d. Viral Infection Process. Diseases in this category range from the common
cold and influenza to chicken pox, German measles, and herpes simplex. All are viral
e. Rheumatic Fever. This fever characteristically follows a streptococcal
infection. A common complaint among many patients is migratory joint pain.
This type of pain is chronic but does not have the characteristics of deformity of
the area with the exception that there is swelling. Subacute pain can be a symptom of
rheumatoid arthritis, systemic lupus erythematous, and metabolic-caused joint pain.
Subacute pain can also be characteristic of ankylosing spondylitis, a progressive
chronic disease of the small vertebral joints of the spine.
Section III. SPECIFIC MUSULOSKELETAL DISEASES
RHEUMATOID ARTHRITIS (RA)
Rheumatoid arthritis is a chronic, systemic, inflammatory disease that attacks
outer body joints and the surrounding muscles, tendons, ligaments, and blood vessels.
RA is characterized by recurrent inflammation involving the synovial joints or the lining
of those joints. If untreated, fibrous tissue in the joints calcifies, and the patient is
unable to move the affected joints. The cause of RA is unknown; however, one theory
is that infectious, genetic, and endocrine factors help determine whether a person will
develop rheumatoid arthritis.
a. Stages of Rheumatoid Arthritis. If RA is untreated, the inflammatory
process in the joints progresses in four stages.
(1) Stage 1. Congestion and edema of the synovial membrane and joint
capsule cause synovitis (inflammation of the membranes lining a joint).
(2) Stage 2. Pannus (thickened layers of granulated tissue) forms, covers,
and invades cartilage, and finally destroys the joint capsule and bone.
(3) Stage 3. Fibrous ankylosis (abnormal immobility and fixation of a joint
caused by the presence of fibrous bands between the bones forming the joint) takes
place closing the joint and causing the joint to be immovable. It is in this stage that
visible deformities can be seen.
(4) Stage 4. Fibrous tissue calcifies in this stage, and the affected joint
becomes totally immovable.