Rheumatoid arthritis

1. RHEUMATOID
ARTHRITIS
Dr. Ajith JS
Asst. Professor
Department of Pharmacology
Sanjivani College of Pharmaceutical Education & Research, Kopargaon

2. INTRODUCTION
▹ Rheumatoid arthritis (RA) is an autoimmune disease that can cause
joint pain and damage throughout the body
▹ The joint damage that RA causes usually happens on both sides of
the body

3. PATHOPHYSOLOGY
Triggering
factors
( MHC, STAT)
Increase
inflammatory
mediators
Release B-
cells
T- cell
activation
Auto immune
T-cell
Proliferation
of T cell

4. SYMPTOMS
The main symptoms of rheumatoid arthritis are:
▹ Joint pain
▹ Joint swelling, warmth and redness
▹ Stiffness, especially first thing in the morning or after sitting still for a long time.
Other symptoms can include:
▹ Tiredness and lack of energy – this can be known as fatigue
▹ Weight loss
▹ A high temperature, or a fever
▹ Sweating
▹ Dry eyes – as a result of inflammation
▹ Chest pain – as a result of inflammation.
▹

5. RISK FACTORS
Exposure to certain types of bacteria
Having a history of viral infections
Smoking cigarettes
▹ Sex
▹ Having a family history of RA
▹
▹
▹
▹ Having obesity

6. COMPLICATIONS
 Effects on the Skin
 Eye Complications
 Pain in the Neck
 Heart and Blood Vessel Disease
 Blood Disease
 Lung Problems
 Infections

7. DIGNOSIS
Physical examination
Examining joint function and range of motion
Touching the affected joints to check for warmth and tenderness
▹ Looking for swelling and redness
▹
▹
▹ Testing your reflexes and muscle strength

8. Blood test
▹ Rheumatoid factor test
▹ Anticitrullinated protein antibody test
▹ Anti nuclear antibody test
▹ Erythrocyte sedimentation rate
▹ C-reactive protein test.
 DAS 28

9. Nonpharmacological treatment
▹ Physiotherapy
▹ Physical activity
▹ Hydrotherapy
▹ Foot care
TREATMENT
6)NICE guideline Draft for consultation, January 2018Rheumatoid arthritis in adults: management [Internet], cited on 22 Aug 2020; Available from;
https://www.nice.org.uk/guidance/ng100/documents/draft-guideline
7)Daniel Aletaha, Tuhina Neogi, Alan J. Silman,2010 Rheumatoid Arthritis diagnosis Criteria An American College of Rheumatology/European League Against Rheumatism [Internet], cited
on 22 Aug 2020;Available from; https://www.rheumatology.org/Portals/0/Files/2010_revised_diagnostic criteria ra.pdf
8)JASVINDER A. SINGH, KENNETH G. SAAG 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis[Internet], cited on 22 Aug 2020;Available
from; https://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.
9)Aneela Mian , Fowzia Ibrahim and David L. Scott A systematic review of guidelines for managing rheumatoid arthritis [Internet], cited on 22 Aug 2020;Available from;
https://bmcrheumatol.biomedcentral.com/track/pdf/10.1186/s41927-019-0090-7

10. Pharmacological treatment
▹ First-line treatment for RA was disease-modifying anti-rheumatic drug (DMARD)
Eg, T. Methotrexate 7.5 mg once a week
T. Leflonumide 10 mg OD ( second line DMARD)
▹ NSAIDs
Eg, T. Ibuprofen 200mg TID
T. Naproxen 250mg BD
▹ Biological agents
Eg, Inj .Tocilizumab 4mg/kg IV once in a month and 162mg SC once in a
week
Inj .Infliximab 3mg/kg IV once in every 2 weeks
▹ Corticosteroids
Eg,T. Prednisolone 5- 60 mgOD