Rheumatoid Arthritis

Pathophysiology
Maj Muhammad Omair Riaz

Learning objectives
What is Rheumatoid Arthritis (RA)? What is the pathophysiology of RA? What are its clinical features? How to diagnose? How to manage it?

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Sequence of Presentation
Introduction Epidemiology & history Etiology and risk factors Pathophysiology Clinical Features Complications Diagnosis Management
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Introduction
Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
Mayo Clinic. http://www.mayoclinic.com. Accessed 16 May 2012

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Epidemiology (Disease burden)

World Pakistan Population: Disease burden: 3 per 10,000 population

180 Million 54000

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History
First known cases 4500 BC First historic case report 123 AD First modern description 1800 by French physician Dr Augustin Jacob Landr-Beauvais (17721840)

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Etiology
Genetics No disease causing gene identified Disease susceptibility genes ? Infections Viral Bacterial

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Risk factors
Gender Women are more likely to develop RA Age Can occur at any age Most commonly 40-60 years Family history Smoking
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Clinical features
Tender, warm, swollen joints Initial small joint involvement often bilateral Morning stiffness that may last for hours Firm bumps of tissue under the skin on arms (rheumatoid nodules) Fatigue, fever and weight loss

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Complications
Osteoporosis Carpal tunnel syndrome Heart problems Lung disease Eye manifestations

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Osteoporosis

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Carpal tunnel syndrome

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Heart Problems

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Lung disease

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Rheumatoid Arthritis & Pregnancy

No adverse effects on pregnancy outcomes Infact, disease severity actually DECREASES during pregnancy

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Eye manifestations

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Diagnosis
History Physical Examination Laboratory investigations X-Rays

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Laboratory Investigations
Blood Complete Picture with DLC & ESR CRP RA Factor Anti-CCP Antibodies

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There is NO CURE for Rheumatoid Arthritis

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Management
NSAIDs Steroids DMARDs Immunosuppressants TNF-alpha inhibitors Other drugs Brufen Prednisone Azathioprine Methotrexate Etanerceptk

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Physiotherapy & joint exercises are the BIGGEST help!

If all else fails, then SURGERY!

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