PowerPoint Presentation On Rheumatoid Arthritis

Rheumatoid Arthritis PPT

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1. Rheumatoid Arthritis

2. Goals
General Approach to Arthritis
Rheumatoid Arthritis
Diagnostic Criteria
Pathophysiology
Therapeutic Approach
Disease Severity and Course

3. Rheumatoid Arthritis: Definition
Progressive, systemic, inflammatory disorder
Unknown etiology
Characterized by
Symmetric synovitis
Joint erosions
Multisystem extra-articular manifestations

4. Epidemiology of Rheumatoid Arthritis
Approximately 1% of the total adult population is affected by RA
40% to 60% with advanced (functional class IV) RA will:
Survive 5 years or less following diagnosis
Die 10-15 years earlier than expected

5. Approach to Arthritis

6. Joint Pain
most common symptom
Pain (arthralgia) vs. Inflammation (arthritis)
Inflammation:
heat, redness, pain, swelling, loss of function
inflammatory arthritis (RA, SLE) vs. pain syndrome (fibromyalgia)

7. Number of Joints Affected
Monoarticular
Crystal-induced
Infection
Reactive Arthritis
Hemarthrosis
OA: joint effusions
Autoimmune disease
Psoriasis, IBD, AS, Behçet's
Oligo/Polyarticular
Monoarticular causes
RA
SLE
Viral infection
B19
Acute Serum Sickness
Untreated Crystal-induced
Vasculidities

8. Inflammatory vs. Non-Inflammatory
Inflammatory: i.e. RA
Generalized AM stiffness
> 30 min
Resolves with movement
Classic signs of inflammation

Non-Inflammatory: i.e. Osteoarthritis
Localized AM stiffness
< 30 min 9. Arthrocentesis Confirm diagnoses Differentiate between inflammatory & noninflammatory Therapeutic/Adjunct to Antibiotics Labs: cell count w/diff crystal analysis Gram stain & Culture WBC >2000/µL indicates inflammatory arthritis

Arthroscopy
Evaluate ligamentous & cartilaginous integrity
Biopsy
Infectioun: aspirate thick or loculated fluid

9. RA
Systemic inflammatory autoimmune disorder
~1% of population
Onset: 52 years
40-70 years of age
<60 - 3-5:1 female predominance

10. Genetics
Increased incidence among Pima & Chippewa Native American tribes (5%)
Genetic & Environmental

HLA-DRB1*0401 & HLA-DRB1*0404
Increased risk
Increased joint damage
Increased joint surgery

11. Pathophysiology

12. Immunology
Macrophages:
Produce cytokines
Cytokines (TNF-α) cause systemic features
Release chemokines  recruit PMNs into synovial fluid/membrane

TNF-α & IL-1:
Proliferation of T cells
Activation of B cells
Initiates proinflammatory/joint-damaging processes

TH-1 cells:
Mediate disease processes
Activate B cells

B cells:
Release cytokines
Plasma cells that produce Ab

Osteoclasts:
Bone erosion
Juxta-articular & Systemic osteoporosis

13. Pathophysiology
Swelling of Synovial lining
Angiogenesis

Rapid division/growth of cells = Pannus
Synovial thickening/hyperplasia
Inflammatory vascularized tissue
Generation of Metalloproteinases

Cytokine release
Infiltration of leukocytes
Change in cell-surface adhesion molecules & cytokines
Destruction of bone & cartilage

14. Bottom Line Proliferation Destruction of joints Disability

15. For more info please refer PPT. Thanks