clinical:

  • Tumour - swelling.
  • Rubor - redness.
  • Calor - heat.
  • Dolor - pain.

Gross

Features:

  • Pannus[2] - fibrovascular tissue or granulation tissue.
  • Irregular surface - synovial hyperplasia.
  • Subchondral cysts - involve the entire femoral head (late stage of disease).[3]

Note:

Image:

Microscopic

Features:[5]

  • Chronic inflammation, esp. lymphocytes.
    • +/-Lymphoid follicles.
  • Synovial hyperplasia - with papillary or polypoid architecture.
    • Synoviocytes may show binucleation and mild atypia.
  • +/-Fibrin.
  • +/-Bone.
  • +/-Cartilage.

Note:

DDx:

  • Infected joint.

Images:

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Femoral head

FEMORAL HEAD, LEFT, HIP ARTHROPLASTY:
- CHRONIC SYNOVITIS WITH SYNOVIAL HYPERPLASIA AND LOSS OF CARTILAGE.
- BONE WITHOUT APPARENT PATHOLOGY.
- SEE COMMENT.

COMMENT:
The findings are compatible with rheumatoid arthritis.

Hand

SYNOVIUM, LEFT HAND, EXCISION:
- SYNOVIAL HYPERPLASIA.
- CHRONIC AND FOCAL ACUTE SYNOVITIS.
- FIBRINOUS EXUDATE.
- GRANULATION TISSUE AND HEMOSIDERIN-LADEN MACROPHAGES.
- SEE COMMENT.

COMMENT:
The findings are compatible with rheumatoid arthritis.

Knee

KNEE - BONE AND SOFT TISSUE, RIGHT, KNEE ARTHROPLASTY:
- CHRONIC SYNOVITIS WITH SYNOVIAL HYPERPLASIA AND LOSS OF CARTILAGE.
- BONE WITHOUT APPARENT PATHOLOGY.

COMMENT:
The findings are compatible with rheumatoid arthritis.

KNEE - BONE AND SOFT TISSUE, LEFT, KNEE ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE WITH CHRONIC SYNOVITIS AND SYNOVIAL HYPERPLASIA.
- BONE WITHOUT APPARENT PATHOLOGY.

COMMENT:
The findings are compatible with rheumatoid arthritis.

Rheumatoid nodule

Rheumatoid nodule
External resources
EHVSC 10182
  • Abbreviated RN.

General

  • Seen in rheumatoid arthritis - usually only in seropositive cases, i.e. rheumatoid factor (RF) positive.[7]
    • Exceptions are reported.[8]

Gross

  • Usually on the extensor aspect of the extremities, e.g. dorsal aspect of elbow.[9]
  • Typically close to a joint.[citation needed]

Microscopic

Features:[7][10]

  • Necrotic collagen bundles with fibrin surrounded by:
  • +/-Eosinophils.

Notes:

DDx:

Images

www:

  • Rheumatoid nodule - low mag. (WC)

  • Rheumatoid nodule - intermed. mag. (WC)

  • Rheumatoid nodule - high mag. (WC)

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Lesion (subcutaneous), right index finger, excision:
- Palisading granulomas with cores of necrobiotic collagen, consistent with rheumatoid nodule.

Micro

The sections show foci with strands of necrobiotic collagen surrounded by palisading granulomas. Rare Neutrophils are seen in the core of the granulomas. Multinucleated cells are not apparent.

Benign fibroadipose tissue and dense connective tissue are also present.

Pleural disease

See Rheumatoid pleuritis.

Lung disease

See Medical lung disease.

RA may involve the lung.

Miscellaneous

Amyloidosis

See Amyloidosis.

Amyloidosis may be due to RA.

Felty syndrome

RA may occur in Felty syndrome -- the triad:[13]

Felty syndrome is associated with large granular lymphocytic leukemia.[13][14]

See also

References

  1. ↑ 1.0 1.1 Mashek, HA.; Pham, CT.; Helm, TN.; Klaus, M. (Jun 1997). "Rheumatoid neutrophilic dermatitis.". Arch Dermatol 133 (6): 757-60. PMID 9197831.
  2. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 223. ISBN 978-0443066450.
  3. ↑ 3.0 3.1 Resnick, D.; Niwayama, G.; Coutts, RD. (May 1977). "Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint.". AJR Am J Roentgenol 128 (5): 799-806. PMID 404905.
  4. ↑ 4.0 4.1 4.2 URL: http://www.medpath.info/MainContent/Skeletal/Joint_02.html. Accessed on: 10 November 2012.
  5. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 660. ISBN 978-0781765275.
  6. ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html. Accessed on: 5 December 2010.
  7. ↑ 7.0 7.1 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 299. ISBN 978-0470519035.
  8. ↑ Kaye, BR.; Kaye, RL.; Bobrove, A. (Feb 1984). "Rheumatoid nodules. Review of the spectrum of associated conditions and proposal of a new classification, with a report of four seronegative cases.". Am J Med 76 (2): 279-92. PMID 6364806.
  9. ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 53. ISBN 978-0443066542.
  10. ↑ 10.0 10.1 Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 52. ISBN 978-0443066542.
  11. ↑ 11.0 11.1 URL: http://granuloma.homestead.com/palisading.html. Accessed on: 1 November 2010.
  12. ↑ URL: http://www.pathguy.com/lectures/joints.htm. Accessed on: 1 November 2010.
  13. ↑ 13.0 13.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 328. ISBN 978-1416054542.
  14. ↑ Liu, X.; Loughran, TP. (Jul 2011). "The spectrum of large granular lymphocyte leukemia and Felty's syndrome.". Curr Opin Hematol 18 (4): 254-9. doi:10.1097/MOH.0b013e32834760fb. PMID 21546829.

External links

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