Introduction Risk factors Sign and symptoms Types of RA Pathophysiology Diagnosis Treatment Surgical management Reference

1. Guided By
Dr. S . D Patil
Dept. of pharmacy practice
RCPIPER, SHIRPUR
Presented By
Madhukar Thagnar
Dept. Of pharmacy practice
RCPIPER, SHIRPUR
R. C. Patel institute of pharmaceutical education and research, Shirpur
RHEUMATOID
ARTHRITIS
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3. INTRODUCTION
Rheumatoid arthritis is autoimmune disorder in which
immune system mistakenly attacks our own body's
tissues.
Rheumatoid arthritis (ra) is a chronic inflammatory
disorder that may affect many tissues and organs, but
mainly attacks the joints producing an inflammatory
synovitis.
 affects the lining of your joints, causing a painful
swelling that can eventually result in bone erosion and
joint deformity.
Etiology is unknown.
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4. Rheumatoid arthritis (RA) is a
systemic inflammatory disease mainly
characterized by synovitis and joint
destruction.
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5. RISK FACTORS
 Age. ·
Sex ; female=male ratio of 3:1.
cases higher in women than men.
Genetics or inherited traits.
Smoking
family history
Smoking
Vitamin D deficiency
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6. SIGN AND SYMPTOMS
 Fatigue
 Joint pain
 Joint tenderness
 Joint swelling
 Joint redness
 Joint warmth
 Joint stiffness
 Loss of joint range of motion
 Many joints affected
(polyarthritis)
 Limping
 Joint deformity
 Bisymmetrical
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7. The joints of the hands are often the very first joints
affected by rheumatoid arthritis.
These joints are swollen red and tender when
squeezed.
Swelling due to synovitis
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9. The deformity arises
from hyperextension of
the proximal
interphalangeal joint,
while the distal
interphalangeal joint is
flexed.
SWAN NECK DEFORMITY
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10. MALLET FINGER
Mallet finger is a simple flexion
deformity of the distal interphalangeal
joint preventing extension.
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11. DEFORMITY OF THUMB
 Severe Hyperextension of the
interphalangeal joint of the thumb
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12. PATHOPHYSIOLOGY
• Stage 1. Pre-clinical
• Stage 2. Synovial
• Stage 3. Destruction
• Stage 4. Deformity
Stage 1. Pre-clinical
: the body mistakely
attacks the own joint
tisue .
Stage 2. Synovial :
the body makes the
antibodies and the
joints start swelling
up.
Stage 3. Destruction :
the joints start becoming
bent and deformed . The
fingers becomes crooked
. These misshappen
joints can press on the
nerves and can cause
nerve pain as well.
Stage 4. Deformity :
if not treated ,the
disease will progess
to the last stage , in
which there is no
joint remaining at all
and the joint is
essentially fused
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13. PATHOPHYSIOLOGY
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14. DIAGNOSIS
X Rays.
X rays of hands and feet are generally
performed
in people with RA.
Magnetic Resonance Imaging (MRI).
Ultrasounds.
Blood Tests .
Rheumatoid Factor (RF).
RF is a specific antibody in the blood.
A negative RF does not rule out RA.
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15. PHARMACOLOGICAL TREATMENT
A. NSAIDSs : dec. Inflammation
a. aspirin
b. Ibuprofen
c. Diclofenac
d. Naproxen
e. Piroxicam
f. Etoricoxib
B. Disease modifying antirhematic drugs (DMARDs) : suppress inflammatory sys.
Immunosuppresants : methotrexate ,azathioprine , cyclosporine
a. Sulfasalazine
b. chloroquine
c. hydroxychloroquine
d. leflunomide
e. auranofin 15

16. 3. Biologics
a) TNF ALPHA ANTAGONISTS : etanercept ,
infliximab
b) IL-1 antagonits : anakinra
c) T-cell modulating agent : abatacept
d) b lymphocytes depletor : rituximab
4. Glucocorticoids : anti-inflammatory and
immunosuppressive effects
predisolone , triaamcinolone
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17. SURGICAL MANAGEMENT
Surgeries considered for rheumatoid arthritis include:
1. Arthroplasty (to replace part or all of a joint, such as the hip or knee. )
2. Arthroscopy : which uses a small lighted instrument to remove debris or inflamed tissue from a joint.
3. Carpal tunnel release: to relieve pressure on the median nerve in the wrist.
4. Cervical spinal fusion : to treat severe neck pain and nerve problems.
5. Finger and hand surgeries : to correct joint problems in the hand.
6. Foot surgery such as phalangeal head resection.
7. Synovectomy : to remove inflamed joint tissue.
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18. NURSING DIAGNOSES
Acute and chronic pain
Fatigue and emotional stress/depression.
