Rheumatoid arthritis is a chronic inflammatory disease that causes swelling and stiffness in the joints. It can also cause extra-articular manifestations affecting various organs. The document discusses the epidemiology, etiology, clinical features, extra-articular manifestations and treatment of rheumatoid arthritis. It highlights that rheumatoid arthritis predominantly affects women aged 25-55 years and can involve the lungs, heart, blood vessels and skin. Treatment involves NSAIDs, corticosteroids, conventional DMARDs like methotrexate and biological DMARDs that target cytokines like TNF-alpha if first line treatments are inadequate.
This patient has longstanding SLE with quiescent disease activity currently. She has a history of fetal loss and blood clots while pregnant previously. She is seeking contraceptive options other than barrier methods. Given her history of APL antibodies and blood clots, progesterone-only contraceptives like the progesterone IUD or depot medroxyprogesterone would be safest options to avoid estrogen which could increase her risk for further clotting issues.
This document discusses Mixed Connective Tissue Disease (MCTD), which has features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. It was identified in 1972 and is characterized by high levels of anti-U1 snRNP antibodies. Common symptoms include Raynaud's phenomenon, swollen fingers, and mixed features of the three diseases. Prognosis is generally good, though some patients develop severe and life-threatening complications such as pulmonary hypertension. Treatment focuses on controlling symptoms and complications.
Dermatomyositis is a chronic inflammatory disorder of the skin and muscles that is characterized by an autoimmune pathogenesis. It commonly presents with characteristic rashes like Gottron's papules and heliotrope rash as well as proximal muscle weakness. Dermatomyositis can also involve internal organs like the lungs, esophagus and heart. Diagnosis involves assessing clinical features, muscle enzymes, electromyography, muscle/skin biopsies and identifying myositis-specific antibodies. Prognosis depends on the severity and organ involvement, with risks of residual weakness, contractures and death from respiratory or cardiac complications.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints, causing pain, stiffness, and swelling. It can also impact other body systems. While the exact cause is unknown, genetics and environmental factors are believed to play a role. Common symptoms include joint deformities, fatigue, and anemia. Diagnosis involves evaluating symptoms, physical exam findings, blood tests, and x-rays. Treatment focuses on reducing inflammation and joint damage through medications like DMARDs, NSAIDs, and corticosteroids. The goals are to relieve symptoms, improve function, and prevent disability. Care requires a multidisciplinary approach including medication management, exercise, and lifestyle changes.
Mixed connective tissue disease (MCTD) is a rare autoimmune disorder with features of lupus, scleroderma, rheumatoid arthritis, and polymyositis. It is characterized by high levels of antibodies against ribonucleic proteins. Diagnostic criteria require at least 3 of 5 clinical features plus positive serology. Over time, many patients evolve features meeting criteria for other connective tissue diseases. Common clinical manifestations include Raynaud's phenomenon, arthritis, swollen hands, and lung and heart involvement. Prognosis depends on degree of organ involvement, with 5-year cumulative risks including pulmonary dysfunction in 66% and pericardial disease in 30% of patients.
This document discusses mixed connective tissue disease (MCTD), including its definition, key diagnostic criteria, common symptoms and organ involvement, treatment approaches, and prognosis. MCTD is characterized by features of lupus, scleroderma, and polymyositis combined with high levels of anti-U1 RNP antibodies. Common symptoms include Raynaud's phenomenon, joint and muscle issues, lung and heart involvement. Treatment focuses on managing symptoms with medications like NSAIDs, corticosteroids, calcium channel blockers, and pulmonary hypertension drugs. Overall mortality is lower than lupus, but progressive pulmonary hypertension can be a major cause of death.
Systemic Lupus Erythematosus (SLE) is a multi-gene autoimmune disease caused by a combination of genetic and environmental factors. It is characterized by abnormal immune responses that result in inflammation and damage to various organs. Diagnosis requires meeting 4 out of 11 classification criteria relating to clinical symptoms and blood markers. Management aims to induce remission of acute flares, maintain improvements to suppress symptoms, and prevent organ damage. Treatment choices depend on the severity and potential reversibility of manifestations. The goal is controlling symptoms without cure since complete sustained remission is rare.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs in the body. It is more common in women, especially of childbearing age, and in African Americans. The disease is characterized by autoantibody production and tissue damage caused by immune complexes. Diagnosis is based on meeting criteria from the SLICC classification system, which improved upon previous criteria. Organ manifestations include renal, neurological, cardiac, pulmonary, hematological and cutaneous involvement. Management aims to suppress symptoms and prevent organ damage through medications like glucocorticoids, antimalarials, immunosuppressants and biologics. The goal is complete remission though sustained remission is rare
This patient has longstanding SLE with quiescent disease activity currently. She has a history of fetal loss and blood clots while pregnant previously. She is seeking contraceptive options other than barrier methods. Given her history of APL antibodies and blood clots, progesterone-only contraceptives like the progesterone IUD or depot medroxyprogesterone would be safest options to avoid estrogen which could increase her risk for further clotting issues.
