a short note on rheumatoid arthrotis for ug medicine graduates, prepared and used in 2008

1. Rheumatoid Arthritis
-
R.Malarvizhi

2.  Its a multisystem disease
 Etiology- unknown
Currently as RA occurs in immunogenetically predisposed
individual to effect of microbial agent as trigger action
Newer theory as determined by SUPERANTIGENS – which
bind to HLA-DR ( MHC Class II region)
 Age incidence - 3rd-4 th decade
 More in females
 Highly associated with HLA-DR4 and HLA-DR1 and
familial pre-disposition

3. Genetic susceptibilty
Antigenic stimulation (?infectious agent)
CD4+ T cells
Cytokines
TNFα , INF γ , IL-1
ACTIVATE
ACTIVATE ACTIVATE
B cells
Endothelial cells Macrophages
Anti- IgG
antibodies (RF)
Release of adhesion
molecules
Cytokines,
protease
Pathogenesis

4. Formation of immune complex, inflammatory cells, pannus
Inflammatory damage to synovium, small vessels, collagen
Destruction of cartilage, bone, fibrosis, ankylosis
Joint deformities

6. COMMON SITES

7.  Common manifestations
inflammatory arthritis of peripheral joints
(symmetrical distribution)
 Systemic manifestations
 Haematological (anaemia, Felty’s syndrome)
 Pulmonary ( pleural effusion, bronchilitis, alveolitis)
 Neurological ( neuropathies, compression)
 CV Abnormalities (AR, pericarditis, cardiomyopathy)

8.  Morphology
In joints and tendons
Two types of manifestations
 i) Articular
 ii) Extra-articular

9. Articular
 Initially affects small joints of hands and
feet.
 Then progresses symmetrical to joints of
wrist, elbow, ankle and knees.
 Severe on –proximal interphalangeal and
meta-carpophalangeal joints

10.  M/E
 Increased folds of large villi of synovium
 Marked thickening of synovial membrane
 Intense inflammatory cell infiltrate in synovial
membrane
 Foci of fibrinoid necrosis and fibrin deposition
 The pannus progrssively destroys underlying
cartilage and subchonrial base.

11.  Compare
 RA NORMAL

12. RA Knee Joint

15. RA of Hand

16. Showing symmetrical distribution

17. RA of Hand and Feet

18. Extra - articular
Characteristic RHEUMATOID NODULES
Non-specific inflammatory change in
 BV (a/c vasculitis)
 Lung
 Pericardium
 Myocardium
 Lymph nodes
 Peripheral nerves and eyes

19. Stages of RA
1. Periarticular osteoporosis
2. Loss of articular cartilage ( joint space)
3. Erosions
4. Subluxation and ankylosis

20. Complications
 Septic arthritis
 Sec infection with Staph. Aureus
 Amyloidosis

21. Diagnosis
 Serological tests - RF
 Synovial analysis
 Radiographs
 CT scan / MRI
 CRP, ESR, Hb, Acute phase proteins
 Urinanalysis
 Biochemistry

22. RADIOLOGY

24. RA IS CUARABLE !

25. Management

26. Thank you