Disturbed sleep pattern
Self-care
pain,
sleep disturbance,
fatigue,
altered mood
limited mobility.
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19. Www.Slideshare.Com .
K D tripathi essentials of medical pharmacology ,8th edition , jaypee brothers medical
publication.
Roger and walker clinical pharmacy and therapeutics –churchill livingstone publication .
Pathogenesis of RA : WIKIPEDIA.
Articles on rhematoid arthritis on Google . (radiopedia , etc)
REFERENCE
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20. Thank you
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25. OSTEOARTHRITIS
• Osteoarthritis (OA) is one of the oldest
and most common forms of arthritis.
• Known as the “wear and tear” kind of
arthritis.
• OA is a chronic condition characterized
by the breakdown of the joint’s cartilage.
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26. CAUSES
• There isn’t any single known cause of osteoarthritis, but there are several
risk factors. These risk factors include:
• age ; incidence of OA increase as you age
• Obesity; increased body weight is a serious factor in the development of
OA
• Injury and overuse; higher risk of developing OA due to injury and
increase stress on certain joints.
• Genetics or heredity; inherited abnormalities of the bones that affect the
shape or stability of the joints can lead to oa.
• Muscle weakness;
• other diseases and types of arthritis
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27. EFFECTS
• • The knees, hips, fingers, neck and lower back are most
commonly affected by OA.
• • OA often develops gradually. It may begin with soreness or
stiffness that seems more of a bother than a medical concern.
• • Pain may be moderate, intermittent or not interfere with
your daily activity.
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28. SYMPTOMS
• • The most common signs and symptoms if OA are:
• • Joint stiffness after periods of prolonged use.
• • Stiffness after periods of rest that go away quickly when
activity resumes. • Morning stiffness, lasting approximately 30
minutes.
• • Deterioration of coordination, posture and walking.
• • Joint pain is usually less in the morning and worse in the
evening after a day’s activity.
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30. DIAGNOSED
• • Early diagnosis and treatment is the key to controlling OA.
• • Your doctor will use four main tools to determine your
diagnosis: medical history, a physical exam, X-rays, and joint
aspiration.
• • Your physical exam and medical history will be what he or
she bases the diagnosis on, using X-rays and joint aspiration to
confirm the diagnosis.
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31. TREATMENT
• • Early diagnosis and treatment is the first step to the successful
management of OA.
• • The goals of any treatment plan for OA include: controlling pain,
improving your ability to function in daily activity, and slowing the
disease’s process.
• • Most treatment plans will include a combination of medication,
exercise, weight control, joint protection, and physical and
occupational therapy.
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32. MEDICATION
• • Analgesics- relieve pain without relieving inflammation or swelling.
• • Topical Analgecis- creams and rubs applied directly over the painful area. Often
used in combination with oral medications to relieve pain.
• • Nonsteroidal anti-inflammatory drugs (NSAIDs)- reduce inflammation and
swelling as well as aid in pain relief and are recommended for moderate to
severe pain and signs of inflammation.
• • Cox-2 Drugs- targeted NSAIDs that don’t cause the stomach irritation
associated with traditional NSAIDs (ex. celecoxib and valdecoxib).
• • Injectable glucocorticoids- steroids that are injected into the joint for fast,
targeted pain relief. Recommended for moderate to severe pain.
• • Viscosupplements- used specifically for knee OA and must be administered by
orthopedic surgeon.
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33. NON PHARMACOLOGICAL TREATMENT
• EXERCISE
• WEIGHT CONTROL
• JOINT PROTECTION
• PHYSICAL THERAPY
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