Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. The condition can damage various body systems, including the skin, eyes, lungs, heart, and blood vessels.

1. Rheumatoid
Arthritis

2. What is Rheumatoid Arthritis?
 Rheumatoid arthritis is a chronic inflammatory disorder
that can affect more than just your joints.
 In some people, the condition can damage a wide
variety of body systems, including the skin, eyes, lungs,
heart and blood vessels.
 An autoimmune disorder, rheumatoid arthritis occurs
when your immune system mistakenly attacks your own
body's tissues.
 Unlike the wear-and-tear damage of osteoarthritis,
rheumatoid arthritis affects the lining of your joints,
causing a painful swelling that can eventually result in
bone erosion and joint deformity

3. Signs and symptoms of Rheumatoid
Arthritis-
Signs and symptoms of rheumatoid arthritis may
include:
▪ Tender, warm, swollen joints
▪ Joint stiffness that is usually worse in the mornings
and after inactivity
▪ Fatigue, fever and loss of appetite
Early rheumatoid arthritis tends to affect your
smaller joints first — particularly the joints that attach
your fingers to your hands and your toes to your feet.

4. Pathogenesis
of
Rheumatoid
Arthritis

5. Causes of Rheumatoid Arthritis
 Rheumatoid arthritis is an autoimmune disease.
 Normally, your immune system helps protect your body from
infection and disease.
 In rheumatoid arthritis, your immune system attacks healthy
tissue in your joints.
 It can also cause medical problems with your heart, lungs,
nerves, eyes and skin.
 Doctors don't know what starts this process, although a genetic
component appears likely.
 While your genes don't actually cause rheumatoid arthritis, they
can make you more likely to react to environmental factors —
such as infection with certain viruses and bacteria — that may
trigger the disease.

6. Risk Factors of Rheumatoid Arthritis
Factors that may increase your risk of rheumatoid arthritis include:
 Your sex. Women are more likely than men to develop
rheumatoid arthritis.
 Age. Rheumatoid arthritis can occur at any age, but it most
commonly begins in middle age.
 Family history. If a member of your family has rheumatoid
arthritis, you may have an increased risk of the disease.
 Smoking. Cigarette smoking increases your risk of developing
rheumatoid arthritis, particularly if you have a genetic
predisposition for developing the disease. Smoking also
appears to be associated with greater disease severity.
 Excess weight. People who are overweight appear to be at a
somewhat higher risk of developing rheumatoid arthritis.

7. D. Infections.
Rheumatoid arthritis itself and many of the medications used
to combat it can impair the immune system, leading to increased
infections. Protect yourself with vaccinations to prevent diseases
such as influenza, pneumonia, shingles and COVID-19.
E. Abnormal body composition.
The proportion of fat to lean mass is often higher in people
who have rheumatoid arthritis, even in those who have a normal
body mass index (BMI).
F. Carpal tunnel syndrome.
If rheumatoid arthritis affects your wrists, the inflammation
can compress the nerve that serves most of your hand and fingers.
Risk Factors of Rheumatoid Arthritis

8. Risk Factors of
Rheumatoid Arthritis
G. Heart problems.
Rheumatoid arthritis can increase
your risk of hardened and blocked arteries,
as well as inflammation of the sac that
encloses your heart.
H. Lung disease.
People with rheumatoid arthritis have
an increased risk of inflammation and
scarring of the lung tissues, which can lead
to progressive shortness of breath.
I. Lymphoma.
Rheumatoid arthritis increases the risk
of lymphoma, a group of blood cancers that
develop in the lymph system.

9. Diagnosis
 Rheumatoid arthritis can be difficult to diagnose in its
early stages because the early signs and symptoms
mimic those of many other diseases. There is no one
blood test or physical finding to confirm the diagnosis.
 During the physical exam, your doctor will check your
joints for swelling, redness and warmth. He or she may
also check your reflexes and muscle strength.
A. Blood tests
 People with rheumatoid arthritis often have an
elevated erythrocyte sedimentation rate (ESR, also
known as sed rate) or C-reactive protein (CRP) level,
which may indicate the presence of an inflammatory
process in the body.
 Other common blood tests look for rheumatoid factor
and anti-cyclic citrullinated peptide (anti-CCP)
antibodies.

10. B. Imaging tests
 Your doctor may recommend
X-rays to help track the
progression of rheumatoid
arthritis in your joints over time.
 MRI and ultrasound tests can
help your doctor judge the
severity of the disease in your
body.

