Rheumatoid arthritis is a chronic inflammatory condition of unknown a etiology, which can be disabling causing up to 35% of patients with 10 years of symptoms to early retire and carries a high mortality rate. It targets mainly the synovial membrane and articular cartilage of joints leading to joint deformity and instability. Genetic, immunological and environmental factors are thought to cause the disease in such a way that susceptible genes are triggered by infection or environmental factors leading to inappropriate immune response attacking the joints
Around 1% of general population is affected in the UK it is estimated to affect about 0.8% of the population and in some countries, where it is prevalent, it affects about 2% of population above 60 years. Though highest rates are in north Europe and America some studies are showing decrease of incidence in these regions. It is more common in white race affecting elderly in the 5th and 6th decade with women being affected 3 folds more than men.
Wrist and hands are the most common joints affected in rheumatoid arthritis such that by 4 years of the onset of the disease more than 90% of patients would show symptoms of involvement of at least one of these joints. Affection of carpal ligaments and tendons around the wrist would lead to radial deviation of radio carpal joint with ulnar deviation of the fingers at the MCP joint, subluxation of distal ulna and dropped fingers resulting in a zigzag deformity or what is known as caput ulnae syndrome. Half of the patients might have systemic or extra articular manifestations (ExRA). Nodules are the most common ExRA with the cardiovascular system being the most affected and this might be the reason why these patients show a higher mortality rate than the non-ExRA subgroup.
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