3. CAUSES
Genetic susceptibility(HLA-DR1&HLADRB1 gene)
An immunological reaction, possibly involving foreign Ag,
preferentially focused on synovial tissue
Imflammation at joints, and release of chemicals which
affect bones, cartilage, tendons and ligaments
4. EPIDEMIOLOGY
Affects 1-3% of the population world wide
With peak prevalence between the ages of 30 & 50
years
Women are affected 3 or 4 times more commonly
than men.
6. PATHOLOGY
It is a systemic disease but the most
characterteristics lesions are seen in the synovium
or within rheumatoid nodules
The synovium is engorged with new blood vessels
and packed full of inflammatory cells
7. STAGE 1-PRE CLINICAL
Before RA becomes clinically apparent the
immune pathology is already beginning
Raised ESR, C-reactive protein, and RF may
be detectable years before first diagnosis
8. STAGE 2-SYNOVIAL
Early changes
Vascular congestion with new blood vessels
formation
Proliferation of synoviocytes
Infiltration of the sub synovial layers by
immune cells
Thicking of the capsular structures, villous
formation of the synovium
9. STAGE 3-DESTRUCTION
Persistent inflammation causes joint and
tendon destruction.
Articular cartilage is eroded
At margins of joint, erosion of bone occuers
Swelling of joints, tendins, bursae.
10. STAGE 4-DEFORMITY
Combination of articular destruction, capsular
stretching and tendon rupture.
Deformity at joints
Loss of mechanical function
16. MANAGEMENT
There is no cure for rheumatoid arthritis
Aim to delay the progression of the disease,
alleviate symptoms, reduce functional
limitation
Supportive and palliative
17. MEDICATION
. NSAIDs
Ibuprofen, indomethacin, COX-2 inhibitors like celecoxib and
valdecoxib (reduce inflammation and relieves pain
Analgesics
Morphine and acetaminophen (reduce pain)
Glucocorticoids or prednisolone
Prescribed in a small dose to slow joint damage caused by
inflammation
18. MEDICATION
. Disease Modifying Antirheumatic Drugs (DMARD)
There are used with NSAIDs and/or prednisolone to slow joint
destruction caused by RA over time.
Biologic Response Modifiers
These drugs directly modify the immune system by inhibiting
proteins called cytokines,
Protein - A Immunoadsorption Therapy
This is not a drug, but a therapy that filters the blood to remove
antibodies and immune complexes that promote inflammation
