This presentation is mainly based on Rheumatoid arthritis focusing on orthopaedic side of it.

1. Rheumatoid arthritis
By- Shubham Kamde

3. Definition
• Rheumatoid arthritis (RA) is the most common cause of chronic
inflammatory joint disease.
• It is an Autoimmune disease.
• Women are affected 3 or 4 times more commonly than men.
• Commonly in 3rd to 6th decade.

4. • The cause of RA is still incompletely worked out.
• Important factors in the evolution of RA are:
(1)Genetic susceptibility
(2)An immunological reaction, possibly involving a foreign antigen, preferentially focussed
on synovial tissue
(3)An inflammatory reaction in joints and tendon sheaths
(4)The appearance of rheumatoid factors (RF) in the blood and synovium
(5)Perpetuation of the inflammatory process
(6)Articular cartilage destruction.

5. • RA is more common in first degree relatives of patients
• The human leucocyte antigen (HLA) DR4 occurs in about 70 per cent of people with RA,
compared to a frequency of less than 30 per cent in normal controls.
• Once the APC/T-cell interaction is initiated, various local factors come into play and lead
to a progressive enhancement of the immune response.
• B-cell activation in RA leads to the production of anti-IgG autoantibodies, which are
detected in the blood as ‘rheumatoid factor’(RF).
• The most important are anticyclic citrullinated peptide antibodies (anti-CCP). The
presence of anti-CCP is very specific for RA.

16. Laboratory investigations
• CBC, ESR, CRP
• Rheumatoid Factor (RF)
• Anti- CCP antibodies

17. Radiological Investigation

19. Medical Management
• Treatment should be aimed at controlling inflammation as rapidly as
possible.
• Corticosteroids for their rapid onset (initially oral doses of 30 mg of
prednisolone or 120 mg i.m. methylprednisolone may be used).
Steroids should be rapidly tapered to prevent significant side effects.
• Disease-modifying antirheumatic drugs (DMARDs) should be started.
The first choice is now methotrexate at doses of 10–25 mg/week.
• Control of pain and stiffness with non-steroidal anti-inflammatory
drugs (NSAIDs) may be needed, maintaining muscle tone and joint
mobility by a balanced programme of exercise, and general advice on
coping with the activities of daily living.

20. • If there is no satisfactory response to DMARDs, it is wise to progress
rapidly to biological therapies such as the TNF inhibitors infliximab,
etanercept and adalimumab

25. PHYSIOTHERAPY AND OCCUPATIONAL
THERAPY
• Preventative splinting and orthotic devices may delay the events;
however, it is important to encourage activity. If these fail to restore
and maintain function, operative treatment is indicated.
• Prolonged rest and immobility is likely to weaken muscles and lead to
a worse prognosis. However, some splinting can be helpful at any
stage of the disease.

26. SURGICAL MANAGEMENT
• At first this consists mainly of soft-tissue procedures (synovectomy,
tendon repair or replacement and joint stabilization); in some cases
osteotomy may be more appropriate. In late rheumatoid disease,
severe joint destruction, fixed deformity and loss of function are clear
indications for reconstructive surgery. Arthrodesis, osteotomy and
arthroplasty

27. Thank You