Difference between revisions of "Rheumatoid arthritis"
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**[http://commons.wikimedia.org/wiki/File:Rheumatoid_nodule_-_intermed_mag_2.jpg Rheumatoid nodule - intermed. mag. (WC)]. | **[http://commons.wikimedia.org/wiki/File:Rheumatoid_nodule_-_intermed_mag_2.jpg Rheumatoid nodule - intermed. mag. (WC)]. | ||
**[http://commons.wikimedia.org/wiki/File:Rheumatoid_nodule_-_high_mag.jpg Rheumatoid nodule - high mag. (WC)]. | **[http://commons.wikimedia.org/wiki/File:Rheumatoid_nodule_-_high_mag.jpg Rheumatoid nodule - high mag. (WC)]. | ||
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<pre> | |||
Lesion (subcutaneous), right index finger, excision: | |||
- Palisading granuloma with necrobiotic core, consistent with rheumatoid nodule. | |||
</pre> | |||
=Pleural disease= | =Pleural disease= | ||
Revision as of 12:31, 17 April 2013
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:
- Osteoarthritis subchondral cysts are associated with cartilage loss.[3]
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:
- Changes are non-specific - DDx includes other rheumatic diseases (systemic lupus erythematosus, psoriatic arthritis).
DDx:
- Infected joint.
Images:
- RA (med.utah.edu).[6]
- Rheumatoid arthritis (nature.com).
- Synovial hyperplasia and inflammation (medpath.info).[4]
- RA cartilage loss (bmj.com).
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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.
Rheumatoid nodule
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
- Necrotic collagen bundles with fibrin surrounded by:
- Palisading granuloma.
- +/-Eosinophils.
Notes:
- Histomorphologically very similar to Granuloma annulare.
DDx:
- Granuloma annulare - has mucin in the core of the granuloma.[10]
- Necrobiosis lipoidica.
Images:
- www:
- WC:
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Lesion (subcutaneous), right index finger, excision: - Palisading granuloma with necrobiotic core, consistent with rheumatoid nodule.
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]
- Rheumatoid arthritis.
- Splenomegaly.
- Neutropenia.
Felty syndrome is associated with large granular lymphocytic leukemia.[13][14]
See also
References
- ↑ 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.
- ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 223. ISBN 978-0443066450.
- ↑ 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.
- ↑ 4.0 4.1 URL: http://www.medpath.info/MainContent/Skeletal/Joint_02.html. Accessed on: 10 November 2012.
- ↑ 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.
- ↑ URL: http://library.med.utah.edu/WebPath/EXAM/IMGQUIZ/msfrm.html. Accessed on: 5 December 2010.
- ↑ 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.
- ↑ 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.
- ↑ Busam, Klaus J. (2009). Dermatopathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Saunders. pp. 53. ISBN 978-0443066542.
- ↑ 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.
- ↑ 11.0 11.1 URL: http://granuloma.homestead.com/palisading.html. Accessed on: 1 November 2010.
- ↑ URL: http://www.pathguy.com/lectures/joints.htm. Accessed on: 1 November 2010.
- ↑ 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.
- ↑ 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.