Rheumatoid Arthritis

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Rheumatoid Arthritis

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  3. 3. CONTENTS :1. History2. Introduction3. Epidemiology4. Causes5. Signs and Symptoms6. Diagnosis7. Treatment8. Conclusion9. Path Forward10. References 3
  4. 4. History of R.A 1858 – Dr. Alfred Baring Garrod, named the condition Rheumatoid Arthritis. In the 1920’s, physicians suspected the cause of RA was bacterial infection, they used gold and malaria drugs. 1940- Scientists discovered that RA was associated with a malfunction of the immune system. 1949 – Dr. Phillip Hench treated arthritic patients successfully with 4
  5. 5. What is Rheumatoid Arthitis(R.A)? Rheumatoid arthritis is an autoimmune disease in which the normal immune response is directed against an individuals own tissue, including the joints, tendons, and bones, resulting in inflammation and destruction of these tissues. 5
  6. 6. Epidemiology.. Who gets R.A?? ANYONE CAN GET R.A ◦ From babies to the very old Common Age to Start: 20’s to 50’s Sex: Females more common than males 3:1 1% of Indian population is affected with R.A 6
  7. 7. Causes : The exact cause of RA is unknown. Suspected causes are:1. Bacterial Infection2. Genetic Marker3. Stress4. Viral Infection Other suspects include female hormones. Smoking. 7
  8. 8. How does it start? RA usually starts off slowly (insidious) over weeks to months and progresses (70%) It can come on overnight (acute) but this is rare (10%) It can come on over a few weeks (subacute – 20%) In the initial stages of each joint involvement, there is warmth, pain, and swelling, with corresponding decrease of range of motion of the affected joint. Progression of the disease results in reducible and later fixed deformities. 8
  9. 9. Joints affectedhttp://www.umm.edu/graphics/images/en/17128.jpg 9
  10. 10. Normal jointhttp://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/joints_bones_and_muscles/arthritis_basics_normal_joint.JPG 10
  11. 11. What happens in theJOINTS? In RA, for some unknown reason, the immune system considers its own joint tissues as foreign. WBC that normally protect the body, migrate to the joint cavity. Synovium becomes inflammed and engorged with fluid, causing synovitis. Lymphocytes, Macrophages, continue to enter the joint cavity and multiply, differentiate, and release inflammatory mediators, cytokines, leukotrienes, and prostaglandins. 11
  12. 12. Continued… Within weeks the synovium becomes thickened. The mass of synovial tissue that spreads over the top of cartilage in a rheumatoid joint is called a Pannus, made of white blood cells: macrophages, B&T Cells, neutrophils, plasma cells, NK cells, and T Helper cells. These cells produce the Rheumatoid Factor, prostaglandins, cytokines and other mediators. Over time, the chemicals from the cells damage cartilage, ligaments, tendons, and bone. 12
  13. 13. Tumor Necrosis Factor (TNF)  TNF is a potent inflammatory cytokine  TNF is produced mainly by macrophages and monocytes  TNF is a major contributor to the inflammatory and destructive changes that occur in RA  Blockade of TNF results in a reduction in a number of other pro-inflammatory cytokines (IL-1, IL-6, & IL-8) 13
  14. 14. TNF ReceptorHow DoesTNF Exert Its Any CellEffect?Trans-MembraneBound TNF Macrophage Soluble TNF 14
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  16. 16. How Are the Effects of TNF ReceptorTNF NaturallyBalanced? Any Cell Trans-Membrane Bound TNF Macrophage Soluble Receptor Soluble TNF 16
  17. 17. Established R.Ahttp://t0.gstatic.com/images?q=tbn:ANd9GcTuR85lK2XKocig-Sut0u1LP3BrEF9aXmUYf9sAt4acgxa36SKIOuQmWA 17
  18. 18. Real images of affectedjoints.. 18http://t3.gstatic.com/images?q=tbn:ANd9GcRDNkPcY3zheYEWvL5Fk5xsg8iGiojZmXaO74GOO_4uNotthMhMeA
  19. 19. Signs & Symptoms :• Fatigue.• Stiffness, especially in early morning and after sitting a long period of time.• Low Grade Fever, Weakness.• Muscle pain and pain with prolonged sitting.• Rheumatoid nodules.• Deformity of joints over time. Joints are usually ◦ Swollen ◦ Warm ◦NOT REDhttp://lh3.ggpht.com/RBG1yD3ab-uyQdaCaEmH1B8r5MCchN5Y3e9WAJFn6LrzD2tdfTV1bYhKgBjjEvyYWdbN=s133 19
  20. 20. Diagnosis :  Anti-CCP antibody test.  Complete blood count.  Synovial fluid test.  Imaging Studies 1. X-Ray 2. M.R.I Scan 3. C.A.T Scan 4. Bone Scan 20
  21. 21. Treatment : Physical Healthy Surger Medications therapy Diet y Removal Disease of the Total joint Modifying Anti- joint replacemen inflammatory lining t Anti (Synovec Rheumatic medications : Eg. Asprin, tomy) Drugs(DMARDs): Nonsteroidal Eg. Anti-Methotrexate Inflammatory Drugs (NSAIDs)-such Biological as ibuprofen . Therapies (Biologics) : Eg. Infliximab 21
  22. 22. Biological Therapies (Biologics) Monoclonal Antibody : Strategies for Infliximab Reducing Effects of TNF!!. Trans-Membrane Bound TNF Macrophage Soluble TNF 22
  23. 23. Chimeric (murine & human)monoclonal antibody directedagainst TNF-αhttp://lh6.ggpht.com/_K-9oRygAfTpS3Y7yX8j6lYqZAnkhCXmLu1q9-iQQeHO2XUSz0qdwAmK_UGM9_J1EtEX=s122 23
  24. 24. Conclusion  R.A is a chronic disease of unknown cause affecting the joints and other tissues resulting in deformity of joints over time.  RA patients today can live a healthy and productive life. Today’s medicines used can relieve pain and swelling and in some cases put the disease in remission, preventing bone damage or deformity. 24
  25. 25. Path forward :-  New drugs are emerging with increased efficacy but long term risks unknown.  It is only a matter of time when researchers will find the reason why the body’s immune system attacks the synovial lining of the joints which causes this disorder known as Rheumatoid Arthritis. 25
  26. 26. References Arthritis Foundation. “Disease Center.” Arthritis Foundation. 2004. 24 Aug. 2005. <http://www.arthritis.org/conditions/DiseaseCenter/RA/ra_overview.a sp>. Arthritis Foundation. Good Living with Rheumatoid Arthritis. Atlanta: Arthritis Foundation, 2004. Lahita, Robert G. M.D. Rheumatoid Arthritis – Everything You Need to Know. New York: Avery, 2001 Mayo Clinic. “Rheumatoid Arthritis.” Mayo Clinic.com. Mayo Foundation for Medical Education and Research. 8 April. 2005. 10 Oct. 2005 http://www.mayoclinic.com/invoke.cfm?id=DS00020>. National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Questions and Answers About Juvenile Rheumatoid Arthritis.” National Institute of Health. 2001 July. 10 Oct. 2005. <http://www.niams.nih.gov/hi/topics/juvenile_arthritis/juvarthr.htm>. Oxford Journals. “Alfred Baring Garrod.” Heberden Historical Series. British Society for Rheumatology. 2001. 28 Oct. 2005. <http://rheumatology.oxfordjournals.org/cgi/content/full/40/10/1189?e af>. Parham, Peter. The Immune System. New York: Garland Science 26
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