Diagnosing RA
• Medical history and physical exam: to establish possible genetic links
/ risks & check for joint inflammation and typical signs
• Blood tests: elevated erythrocyte sedimentation rate (ESR) w/ RA and
immunological studies look for:
• rheumatoid factors (non-specific antibodies), but negative RF does not rule
out RA -- 15-20% are seronegative. RF is usually negative early in disease,
plus it’s found in 10% of healthy population and other conditions: Sjögren's
syndrome, Hepatitis C and some other chronic infections
• other tests look for the presence of anti-citrullinated protein antibodies
(ACPAs) -- positive in 67% of RA cases, but rarely positive if not present, so
specificity is high at 95%
• Imaging: X-rays eventually show loss of joint space, soft tissue
swelling, and characteristic deformity; ultrasonography can depict
early cartilage erosion, synovium swelling and vascular changes

RHEUMATOID ARTHRITIS
Rheumatoid arthritis causes subcutaneous nodules over the hands, fingers, elbows, swelling of the wrists, ulnar deviation at the metacarpophalangeal joints, Butoinneire’s deformity, dinner fork deformity and swelling of the proximal interphalangeal joints.
Periarticular erosions on the X ray are suggestive of rheumatoid arthritis.
Disease Modifying Anti Rheumatic Drugs (DMARDs) used in Rheumatoid arthritis. D-penicillamine, gold, antimalarials, choloroquine, sulfasalazine, leflunomide, methotrexate. NSAIDs are important in symptom relief, but do not prevent disease progression. 

Anti-TNF biologics drugs are this group infliximab, etanercept and adalimumab. The criteria for treatment are that the patient has been treated with at least two DMARDs (disease-modifying) drugs but continue to have active rheumatoid arthritis.
Felty's syndrome consists of a triad of neutropenia, hypersplenism and rheumatoid arthritis,
The pulmonary complications of rheumatoid arthritis are : pulmonary fibrosis (interstitial lung disease) bronchiolitis obliterans with organizing pneumonia bronchiectasis interstitial pneumonitis secondary to drugs
exudative pleural effusions Caplan’s syndrome (pneumoconiosis, pulmonary nodules).

Juvenile chronic arthritis is rheumatoid factor negative. Commonest type is Still’s disease. Peaks of disease are about 5 years and 15 years of age. A high swinging fever is typical. An erythematous rash can occur, but it is non purpuric. Haematuria is not typical. Certain forms can involve only one or two large joints only.
Different classifications are systemic, pauciarticular and polyarticular.
Diagnostic criteria include high fever, hepatomegaly, splenomegaly, lymphadenopathy, serositis (pleuritis, pericarditis), leucocytosis. Bone destruction and micrognathia occurs.

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