U.C.L.A. Rheumatology Pathophysiology of Disease Course Lecture,
Second Year Medical School 1997
Rheumatoid Arthritis Page 16
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All of the swelling, dislocation, and attendant deformity of RA result from the continual proliferation of the synovial lining; the outpouring of inflammatory products into the joint space causes distension of the joint capsule and thinning of the articular cartilage, while the growing inflammatory tissue (pannus) erodes the bony margins of the joints. Muscles which surround the joints atrophy, ligaments stretch and eventually break and pain arises from the inflamed and swollen joints and, later, from the mechanical derangement of the joints. If the synovial proliferation is left unchecked the joint surfaces are eventually destroyed and scar tissue forms further restricting joint motion.
Subcutaneous nodules may develop typically around joints and in areas subject to pressure, such as the olecranon surface of the elbow (figure 7). These nodules may form in the eye causing thinning and inflammation of the sclera. RA may be associated with dry eyes and dry mouth in a condition called Sjogren's Syndrome. This is an inflammatory lymphocytic process which destroys the lacrimal and salivary glands reducing tear and saliva production. About 80% of patients with RA are positive for RF. These patients tend to have more severe disease and an increased risk of involvement of other tissue sites such as the heart and lung.
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