This document discusses Mixed Connective Tissue Disease (MCTD), which has features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. It was identified in 1972 and is characterized by high levels of anti-U1 snRNP antibodies. Common symptoms include Raynaud's phenomenon, swollen fingers, and mixed features of the three diseases. Prognosis is generally good, though some patients develop severe and life-threatening complications such as pulmonary hypertension. Treatment focuses on controlling symptoms and complications.
Dermatomyositis is a chronic inflammatory disorder of the skin and muscles that is characterized by an autoimmune pathogenesis. It commonly presents with characteristic rashes like Gottron's papules and heliotrope rash as well as proximal muscle weakness. Dermatomyositis can also involve internal organs like the lungs, esophagus and heart. Diagnosis involves assessing clinical features, muscle enzymes, electromyography, muscle/skin biopsies and identifying myositis-specific antibodies. Prognosis depends on the severity and organ involvement, with risks of residual weakness, contractures and death from respiratory or cardiac complications.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints, causing pain, stiffness, and swelling. It can also impact other body systems. While the exact cause is unknown, genetics and environmental factors are believed to play a role. Common symptoms include joint deformities, fatigue, and anemia. Diagnosis involves evaluating symptoms, physical exam findings, blood tests, and x-rays. Treatment focuses on reducing inflammation and joint damage through medications like DMARDs, NSAIDs, and corticosteroids. The goals are to relieve symptoms, improve function, and prevent disability. Care requires a multidisciplinary approach including medication management, exercise, and lifestyle changes.
Mixed connective tissue disease (MCTD) is a rare autoimmune disorder with features of lupus, scleroderma, rheumatoid arthritis, and polymyositis. It is characterized by high levels of antibodies against ribonucleic proteins. Diagnostic criteria require at least 3 of 5 clinical features plus positive serology. Over time, many patients evolve features meeting criteria for other connective tissue diseases. Common clinical manifestations include Raynaud's phenomenon, arthritis, swollen hands, and lung and heart involvement. Prognosis depends on degree of organ involvement, with 5-year cumulative risks including pulmonary dysfunction in 66% and pericardial disease in 30% of patients.
This document discusses mixed connective tissue disease (MCTD), including its definition, key diagnostic criteria, common symptoms and organ involvement, treatment approaches, and prognosis. MCTD is characterized by features of lupus, scleroderma, and polymyositis combined with high levels of anti-U1 RNP antibodies. Common symptoms include Raynaud's phenomenon, joint and muscle issues, lung and heart involvement. Treatment focuses on managing symptoms with medications like NSAIDs, corticosteroids, calcium channel blockers, and pulmonary hypertension drugs. Overall mortality is lower than lupus, but progressive pulmonary hypertension can be a major cause of death.
Systemic Lupus Erythematosus (SLE) is a multi-gene autoimmune disease caused by a combination of genetic and environmental factors. It is characterized by abnormal immune responses that result in inflammation and damage to various organs. Diagnosis requires meeting 4 out of 11 classification criteria relating to clinical symptoms and blood markers. Management aims to induce remission of acute flares, maintain improvements to suppress symptoms, and prevent organ damage. Treatment choices depend on the severity and potential reversibility of manifestations. The goal is controlling symptoms without cure since complete sustained remission is rare.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect various organs in the body. It is more common in women, especially of childbearing age, and in African Americans. The disease is characterized by autoantibody production and tissue damage caused by immune complexes. Diagnosis is based on meeting criteria from the SLICC classification system, which improved upon previous criteria. Organ manifestations include renal, neurological, cardiac, pulmonary, hematological and cutaneous involvement. Management aims to suppress symptoms and prevent organ damage through medications like glucocorticoids, antimalarials, immunosuppressants and biologics. The goal is complete remission though sustained remission is rare
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation and circulating autoantibodies directed against self-antigens. SLE predominantly affects females and can involve many organs systems, leading to a variety of clinical manifestations. Diagnosis is based on meeting 4 out of 11 criteria developed by the Systemic Lupus International Collaborating Clinics, including at least 1 clinical and 1 immunologic criteria. Treatment involves controlling symptoms, preventing organ damage, and immunosuppressive drugs such as corticosteroids and hydroxychloroquine. The course of SLE can be variable with periods of disease exacerbation and remission.
