Rheumatoid arthritis is an autoimmune disorder where the immune system attacks the synovial membrane lining the joints, causing inflammation. It is more common in women and risk factors include family history, smoking, and genetic factors. Symptoms include pain, swelling and stiffness in small joints of hands and feet. Diagnosis is based on clinical features and tests like rheumatoid factor. Treatment focuses on reducing inflammation and preventing joint damage through medications, surgery, and physical therapy. The goals are to relieve symptoms, improve function, and delay disease progression.

1. RHEUMATOID ARTHRITIS
PRESENTED BY- DR. VIJAY GOYANKA
PRIMARY DNB RESIDENT
DEPT. OF ORTHOPAEDICS
APOLLO HOSPITALS, BILASPUR
MODERATOR -
DR. G. S. ASATI
SENIOR CONSULTANT (ORTHOPAEDICS AND JOINT
REPLACEMENT SURGEON)
DR. ASHISH JAISWAL
SENIOR CONSULTANT (ORTHOPAEDICS AND SPINE SURGEON)

2. INTRODUCTION
 Autoimmune disorder in which
immune system identifies “Synovial
Membrane as foreign” and attacks it.
 May affect many tissue and organs
but mainly affects joints with synovial
membrane.

3. ETIOLOGY
 RISK FACTORS
◦ Environmental influences (Trauma,
Infection)
◦ Geneticmarkers (such HLA-DR4 and
HLA-DRB1)
◦ Gender- Women > Men (3:1) Age- 30 to
50
◦ Familial
◦ Smoking
◦ Vitamin D deficiency

4. PATHOGENESIS OF RHEUMATOID ARTHRITIS

5. NORMAL JOINT V/S RHEUMATOID
JOINT

6. PATHOLOGY
Stage 1: Pre-clinical - Before RA
becomes clinically apparent; Raised
ESR, C-reactive protein (CRP) and RF
may be detectable.
Stage 2: Synovitis – Angiogenesis,
synoviocytes proliferation and infiltration
of the subsynovial layers by Leucocytes.
◦ Structures are still intact and mobile
◦ Potentially reversible.

7.  Stage 3: Destruction- Persistent
inflammation causes joint and tendon
destruction.
◦ Articular cartilage is eroded by a pannus of
granulation .
◦ At the margins of the joint, bone is eroded
by tissue invasion and osteoclastic
resorption.
◦ Tenosynovitis also occurs.
 Stage 4: Deformity – Mechanical and
functional effects of joint and tendon
disruption now become vital.

9. CLINICAL FEATURES
Early feature (synovitis)
Most commonly affected MCPJ and PIPJ,
wrist, tendon sheaths around the joints (wrist-
feet-knee-shoulder)
Bilateral symmetrical polysynovitis
Pain, fusiform swelling, stiffness, loss of
mobility
Constitutional symptom:
a. Loss of Appetite, malaise and low grade fever
b. Tenosynovitis

10. Late feature (DESTRUCTIVE)
Spread to other joint - wrist, ankle, knee,
shoulder (in order of frequency)
Morning stiffness (more than 30 min) -
improve with activity
Activity of daily living will be affected -quality
of life affected
Rheumatoid Nodules

11. More later (DEFORMITY)
Pain, deformity, instability, decreased ROM
Thumb-Z-deformity
Fingers - Swan neck deformity/
Boutonniere's deformities, ulnar deviation
Wrist-radial and volar displacement
Knees swollen, flexion and vulgus
Toes-clawed

12. SOME COMMON
DEFORMITIES IN
RHEUMATOID ARTHRITIS

14. DIAGNOSIS
Mostly clinical
Bilateral, symmetrical Rheumatoid
subcutaneous nodules, polyarthritis
Involving proximal joints of hand or
feet
Present for at least 6 weeks
Confirmed with
Subcutaneous nodules or periarticular
erosions on x-ray

15. LAB INVESTIGATIONS
 CBC- Normocytic hypochromic
anaemia
 Inflammatory markers- ESR, CRP
elevated
 Rheumatoid factor(RF)- Anti-IgG auto
Ab 80% will have it
 Anti-cyclic citrullinated peptide(CCP)
Ab

16. SYNOVIAL FLUID
ANANLYSIS

17. IMAGING
EARLY STAGE(SYNOVITIS)
Soft tissue swelling, periarticular
osteopenia
LATER STAGE(DESTRUCTIVE)
Juxtaarticular erosions, narrowing of joint
space
ADVANCE STAGE(DEFORMITY)
Articular destruction and joint deformity

20. MANAGEMENT
 No treatment cures RA
 Goals of management are-
 Alleviate symptoms
 Reduction of functional limitation
 Delay progreesion and maintenance of
remission with disease modifying agents

21. DIFFERENT MODALITIES
NSAIDS

22. PHARMACOTHERAPY

25. TREATMENT
Early (1st 6-12 month)
 NSAIDs, analgesic, low dose corticosteroid
 Disease modifying drug
 Physiotherapy
 Splintage
Progressive erosive (1-5 years)
 Disease modifying drug
 Splintage
 Surgical management (synovectomy, arthroscopic
surgery), late (5-20 years)
 Reconstructive surgery (arthrodesis, osteotomy,
arthroplasty)

26. SURGERY
1. Synovectomy
When one or two joints are affected
Removing the diseased synovium or lining of
the joint
Slowing or prevention of further joint damage
2. Arthroscopic Surgery
Tissue samples taken, remove loose
cartilage, repair tears
It is most commonly performed on the knee
and shoulder

27. 3. Osteotomy
Literally meaning, "to cut bone," this procedure is
used to increase stability by redistributing the weight
on the joint.
4. Joint Replacement Surgery or Arthroplasty
Usually recommended for people over 50 or who
have severe disease progression.
5. Arthrodesis or fusion
 This procedure fuses two bones together. While it
limits movement
 It does decrease pain and increase stability of the
joints in the ankles, wrists, fingers, toes and spine.

28. COMPLICATIONS
 Fixed deformities
 Muscle weakness
 Infection
 Spinal cord compression
 Systemic vasculitis
 Amyloidosis- Renal failure