11. Treatment-
 There is no cure for rheumatoid arthritis.
 But clinical studies indicate that remission of symptoms is more likely when treatment begins
early with medications known as disease-modifying antirheumatic drugs (DMARDs).
A. Medications
 The types of medications recommended by your doctor will depend on the severity of your
symptoms and how long you've had rheumatoid arthritis.
1.NSAIDs
i. Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation.
ii. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium
(Aleve).
iii. Stronger NSAIDs are available by prescription. Side effects may include stomach irritation,
heart problems and kidney damage.

12. Steroids
Corticosteroid medications, such as
prednisone, reduce inflammation and pain
and slow joint damage.
• Side effects may include thinning of bones,
weight gain and diabetes.
• Doctors often prescribe a corticosteroid to
relieve symptoms quickly, with the goal of
gradually tapering off the medication.
Conventional DMARDs.
These drugs can slow the progression of
rheumatoid arthritis and save the joints and
other tissues from permanent damage.
• Common DMARDs include methotrexate
(Trexall, Otrexup, others), leflunomide
(Arava), hydroxychloroquine (Plaquenil)
and sulfasalazine (Azulfidine).
• Side effects vary but may include liver
damage and severe lung infections.

13. •Also known as biologic response modifiers,
includes
•abatacept (Orencia),
•adalimumab (Humira),
•anakinra (Kineret),
•infliximab (Remicade),
•rituximab (Rituxan), sarilumab (Kevzara) and
•tocilizumab (Actemra).
•Biologic DMARDs are usually most effective
when paired with a conventional DMARD,
such as methotrexate.
•This type of drug also increases the risk of
infections.
4. Biologic agents.
5. Targeted synthetic DMARDs.
i. Baricitinib (Olumiant), tofacitinib (Xeljanz)
and upadacitinib (Rinvoq) may be used if
conventional DMARDs and biologics
haven't been effective.
ii. Higher doses of tofacitinib can increase
the risk of blood clots in the lungs, serious
heart-related events and cancer.

14. B. Therapy
 Your doctor may refer you to a physical or occupational therapist who can teach you
exercises to help keep your joints flexible.
 The therapist may also suggest new ways to do daily tasks that will be easier on your
joints.
 For example, you may want to pick up an object using your forearms.
 Assistive devices can make it easier to avoid stressing your painful joints.
 For instance, a kitchen knife equipped with a hand grip helps protect your finger and
wrist joints.
 Certain tools, such as buttonhooks, can make it easier to get dressed.
 Catalogs and medical supply stores are good places to look for ideas.

15. C. Surgery
 If medications fail to prevent or slow joint damage, you and your doctor may consider surgery
to repair damaged joints.
 Surgery may help restore your ability to use your joint. It can also reduce pain and improve
function.
 Rheumatoid arthritis surgery may involve one or more of the following procedures:
• Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can help reduce
pain and improve the joint's flexibility.
• Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen
or rupture. Your surgeon may be able to repair the tendons around your joint.
• Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for
pain relief when a joint replacement isn't an option.
• Total joint replacement. During joint replacement surgery, your surgeon removes the damaged
parts of your joint and inserts a prosthesis made of metal and plastic.

16. If untreated, what are the complications of Rheumatoid Arthritis?
Rheumatoid arthritis increases your risk of developing:
A. Osteoporosis.
Rheumatoid arthritis itself, along with some medications
used for treating rheumatoid arthritis, can increase your risk of
osteoporosis — a condition that weakens your bones and
makes them more prone to fracture.
B. Rheumatoid nodules.
These firm bumps of tissue most commonly form around
pressure points, such as the elbows. However, these nodules
can form anywhere in the body, including the heart and lungs.
C. Dry eyes and mouth.
People who have rheumatoid arthritis are much more
likely to develop Sjogren's syndrome, a disorder that decreases
the amount of moisture in the eyes and mouth.

17. Whom the patients can
contact?
Make an appointment with
the family doctor if you have
any signs or symptoms that
worry you.
If your doctor suspects you
may have any symptoms
related to rheumatoid arthritis
or another disease that
affects your bones , muscles
or joints, you may be referred
to a rheumatologist .
They are trained to make
difficult diagnoses and to
treat all types of arthritis ,
especially those requiring
complex treatment.

18. Precautions
 Wear protective gear when
playing sports and always lift
with your knees and hips , not
your back.
 Quit smoking. Smoking puts
stress on tissues that protect
your joints and can lead to
arthritis pain.

19. Reference
 https://www.mayoclinic.org/diseases-
conditions/rheumatoid-arthritis/symptoms-
causes/syc-20353648
 https://www.mayoclinic.org/diseases-
conditions/rheumatoid-arthritis/diagnosis-
treatment/drc-20353653
 https://www.verywellhealth.com/how-is-
rheumatoid-arthritis-diagnosed-190339
Edited by- PharmaCampus
Contributed by- Snehal Shinde- B-Pharmacy
(Modern College of Pharmacy, Moshi)