Cutaneous lupus erythematosus (CLE) is a manifestation of the autoimmune disease systemic lupus erythematosus (SLE) that presents with diverse skin lesions. There are three main subtypes of CLE - acute (ACLE), subacute (SCLE), and chronic (CCLE, including discoid lupus erythematosus (DLE)). CLE results from a complex interplay between genetic susceptibility, environmental triggers like ultraviolet light, and dysregulated immune responses. Histopathology is useful but not definitive for diagnosis, which relies on clinical presentation and serological markers. CLE can range from limited skin involvement to systemic disease affecting major organs.
This document discusses diabetic neuropathy, its types, risk factors, pathogenesis, and treatment. Diabetic neuropathies are chronic complications of diabetes that manifest in diverse clinical ways. The most common types are distal symmetric polyneuropathy and diabetic autonomic neuropathies. Tight control of blood sugar levels is the primary treatment approach, though additional therapies show some benefits for neuropathic pain relief and prevention of progression. Overall management of this condition remains challenging as existing nerve damage is largely irreversible.
Lupus is an autoimmune disease where the immune system attacks its own tissues. There are two main types: discoid lupus which only affects the skin, and systemic lupus erythematosus (SLE) which can impact internal organs like the heart, lungs and kidneys. SLE is more common in women and typically develops between ages 20-45. Symptoms can include rashes, arthritis, organ inflammation and damage. The cause is unknown but genetics and environmental factors may play a role. Diagnosis involves looking for at least 4 of 11 specific clinical criteria.
This document discusses inflammatory myositis, including dermatomyositis (DM), polymyositis (PM), and inclusion body myositis. It is a heterogeneous group of autoimmune disorders that predominantly affect skeletal muscles, resulting in muscle inflammation and weakness. The most common forms are DM, PM, and immune-mediated necrotizing myopathy. Treatment involves systemic glucocorticoids. Refractory cases may require steroid-sparing agents like azathioprine, methotrexate, or rituximab. There is an increased risk of associated malignancy that warrants cancer screening.
Rheumatoid arthritis is a chronic inflammatory disease that causes swelling and stiffness in the joints. It is the most common form of inflammatory arthritis. It can affect other parts of the body as well as the joints, causing extra-articular manifestations like fatigue, lung involvement, and vasculitis. The disease typically affects women between 25-55 years of age and causes symptoms like morning joint stiffness lasting over an hour that improves with activity. Treatment involves medications like NSAIDs for pain relief, DMARDs like methotrexate to slow disease progression, and corticosteroids or biologics for more severe cases. Early treatment can help prevent long-term joint damage and deformities.
The document discusses several myths and realities regarding systemic lupus erythematosus (SLE). It notes that while early deaths were once caused by active SLE, later deaths are now primarily due to cardiovascular disease. It also clarifies that fatigue and pain are often due to other conditions like fibromyalgia rather than active SLE. Additionally, the document states that ANA-negative lupus can still exist and SLE can develop after age 50, contradicting common misconceptions.
The document discusses neuropsychiatric systemic lupus erythematosus (NPSLE), presenting cases seen at UMMC. It notes varied NPSLE manifestations based on revised ACR criteria. Diagnosis is challenging due to subtle presentations and differential diagnoses. MRI is very useful for diagnosis while CSF analysis and specific antibodies provide additional information. Treatment approaches range from symptomatic therapy for mild disease to high-dose corticosteroids and immunosuppressants like cyclophosphamide for severe disease. The current practice at UMMC combines intravenous steroids with cyclophosphamide regimes.
This document discusses peripheral neuropathy and provides guidance on evaluating and diagnosing peripheral nerve disorders. It defines peripheral neuropathy as disorders affecting the peripheral nervous system, which can involve sensory nerves, motor nerves, or both. The document outlines that peripheral neuropathies can be classified based on whether they primarily affect the cell body, myelin, or axon. It also lists common causes of peripheral neuropathy like diabetes, paraproteinemia, alcohol misuse, and vitamin B12 deficiency. The document provides guidance on clinical assessment, laboratory and electrodiagnostic testing, skin or nerve biopsy, and treatment approaches for peripheral neuropathy.
