Rheumatoid Arthritis PPT
Download
Presentation Transcript:
1. Rheumatoid Arthritis2. 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
