Rheumatoid Arthritis Causes Symptoms Diagnosis and Treatment

Rheumatoid Arthritis Causes Symptoms Diagnosis and Treatment

Rheumatoid Arthritis

Rheumatoid arthritis is a chronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » multisystem diseaseFALCIPARUM Malaria fever in Different Conditions and Complications Signs and Symptoms. 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 (TumorUses of Ayurveda for Improvement in Cancer Patients Treatment. Read more ... » Necrosis Factor) and interleukin (Il) 10 genes are seen.

Rheumatoid Arthritis Etiology

Pathology

Rheumatoid Arthritis ClinicalFALCIPARUM Malaria fever in Different Conditions and Complications Signs and Symptoms. Read more ... » manifestations

Symptoms:

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.

Extra-articular involvement

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 glucoseSome Facts about Glucocorticoid & Major side effects. Read more ... », WBC increased.
  • Imaging –

  • X-ray
    • 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
  • Disease modifying Antirheumatic drugs (DMARDs)
    • Methotrexate, Gold compounds, Antimalarials, Sulfasalazine.
    • Methotrexate (MTX) (Rheumatrex): 7.5–25 mg per week PO
  • 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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