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    Rheumatoid Arthritis

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    Rowsan Rijal
    Rheumatoid arthritis is an autoimmune disease that principally attacks synovial joints, affecting 1-3% of adults. It progresses through three stages: initial synovitis and inflammation, destruction of articular cartilage and bone, and finally deformity. Clinical features include symmetrical polyarthralgia, morning stiffness, and constitutional symptoms. Diagnosis involves lab tests like rheumatoid factor, anti-CCP antibodies, and imaging of joint erosion and space narrowing. Treatment includes NSAIDs, DMARDs like methotrexate, biologics that target cytokines, immunosuppressants, and surgery for joint replacement or reconstruction in advanced cases.

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    Rheumatoid Arthritis

    Uploaded by

    Rowsan Rijal
    88 views21 pages
    Rheumatoid arthritis is an autoimmune disease that principally attacks synovial joints, affecting 1-3% of adults. It progresses through three stages: initial synovitis and inflammation, destruction of articular cartilage and bone, and finally deformity. Clinical features include symmetrical polyarthralgia, morning stiffness, and constitutional symptoms. Diagnosis involves lab tests like rheumatoid factor, anti-CCP antibodies, and imaging of joint erosion and space narrowing. Treatment includes NSAIDs, DMARDs like methotrexate, biologics that target cytokines, immunosuppressants, and surgery for joint replacement or reconstruction in advanced cases.

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    Rheumatoid arthritis is an autoimmune disease that principally attacks synovial joints, affecting 1-3% of adults. It progresses through three stages: initial synovitis and inflammation, destruction of articular cartilage and bone, and finally deformity. Clinical features include symmetrical polyarthralgia, morning stiffness, and constitutional symptoms. Diagnosis involves lab tests like rheumatoid factor, anti-CCP antibodies, and imaging of joint erosion and space narrowing. Treatment includes NSAIDs, DMARDs like methotrexate, biologics that target cytokines, immunosuppressants, and surgery for joint replacement or reconstruction in advanced cases.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    88 views21 pages

    Rheumatoid Arthritis

    Uploaded by

    Rowsan Rijal
    Rheumatoid arthritis is an autoimmune disease that principally attacks synovial joints, affecting 1-3% of adults. It progresses through three stages: initial synovitis and inflammation, destruction of articular cartilage and bone, and finally deformity. Clinical features include symmetrical polyarthralgia, morning stiffness, and constitutional symptoms. Diagnosis involves lab tests like rheumatoid factor, anti-CCP antibodies, and imaging of joint erosion and space narrowing. Treatment includes NSAIDs, DMARDs like methotrexate, biologics that target cytokines, immunosuppressants, and surgery for joint replacement or reconstruction in advanced cases.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 21

    Rheumatoid arthritis

    Introduction
    • Autoimmune disease that results in a chronic,
    systemic inflammatory disorder that may
    affect many tissues and organs, but
    principally attacks synovial joints.
    • Affects 1-3% of adult population
    • F>M: 3 to 1
    • Peak age of onset -35 and 45
    Pathophysiology
    Stage 1: Synovitis
    - Angiogenesis, proliferation of synoviocytes and infiltration of
    the subsynovial layers by inflammatory cells
    - Thickening of the capsular structures, villous formation of the
    synovium and a cell-rich effusion into the joints and tendon
    sheaths
    - Potentially reversible

    Stage 2: Destruction
    - Articular cartilage is eroded by proteolytic enzymes and
    pannus
    - Bone is eroded by pannus invasion and osteoclastic
    resorption
    - Tendon sheaths tenosynovitis rupture of
    tendons
    - Synovial effusion swelling of the joints

    Stage 3: Deformity
    - Articular destruction, capsular stretching and tendon
    rupture  instability and deformity
    - In some cases, adhesion develops between apposing
    layer of pannus causing fibrous ankylosis and later
    bony ankylosis
    Clinical features
    • Symmetrical polyarthralgia, morning stiffness,
    joint swelling
    • Constitutional symptoms: mild grade fever,
    weakness, easy fatigability, anorexia, and weight
    loss
    • Later on, there may be limitation of motion due
    to pain or joint destruction
    • Predilection for the small joints of the hands, feet
    and wrists: MP joints, PIP joints, and wrists are
    first to become symptomatic
    Deformities
    • Hand: flexor tendon synovitis, triggering of
    fingers, swan neck deformity, Z deformity,
    boutonniere or button hole deformity, piano-
    key movement" of the ulnar styloid
    • Foot: cock-up toe deformity, Hallux valgus
    (lateral deviation of toes), hammer toe, claw
    toe, calcaneovalgus (eversion) of hindfoot,
    pes planus
    • Knee: Early- flexion deformity
    Late- Triple subluxation (flexion,
    posterior subluxation and external
    rotation)
    Popliteal (‘Baker’s’) cysts
    Diagnosis
    Lab Tests
    • Rheumatoid Factor: Rose Waller test, present in most RA
    patients (80 % of affected pts); 5% normal pts also +ve.
    False +ve in- SLE, sarcoidosis, TB, syphilis, chronic liver
    disease
    • Anti CCP antibody (anti-cyclic citrullinated peptide
    antibodies): more specific ( 95%) than RA factor.
    • Synovial Fluid Analysis: joint fluid in RA is sterile & has
    pleocytosis (usually PMN), incr protein, & decreased
    viscosity & decreased complement
    • ESR: Elevated
    • C Reactive Protein: positive
    • Peripheral blood smear: Normocytic normochromic
    anaemia
    • CBC: count normal
    X ray
    • Juxta-articular osteopenia (rarefaction)
    • Soft tissue shadow at the level of joint
    because of joint effusion or synovial
    hypertrophy
    • Symmetric joint space loss
    • Erosion of articular margin
    • Subchondral erosions and cysts
    • Joint subluxation and collapse
    TREATMENT
    Medical Management:
    1. NSAIDS
    2. Oral Corticosteroids- used to alleviate intractable joint
    inflammation or vasculitis
    3. DMARDS
    – Methotrexate: anti folate, hepatic and pulmonary
    toxicity; first choice DMARD, upto 15 mg per week, add
    folate to reduce toxicity
    – Hydroxychloroquine: check visual acuity regularly
    – Sulfasalazine (anti folate activity): orange staining of urine
    – Leflunomide: inhibit the proliferation of T lymphocytes
    – D-Penicillamine (modulate lymphocyte functions)
    – Gold: gold salts (inhibit monocyte function), side
    effects thrombocytopenia, neutropenia, or proteinuria
    4. Anti-cytokine agents
    – Etanercept - TNF type II receptor fused to IgG1
    – Infliximab- monoclonal antibody to TNF
    – Adalimumab- human antibody to TNF
    5. Immunosuppressive agents
    – Azathioprine
    – Cyclophosphamide
    – Cyclosporin A
    Surgical treatment
    – Synovectomy
    – Arthroplasty- hip, knee, shoulder, elbow, wrist,
    MCP
    – Arthrodesis- wrist, PIP, MCP
    – Tendon transfer & reconstructive surgery of hand
    Thank you

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