Rheumatoid Arthritis Causes Symptoms Diagnosis and Treatment

Rheumatoid Arthritis Causes Symptoms Diagnosis and Treatment

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic multisystem diseaseVasculitis Syndrome Causes Differential Diagnosis Symptoms and Treatment. Read more ... ».

There are systemic manifestations.

  • There is persistent inflammatory synovitis. chronic systemic disease marked by inflammation of multiple synovial joints,Involves peripheral joints symmetrically. There is damage of cartilage and bone.
  • Patients typically complain of joint stiffness in the morning rather than after activities. Women are affected 3 times more often than men.
  • Female: Male ratio is 3 : 1
  • Age: 35-50 yrs.
  • There is genetic predisposition
  • Association with rheumatoid factor-auto antibody. HlA-DR4 is major genetic risk factor for RA. Polymorphism in TNF (Tumor Necrosis Factor) and interleukin (Il) 10 genes are seen.

Rheumatoid Arthritis Etiology

  • · Unknown
  • · Genetic
  • · Autoimmune
  • · Infectious agent-Mycoplasma, Epstein Barr Virus, Cytomegalovirus, Rubella virus
  • · Molecular mimicry
  • · Super antigens
  • · Cigarette smoking
  • · Environmental factors.

Pathology

  • · Microvascular injury
  • · T-Iymphocyte – CD4+ T cells found
  • · HlA DR + macrophages
  • · Autoimmune inflammatory process.

Rheumatoid Arthritis ClinicalVasculitis Syndrome Causes Differential Diagnosis Symptoms and Treatment. Read more ... » manifestations

Symptoms:

  • Joint pains, morning stiffness,
  • gelling (stiffness that returns after the patient sits or rests),
  • malaise, and fatigueFatigue diagnosis medicine and treatment. Read more ... » are often present.
  • · Chronic polyarthritis begins insidiously
  • · Fatigue, anorexia, weakness
  • · Musculoskeletal weakness and pain
  • · Synovitis – swelling, tenderness and limitation of motion.
  • · Arthritis of hands, wrists, knees, feet-loss of function.
  • · Symmetrical involvement.
  • Systemic: Fatigue, depression, malaise, anorexia,
  • rheumatoid nodules, ocular disease, lymphadenopathy,
  • splenomegaly, entrapment neuropathies, osteoporosis.
  • Constitutional symptoms-Fever, lymphadenopathy, splenomegaly.
  • Pain, swelling, tenderness of joints.
  • Generalized stiffness, Morning stiffness more than 1 hour.

Description of Arthritis

  • · Joint inflamed, held in flexion.
  • · Joints involved are proximal interpharyngeal, metacarpopharyngeal, distal interpharyngeal, wrist, elbow, knee, ankle, axial spine.
  • · There is swelling, pain, synovitis, deformity, laxity of tissues.
  • · Characteristic changes are radial deviation of wrist, ulnar deviation of digits, hyperextension of interphalangeal joints.

Extraarticular involvement

  • · Rheumatoid nodules-found near joints, extensor surfaces, pleura, meninges
  • · Skeletal muscle atrophy
  • · Rheumatoid vasculitis
  • · Polyneuropathy
  • · Cutaneous vasculitis
  • · Myocardial Infarction
  • · Renal disease
  • · lymphadenopathy
  • · Splenomegaly
  • · Interstitial fibrosis-lungs
  • · Caplan’s syndrome – diffuse nodular fibrotic le­sions in lung
  • · Episcleritis
  • · Felty’s syndrome-chronic rheumatoid arthritis, splenomegaly, neutropenia, anaemia, thromb­ocytopenia
  • · Osteoporosis.

Rheumatoid Arthritis Diagnostic Tests

  • Lab tests

  • · No specific tests
  • ESR: Usually elevated
  • C-reactive protein: Unspecific, direct measure of impact of IL-6 on liver cells
  • Rheumatoid factor (RF): >1:80 in 70–80% of patients with RA (most commonly IgM Ab)
  • · Rheumatoid factor positive
  • · Normochromic normocytic anaemia
  • · Increased ESR
  • · Increased C-reactive protein
  • · Synovial fluid analysis – turbid, increased pro­tein, decreased glucose, WBC increased.
  • Imaging —

  • Xray
    • Radiographic abnormalities are very useful in the diagnosis and treatment.
    • Periarticular osteopenia is the earliest change.
    • Typical deformity seen in the joints affected.
  • CT Scan, MRI
  •  mTc biphosphonate bone scan

Rheumatoid Arthritis Differential Diagnosis

  • Vasculitis: Behçet syndrome
  • Seronegative polyarthritis
  • Erosive osteoarthritis
  • Chronic infections: Lyme disease
  • Other systemic connective tissue diseases:
  • Sjögren syndrome, systemic lupus erythematosus, systemic sclerosis, adult Still disease, mixed connective tissue disease
  • Psoriatic arthritis
  • Viral-induced arthritis: Parvovirus B19, hepatitis C (with cryoglobulinemia)
  • Occult malignancy

Rheumatoid Arthritis Treatment

  • Relief of pain
  • Reduce inflammation Restore function
  • Treat systemic features Protection of joints.
  • Start DMARDs within 2 months of diagnosis if patient has ongoing active disease despite appropriate dose of aspirin or other NSAIDs.
  • Precautions: Offer proton pump inhibitors (PPIs) for chronic NSAID therapy; avoid NSAID combination.
  • Relief of Pain
    • · NSAIDs (Ibuprofen, aceclofenac, nimuselide).
    • · COX-I! inhibitors (Rofecoxib, valdecoxib – not approved by FDA).
  • Reduce inflammation
    • Glucocorticoids. Intraarticular glucocorticoids.
  • Disease modifying Antirheumatic drugs (DMARDs)
  • Immunosuppressive/ cytotoxic drugs Omega-3 fatty acids
    • Leflunomide (Arava): Dose: 10–20 mg/d. Modifies T-cell function to decrease autoimmune activity,
  • Surgery
    • Reconstructive, arthroplasties, joint replacement, synovectomy.

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