Rheumatoid arthritis : Clinical presentation and initial assessment

Rheumatoid arthritis is characterized by symmetric polyarthritis, with joint swelling, tenderness, and morning stiffness as common initial findings. The disease progresses to involve specific deformities such as swan-neck deformity and ulnar deviation, particularly in the hands and feet. The underlying pathophysiology involves chronic synovitis driven by an autoimmune response, leading to joint destruction, muscle atrophy, and systemic symptoms. Understanding these clinical features and their pathophysiology is essential for early diagnosis and effective management of RA.

Synovial Thickening with a "Boggy" Feel on Palpation

• Examination: When examining joints affected by rheumatoid arthritis (RA), a common finding is synovial thickening, which gives the joint a characteristic "boggy" feel on palpation. This sensation is due to the inflammation and hypertrophy of the synovial membrane.
• Pathophysiology: In RA, the synovial lining of the joint becomes inflamed due to the autoimmune attack on the synovium. This leads to hyperplasia of the synovial cells and increased vascularity, resulting in the thickening of the synovium. The proliferating synovial tissue, also known as pannus, invades the joint space and contributes to the characteristic boggy sensation felt during the examination.

Comment: The boggy feel is a hallmark of active synovitis in RA, indicating ongoing inflammation and...