2. DEFINATION
Rheumatoid arthritis is a chronic inflammatory disorder followed by
1- chronic pain,stiffness,swelling around joint and tendon.
2- associate with extra- articular feature.
3- chronic inflammatory synovitis of peripheral joint.
4- course of disease is prolong with exacerbation and remission.
5. Pathology
Stage I:- preclinical characterized by..
immune pathology is beginning
increased ESR, C-reactive protein and
rheumatoid factor.
Stage II:- synovitis characterized by..
thickening and cell rich synovial membrane.
painful and swelling.
joint and tendon still intact.
this disorder reversible.
6. pathology
Stage III:- destruction characterized by..
due to persist inflammation.
articular cartilage is eroded by proteolyses
enzymes.
bone is eroded by granulation tissue
invasion and osteoclast resorpation.
tenosynovitis lead to partially or complete
rupture of tendons.
synovial effusion due to fibrinoid material
also lead to swelling.
7. pathology
Stage IV:- deformity characterized by..
combination of articular destruction, capsular stretching and tendon
rupture lead to progressive instability and deformity.
8. ETIOLOGY OF RA
1- genetic factor associate with HLA-DR4
2- autoimmunity for the following
reasons:
a-present auto antibodies IgG,IgM.
b-immune complex in synovial fluid and
circulation.
3- female gender.
11. III-late stage: -constant ache of joint
destruction.
-rheumatoid deformity.. Ulnar
deviation of finger, valgus
knee, valgus feet, clowed toes.
-extra articular feature as muscle
wasting,
lymphadenopathy, neuropathy….
12. SYMPTOMS AND SIGNS OF RHEUMATOID
ARTHRITIS
Certain characteristic hand deformities can
occur with long-standing rheumatoid arthritis
like
Swan neck deformities
Boutonniere deformities
Z deformity of thumb
Bow string sign
The tendons on the back of the hand may
become very prominent and tight, called the
bow string sign.
13. Swan neck deformity
The deformity
arises from
hyperextension of
the proximal
interphalangeal
joint, while the
distal
interphalangeal
joint is flexed.
17. Mallet Finger
Mallet finger is a simple
flexion deformity of the
distal interphalangeal
joint preventing
extension. This
deformity results from
an extensor tendon
rupture.
18. Z- deformity of Thumb
Severe hyperextension
of the interphalangeal
joint of the thumb with
flexion of the
metacarpophalangeal
(MCP) joint can occur;
this is called a duck bill,
Z (zigzag) type, or 90°-
angle deformity.
With simultaneous
thumb instability, pinch
is greatly impaired.
19. Buttonhole Deformity
Flexion of the PIP joint
accompanied by hyperextension of
the DIP joint .
This deformity can result from
tendon laceration, dislocation,
fracture, osteoarthritis, or RA.
32. 5- pulmonary: pleural effusion,
rheumatoid nodules in lung.
6-lymphadenopathy.
7-felty’s syndrome:- RA associate with
splenomegaly and neutropenia, in <1%.
35. RA can affect the glands
located near the eyes
and mouth, resulting in a
condition called
secondary Sjogren's
syndrome
Decreased tear and
saliva production can
cause dry mouth, and dry
eyes.
Sjogren's syndrome
43. Diagnostic Criteria for RA ≥ 4 criteria
present > 6 wks
Morning stiffness > 1
hour
Arthritis of ≥ 3 joints
areas (PIP, MCP, wrist,
elbow, knee, ankle,
and MTP)
Arthritis of hand joints
(wrist, MCP, PIP)
Symmetric arthritis
Rheumatoid nodules
RF+
Radiographic changes erosions
Unequivocal Periarticular
osteopenia
44.
45.
46. Rheumatoid Arthritis
Differential Diagnosis
Pyogenic arthritis: usually monoarticular,
fever and chills, abnormal joint fluid
Chronic Lyme disease: commonly
monoarticular and associated with positive
titers
Human Parvovirus infection: arthralgia
more common than arthritis, rash may be
present, serologic evidence of parvovirus
B19 infection
Polymyalgia rheumatica is associated with
proximal muscle weakness and stiffness
48. Laboratory – RF
Rheumatoid Factor
Antibody igM against the Fc fragment of IgG
Not sensitive
80% of RA patients
RF+ patients more likely to have
More severe disease
Extraarticular manifestations
49. TREATMENT OF RHEUMATOID
ARTHRITIS Nonsteroidal anti inflammatory drugs (NSAIDs) are a class of drugs that
reduce inflammation, pain, fever, and swelling and are commonly prescribed
for the inflammation of the joints (arthritis) and other tissues, such as in
tendinitis and bursitis.
50. Nonsteroidal anti inflammatory
drugs
Examples of NSAIDs include:
Aspirin
Indomethacin
Ibuprofen
Naproxen
Piroxicam
Nabumetone
Diclofenac
All NSAIDs should be taken with meals to
prevent stomach upset.
53. rhumatoid drugs
(DMARD)
a- methotrexate:-is ttt of choice.
b- antimalaria (hydroxychloroquine
sulfate) use in mild cases.
c- pencillamine:- used combination with
methotrexate in severe.
e-immunosuppression therapy (as
cyclophosphamide):-Use in pt who failed therapy
with DMARD.
