Rheumatoid arthritis (RA) is a disease that leads to inflammation of the joints and surrounding tissues. It is a long-term disease. It can also affect other organs. RA can occur at any age, but is more common in middle age. Women get RA more often than men. Infection, genes, and hormone changes may be linked to the disease. Smoking may also be linked to RA.

1. Rheumatoid
Arthritis

2. Contents
 Definition
 Epidemiology
 Etiology
 Pathophysiology
 Clinical Features
 Diagnosis
 Complication
 Treatment

3. Autoimmune , systemic , symmetrical ,
chronic inflammatory
polyarthritis & extra-
articular involvement
commonly small, peripheral
joints . It is the most
common cause of chronic
Inflammatory joint disease.
Definition

4. Etiology
 The etiology of Rheumatoid Arthritis (RA) is idiopathic.
 It is thought result from the interaction between patients'
genotype and environment .
Genetic
 human leukocyte antigen
(HLA- DR1 and HLA–DR4 )
Environment
 cigarette smoking
 specific pathogen like a
bacteria that lives in the intestines.

5. Epidemiology
 Worldwide prevalence of RA is about
0.24 % .
 RA is more prevalent in women
compared to men, with a lifetime risk of
RA 3.6% in women compared to 1.7% in
men.
 RA risk also increases with age,
with a peak incidence between
age 65 to 80 years of age.

6. Pathophysiology

9. Clinical Features
 Onset of pain .
 Early morning stiffness.
 Swelling in the small joints of the hands and
feet .
 As the disease progresses there is weakening
of joint capsules.
_ Joint Instability
_ Subluxation
_ Deformity
 Extra-articular features are common and may
involve multiple organs, including the skin,
eyes, lungs, and blood vessels.

12. The diagnosis of Rheumatoid
Arthritis is usually based on
criteria established by the
American College of
Rheumatology. To be diagnosed
as having RA, a patient must
Meet four Or more criteria .
Diagnosis

13. The Diagnostic Criteria For RA Include :-
1- Morning stiffness in and around the joints
lasting at least 1 hour.
2. Soft-tissue swelling of three or more
joints.
3. Swelling of the proximal interphalangeal
joints, metacarpophalangeal joints, or wrist
joints .

14. 4. Symmetrical arthritis.
5. Subcutaneous nodules .
6. A positive test for rheumatoid
factor .
7. Radiographic evidence of
erosions or per articular
osteopenia in the hand or wrist
joints.

15. Investigation
• Physical examination: The doctor feels the joints
and checks whether they are swollen or stiff. It's
important to find out how many joints are affected
and how long they've been inflamed . Doctor also
looks for other signs of RA, such as inflamed tear
glands or rheumatoid nodules.
• Blood tests: used to detect certain antibodies and
signs of inflammation in the body. ESR, PCR both
are elevated
• Imaging techniques: Changes in the joints can be
seen in x-ray or ultrasound images.

16. Complication
 Joint damage and deformity
 Anemia
 Lung disease
 Cardiovascular disease
 Osteoporosis
 Lymphoma
 Vasculitis
 Eye problems
 Diabetes

17. Treatment
Rheumatoid arthritis can be treated
with medication, physical therapy and
occupational therapy.
There are also various support aids
that can make some everyday tasks
easier.
There is currently no cure for
rheumatoid arthritis.

18. Reduce inflammation and help
stop the disease from getting
worse.
Relieve symptoms like pain and
swelling .
Help people move their joints
more easily again or maintain
joint mobility for as long as
possible .
The Role Of Medications

19. Medications
NSAIDs
• Relieve pain
• Ibuprofen & Cox2 inhibitors .
Analgesics
• Reduce pain
• Morphine & acetaminophen.
Glucocorticoids
prescribed in Low dose .

20.  Disease Modifying Anti-
Rheumatic Drugs (DMARDs)
• There are biologics and non-biologics
agents.
• RA treatment can be either monotherapy
or combination therapy, although several
randomized controlled trials have shown
the superiority of combination therapy
of a biologic DMARD with a
conventional DMARD .

21. DMARDs include :-
• Methotrexate
• Hydroxychloroquine
• Sulfasalazine
• T-cell Costimulatory blockade
• B-Cell Depletion
• Leflunomide

22. References
• Smolen JS, Aletaha D, McInnes IB. Rheumatoid
arthritis. Lancet 2016; 388(10055): 2023-2038.
[PubMed].
• Rheumatoid Arthritis Mayo Clinic, n.d.
• https://www.ncbi.nlm.nih.gov/books/NBK44199.
• https://doi.org/10.7326/AITC201901010