An apt yet detailed description of Polyarthritis for undergraduate level with basic definitions, classification, concept, clinical features along with descriptive images, diagnosis & assessment with distinguishing features along with differential diagnosis.
This document discusses different types of autoimmune encephalitis. It categorizes autoimmune encephalitis as either paraneoplastic, non-paraneoplastic, or associated with vasculitis. Within non-paraneoplastic autoimmune encephalitis, several specific types are described that are associated with antibodies against receptors like NMDA, GABA, AMPA, and LGI1. Clinical features, pathogenesis, diagnosis and treatment approaches are summarized for some of the major types like anti-NMDA receptor encephalitis. Long term management involves immunosuppression with steroids and other agents to prevent relapse, though neurologic sequelae may still occur in some patients.
Systemic sclerosis is an autoimmune connective tissue disease that affects the skin, blood vessels, and internal organs. There are two major subtypes: limited, characterized by skin changes limited to the hands, face, and CREST syndrome features; and diffuse, with generalized skin thickening. Systemic sclerosis causes fibrosis of skin and internal organs due to vascular dysfunction, immune dysregulation, and excessive collagen deposition. It commonly involves the lungs, gastrointestinal tract, kidneys, heart, and musculoskeletal system. Prognosis depends on the degree of internal organ involvement.
The document provides an overview of advancements in the treatment of rheumatoid arthritis. It discusses the disease characteristics and course, classification criteria, treatment objectives and guidelines, and various therapies including biologics. A case example is presented of a patient with joint pains and symptoms meeting classification criteria for rheumatoid arthritis.
Mixed Connective Tissue Disease By Farshid MokhberiFarshid Mokhberi
Mixed connective tissue disease (MCTD) was first identified in 1972 and involves overlapping features of systemic lupus erythematosus, scleroderma, and myositis. The cause is unknown but likely involves autoimmunity against the U1-70 kD small nuclear ribonucleoprotein. Diagnosis requires high levels of anti-U1 RNP antibodies and a positive antinuclear antibody test. While prognosis can be poor if pulmonary hypertension develops, MCTD is generally very responsive to treatment with glucocorticoids.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect the central nervous system and cause neuropsychiatric symptoms. Diagnosing neuropsychiatric SLE (NPSLE) is challenging due to its diverse manifestations. Genetic, autoantibody, and cytokine factors may contribute to NPSLE pathogenesis by disrupting the blood-brain barrier and causing inflammatory changes. Treatment involves immunosuppression but outcomes depend on the specific neuropsychiatric symptoms.
Adrenal insufficiency, also known as Addison's disease, is caused by destruction of the adrenal cortex leading to deficiencies in glucocorticoids and mineralocorticoids. It presents with non-specific symptoms like fatigue, weight loss, and low blood pressure. Diagnosis involves low cortisol levels in response to ACTH stimulation and high ACTH levels. Treatment is lifelong glucocorticoid and mineralocorticoid replacement. An adrenal crisis can result from infection or stress and requires immediate high dose glucocorticoid treatment in addition to intravenous fluids and glucose to prevent shock.
Definition and natural history of Lennox Gastaut syndromePramod Krishnan
Lennox-Gastaut syndrome (LGS) is a severe childhood epilepsy characterized by multiple seizure types including tonic seizures, atypical absence seizures, and drop attacks. It is defined by its clinical features, EEG findings of slow spike-wave discharges and bursts of fast activity during sleep, and associated cognitive impairment. LGS often develops from other childhood epilepsies like West syndrome and has a generally poor prognosis with intellectual disability and persistent seizures in most cases.
Rheumatoid arthritis is a systemic inflammatory disease that commonly affects the small joints of the hands and feet. It is characterized by symmetric polyarthritis, constitutional symptoms, rheumatoid nodules, and can involve various organ systems. Early diagnosis is important to prevent long-term joint damage and complications. The pathogenesis involves autoimmune processes leading to inflammation of the synovial membranes of joints. Diagnosis is based on clinical features and confirmation with serological markers such as rheumatoid factor and anti-CCP antibodies.
