Final Rheumatoid Arthritis - PPT 2
Final Rheumatoid Arthritis - PPT 2
Final Rheumatoid Arthritis - PPT 2
Arthritis
“arthro” = joint
“itis” = inflammation
“Arthritis can affect babies and children, as well as people in the
prime of their lives”
• Rheumatoid arthritis is an autoimmune disease in which the
normal immune response is directed against an individual's
own tissue, including the joints, tendons, and bones, resulting
in inflammation and destruction of these tissues.
Articular/hyaline cartilage
-acts as a shock absorber
- allows for friction-free movement
- not innervated!
Synovial membrane/synovium
-secretes synovial fluid
-nourishes cartilage
-cushions the bones
Overview
Age: Any age, commonly 3rd to 6th decade
Female: male 3:1
pattern of joint involvement could be:-
1) Polyarticular : most common
2) Oligoarticular
3) Monoarticular
Morning joint stiffness > 1 hour and easing with physical activity is
characteristic.
Small joints of hand and feet are typically involved.
Clinical Manifestations
Articular
Extra-articular
Articular manifestation
Morning stiffness ≥1
hr
Joints involved -
Relative incidence of joint
involvement in RA
MCP and PIP joints of hands & MTP of feet 90%
Knees, ankles & wrists-
80%
Shoulders- 60%
Elbows- 50%
TM, Acromio - clavicular & SC joints-
30%
Joints involved in RA
Don’t forget the cervical spine!!
Instability at cervical spine can lead to
impingement of the spinal cord.
Neutropenia
Respiratory- pleural effusion, pneumonitis ,
pleuro-pulmonary nodules, ILD
CVS-asymptomatic pericarditis , pericardial
effusion, cardiomyopathy
Rheumatoid vasculitis- mononeuritis multiplex,
cutaneous ulceration, digital gangrene, visceral
infarction
CNS- peripheral neuropathy, cord-compression
from atlantoaxial/midcervical spine subluxation,
entrapment neuropathies
EYE- kerato-conjunctivitis sicca, episcleritis,
scleritis
Rheumatoid nodule
• These are small subcutaneous nodules
present at the extensor surfaces of hand,
wrist, elbow and back in rheumatoid
arthritis patients.
A negative RF may be repeated 4-6 monthly for the first two year of
disease, since some patients may take 18-24 months to become
seropositive.
PROGNISTIC VALUE- Patients with high titres of RF, in general,
tend to have POOR PROGNOSIS, MORE EXTRA ARTICULAR
MANIFESTATION.
Causes of positive test for RF
Rheumatoid arthritis
Sjogrens syndrome
Vasculitis such as polyarteritis nodosa
Sarcoidosis
Systemic lupus erythematosus
Cryoglobulinemia
Chronic liver disease
Infections- tuberculosis , bacterial endocarditis,
infectious mononucleosis, leprosy, syphilis, leishmaniasis.
Malignancies
Old age(5% women aged above 60)
Anti-CCP
IgG against synovial membrane peptides
damaged via inflammation
Sensitivity (65%) & Specificity (95%)
Both diagnostic & prognostic value
Predictive of Erosive Disease
Disease severity
Radiologic progression
Poor functional outcomes
Acute Phase Reactants
Positive acute phase reactants () Negative acute phase reactants ()
Mild elevations – Albumin
– Ceruloplasmin – Transferrin
– Complement C3 & C4
Moderate elevations
– Haptoglobulin
– Fibrinogen (ESR)
– 1 – acid glycoprotein
– 1 – proteinase inhibitor
Marked elevations
– C-reactive protein (CRP)
– Serum amyloid A protein
Other Lab Abnormalities
Elevated APRs( ESR, CRP )
Thrombocytosis
Leukocytosis
ANA
30-40%
Inflammatory synovial fluid
Hypoalbuminemia
Radiographic Features
Peri-articular osteopenia
Uniform symmetric joint space narrowing
Marginal subchondral erosions
Joint Subluxations
Joint destruction
Collapse
Symmetric arthritis
Rheumatoid nodules
Radiographic changes
Sulphasalazine CyclosporineA
Leflunomide D-penicillamine/bucillamine
Minocycline/Doxycycline
Levamisole
Azathioprine,cyclophosphamide,
chlorambucil
Clinical information about DMARDs
NAME DOSE SIDE EFFECTS MONITORING ONSET OF
ACTION