A Power Point Presentation on the Disease Rheumatoid Arthritis covering everything from explanation and history to causes, effects, treatments, diagnosis, and prognosis.

1. Rheumatoid Arthritis

2. Table of Contents Introduction Explanation & History Signs & Symptoms Diagnostic Testing Diagnosis Treatments Prognosis Conclusion Bibliography

3. Introduction My name is Rebecca Ledford and I am 27 years old. Growing up I have always been a lover of the arts, especially the art of dance. So much that when I was 3 years old, my mother enrolled me into my first dance class. For the better part of 15 years, dance was my life. Classes and competitions every weekend. At age 17 I was faced with the hardest decision I thought I would ever have to make. After seeing the doctor for minor wrist and knee pain, which at the time, I thought was just normal wear and tear from being a dancer for so many years, I was told that if I didn’t stop dancing sometime soon, I would end up on crutches or in a wheelchair, by the time I was 35. I was diagnosed with Rheumatoid Arthritis.

4. Explanation & History Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that may affect many tissues and organs, but mainly attacks the joints producing an inflammatory synovitis. The first known cases date back as far as 4500 BC. Although, the first recognized description of the disease was in 1800 by the French physician Dr. Augustin Jacob Landre-Beauvais. The name, Rheumatoid Arthritis, was coined in 1859 by British rheumatologist Dr. Alfred Baring Garrod. The name is based on the term “rheumatic fever,” an illness which includes joint pain and is derived from the Greek word rheumatos meaning flowing and the suffix –oid meaning resembling, thus giving it the translation as joint inflammation that resembles rheumatic fever.

5. While RA mainly affects the joints, problems involving other organs of the body are known to occur. May also produce inflammation in the lungs, pericardium, pleura, and sclera. It can be difficult to determine whether the extra-articular symptoms are directly caused by RA or from side effects of the medications commonly used to treat it. Cause is unknown but autoimmunity plays a big part in its chronicity and progression. RA is a chronic disease who’s pain intensity and deterioration of joint structures progress over time often leading to deformations and disability.

6. Epidemiology - Statistics About 1% of the worlds population is afflicted, women almost 3 times more often than men. It is 4 times more common among smoker’s than non-smokers and some Native American groups have a higher prevalence rate. Genetics and/or family history play a big role as well. Onset is uncommon under the age of 15, however no age is immune. It is most commonly diagnosed between the ages of 40 and 50 years and normally no later than 80 years of age.

7. JOINTS

8. Arthritis of the joints – Synovitis. An inflammation of the synovial membrane that lines the joints and tendon sheaths. Joints become swollen, tender, and warm, and stiffness limits their movement. RA nearly always affects multiple joints. Common of joints affected are the small joints of the hands, feet, and cervical spine, as well as, larger joints such as the shoulders and knees. Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function. Joints are often affected in a fairly symmetrical fashion, although this is not specific, and the initial presentation may be asymmetrical.

9. The Skin

10. The Rheumatoid Nodule Often subcutaneous, it is the feature most characteristic of RA. The initial pathological process in nodule formation is unknown, however, it is very similar to synovitis because of the structural features that occur in both. The nodule has a central area of fibrinoid necrosis. Tissue death, in which there is accumulation of amorphous, proteinaceous material in the tissue matrix with a staining pattern reminiscent of fibrin. Surrounding the necrosis is a layer of palisading macrophages and fibroblasts, corresponding to the intimal layer in synovium and a cuff of connective tissue containing clusters of lymphocytes and plasma cells.

11. Typically about 3 millimeters to a few centimeters in diameter, the nodules are usually found over bony prominences. The Olecranon – behind the elbow. The Calcaneal Tuberosity – the heel bone. The Metacarpophalangeal Joints – the hands. Also may occur in other areas of the body that sustain repeated mechanical stress.

12. The Lungs & Kidneys

13. Fibrosis of the of lungs The formation or development of excess fibrous connective tissue. A recognized response to RA. It is very rare, but a well identified consequence of therapy. Renal Amyloidosis A progressive, incurable, metabolic disease characterized by abnormal deposits of protein in the kidneys. Treatment with Penicillamine, a metabolite of penicillin although it has no antibiotic properties, and gold salts are causes of membranous nephropathy.

14. The Heart & Blood Vessels

15. Myocardial Infarction Commonly known as a heart attack. Occurs when the blood supply to part of the heart is interrupted causing some heart cells to die. Disambiguation Stroke. The rapid loss of brain function(s) due to disturbance in blood supply to the brain. Atherosclerosis The abnormal narrowing of an artery. The condition in which an artery wall thickens due to a build up of fatty materials such as cholesterol.

