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Answers | Pathophysiology, Clinical Manifestations,
Diagnosis, Laboratory Tests, Joint Deformities, Extra-
Articular Manifestations and NCLEX Review Latest
Updated 2026
RA is a
Chronic inflammatory disease w/ persistent symmetric inflammatory synovitis with cartilage
destruction and bone erosion due to pannus (granulation tissue).
T-cell mediated
Epidemiology of RA
• 1% of population
• Increases with age, most dev 35-50
• Female to male 3:1
• 10% have first-degree relative
MHC-II association
• HLA-DR4
• Dw16
• DR1
, Clinical manifestations of RA
1. Prodrome: constitutional symptoms: fever, fatigue, weight loss, anorexia, dec range of
motion
2. Small joint stiffness: MCP, wrist, PIP, knee, MTP, shoulder ankle) worse with rest!
*morning stiffness >60 min after mvnt, improves later in day
3. Symmetric arthritis: swollen, tender, erythematous, 'boggy joint'
-Boutonniere deformity (flextion @ PIP, hyperextension at DIP
-Swan neck deformity (flexion @ DIP, hyperextension at PIP)
-Ulnar deviation at MCP joint, Rheumatoid nodules
-Knees: medial and later narrowing (just medial in OA)
-Pop-up toes, hallux valgus deformity
4. Felty's syndrome: triad of RA + splenomegaly + decrease WBC/ repeated infection
5. Caplan syndrome: pneumoconiosis + RA
Specific joint deformities
Boutonniere
Swan neck deformity
Ulnar deviation at MCP joint
Pop-up toes