16. Other conditions of the heart caused by RA: Pericarditis Inflammation of the pericardium – the sac that contains the heart and the roots of the great vessels. Endocarditis Inflammation of the inner layer of the heart. Left Ventricular Failure Commonly known as heart failure. Valvulitis Inflammation of one or more of the heart valves.

17. The Eyes

18. Ocular Episcleritis Inflammation of the sclera or white of the eye. Scleromalacia An abnormal softening of the sclera. Keratoconjunctivitis Sicca Dryness of the eyes. Caused by the lack of tear production. When severe, dryness of the cornea can lead to keratitis. Inflammation of the cornea. Loss of vision.

19. The Blood

20. Hematological Anemia The most common abnormality of the blood cells. Red blood cells are of normal size and color but are lacking in number. Neutropenia An abnormally low white blood cell count. Normally only occurs when the patient has an enlarged liver or spleen. Thrombocytosis An increased platelet count. Occurs when inflammation is uncontrolled.

21. Neurological

22. Carpel Tunnel Syndrome Due to compression of the medial nerve by swelling around the wrist. Atlanto-Axial Subluxation Erosion of the odontoid process and/or transverse ligaments in the cervical spine’s connection to the skull. Vertebrae begin slipping over one another and compress the spinal cord. Clumsiness is initially experienced, but without due care this can progress to quadriplegia. Quadriplegia :: paralysis of all four extremities.

23. Diagnostic Testing

24. X Rays X rays of hands and feet are generally performed in people with RA. Magnetic Resonance Imaging (MRI) Ultrasounds

25. Blood Tests Rheumatoid Factor (RF) RF is a specific antibody in the blood. A negative RF does not rule out RA. The arthritis is then called seronegative, most common during the first year of illness and converting to seropositive status over time. Anti-citrullinated Protein Antibodies (ACPAs) Like RF, this testing is only positive in a proportion of all RA cases. Unlike RF, this test is rarely found positive if RA is NOT present, giving it a specificity of about 95%.

26. Other blood tests performed when RA is suspected: Lupus Erythematosus A connective tissue disease Erythrocyte Sedimentation Rate (ESR) The rate at which red blood cells precipitate in a 1 hour period. C-Reactive Protein A protein found in the blood in response to inflammation. Full Blood Count Gives information about all blood cells. Renal Function Kidney Function Liver Enzymes Gives information on the state of a patient’s liver

27. Diagnosis

28. At least FOUR criteria MUST be met for classification of RA. Morning stiffness of more than 1 hour most mornings for at least 6 weeks. Arthritis and soft-tissue swelling of more than 3 of 14 joints, present for at least 6 weeks. Arthritis of the hand joints, present for at least 6 weeks. Symmetric arthritis, present for at least 6 weeks. Subcutaneous nodules in specific places. Rheumatoid Factor at a level above the 95th percentile. Radiological changes suggestive of joint erosion.

29. Treatment

30. Goal of Treatment To alleviate the current symptoms and to prevent future destruction of the joints resulting in handicap. Cortisone Therapy Cortisone, a steroid hormone, can be valuable to a long term treatment plan. Anti-inflammatory Agents Non-Steroidal Anti-Inflammatory Drugs Aspirin Ibuprofen Naproxen Acetaminophen Tylenol Opiates Any of the narcotic alkaloids found in the opium poppy. Diproqualone A Sedative Lidocaine Topical A local anesthetic

31. Other Therapies Include: Weight Loss Occupational Therapy Podiatry The study of the foot, ankle, and leg. Physiotherapy Immunoadsorption Therapy A drug that has effect on the immune system. Radon Therapy A radioactive water bath. Acupuncture A technique of inserting fine needles into specific points of the body to relieve pain.

32. Prognosis

33. Disability Daily living activities are impaired. After 5 years of disease, approximately 33% of sufferers can no longer work. After 10 years of disease, approximately 50% of sufferers have substantial functional disability. Some people have mild or short-term symptoms, but in most cases, the disease is progressive for life. The life shortening effect of RA varies. Most sources cite a lifespan reduction of 5 to 10 years.

34. Conclusion

35. Rheumatoid Arthritis is more severe than I ever really began to think that it was. I watched my grandmother suffer through it for so many years, but never really understood the extent of the disease. I’ve been a sufferer of Rheumatoid Arthritis for almost 11 years now. I’m certainly glad that I’ve been given the chance to better understand the inner workings of my body through this project.

36. Bibliography www.wikipedia.com www.emedicinehealth.com www.nlm.nih.gov