Rheumatoid arthritis is a chronic inflammatory disease that commonly results in joint damage and physical disability. It is characterized by a symmetric, peripheral polyarthritis of unknown etiology that most frequently involves the small joints of the hands and feet. While the disease primarily affects the joints, it can also result in a variety of systemic manifestations involving other organ systems. The risk of rheumatoid arthritis is genetically influenced and increases with certain HLA-DRB1 alleles.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation and circulating autoantibodies directed against self-antigens. SLE predominantly affects females and can involve many organs systems, leading to a variety of clinical manifestations. Diagnosis is based on meeting 4 out of 11 criteria developed by the Systemic Lupus International Collaborating Clinics, including at least 1 clinical and 1 immunologic criteria. Treatment involves controlling symptoms, preventing organ damage, and immunosuppressive drugs such as corticosteroids and hydroxychloroquine. The course of SLE can be variable with periods of disease exacerbation and remission.
Cutaneous lupus erythematosus (CLE) is a manifestation of the autoimmune disease systemic lupus erythematosus (SLE) that presents with diverse skin lesions. There are three main subtypes of CLE - acute (ACLE), subacute (SCLE), and chronic (CCLE, including discoid lupus erythematosus (DLE)). CLE results from a complex interplay between genetic susceptibility, environmental triggers like ultraviolet light, and dysregulated immune responses. Histopathology is useful but not definitive for diagnosis, which relies on clinical presentation and serological markers. CLE can range from limited skin involvement to systemic disease affecting major organs.
This document discusses diabetic neuropathy, its types, risk factors, pathogenesis, and treatment. Diabetic neuropathies are chronic complications of diabetes that manifest in diverse clinical ways. The most common types are distal symmetric polyneuropathy and diabetic autonomic neuropathies. Tight control of blood sugar levels is the primary treatment approach, though additional therapies show some benefits for neuropathic pain relief and prevention of progression. Overall management of this condition remains challenging as existing nerve damage is largely irreversible.
Lupus is an autoimmune disease where the immune system attacks its own tissues. There are two main types: discoid lupus which only affects the skin, and systemic lupus erythematosus (SLE) which can impact internal organs like the heart, lungs and kidneys. SLE is more common in women and typically develops between ages 20-45. Symptoms can include rashes, arthritis, organ inflammation and damage. The cause is unknown but genetics and environmental factors may play a role. Diagnosis involves looking for at least 4 of 11 specific clinical criteria.
This document discusses inflammatory myositis, including dermatomyositis (DM), polymyositis (PM), and inclusion body myositis. It is a heterogeneous group of autoimmune disorders that predominantly affect skeletal muscles, resulting in muscle inflammation and weakness. The most common forms are DM, PM, and immune-mediated necrotizing myopathy. Treatment involves systemic glucocorticoids. Refractory cases may require steroid-sparing agents like azathioprine, methotrexate, or rituximab. There is an increased risk of associated malignancy that warrants cancer screening.
Rheumatoid arthritis is a chronic inflammatory disease that causes swelling and stiffness in the joints. It is the most common form of inflammatory arthritis. It can affect other parts of the body as well as the joints, causing extra-articular manifestations like fatigue, lung involvement, and vasculitis. The disease typically affects women between 25-55 years of age and causes symptoms like morning joint stiffness lasting over an hour that improves with activity. Treatment involves medications like NSAIDs for pain relief, DMARDs like methotrexate to slow disease progression, and corticosteroids or biologics for more severe cases. Early treatment can help prevent long-term joint damage and deformities.
The document discusses several myths and realities regarding systemic lupus erythematosus (SLE). It notes that while early deaths were once caused by active SLE, later deaths are now primarily due to cardiovascular disease. It also clarifies that fatigue and pain are often due to other conditions like fibromyalgia rather than active SLE. Additionally, the document states that ANA-negative lupus can still exist and SLE can develop after age 50, contradicting common misconceptions.
The document discusses neuropsychiatric systemic lupus erythematosus (NPSLE), presenting cases seen at UMMC. It notes varied NPSLE manifestations based on revised ACR criteria. Diagnosis is challenging due to subtle presentations and differential diagnoses. MRI is very useful for diagnosis while CSF analysis and specific antibodies provide additional information. Treatment approaches range from symptomatic therapy for mild disease to high-dose corticosteroids and immunosuppressants like cyclophosphamide for severe disease. The current practice at UMMC combines intravenous steroids with cyclophosphamide regimes.
This document discusses peripheral neuropathy and provides guidance on evaluating and diagnosing peripheral nerve disorders. It defines peripheral neuropathy as disorders affecting the peripheral nervous system, which can involve sensory nerves, motor nerves, or both. The document outlines that peripheral neuropathies can be classified based on whether they primarily affect the cell body, myelin, or axon. It also lists common causes of peripheral neuropathy like diabetes, paraproteinemia, alcohol misuse, and vitamin B12 deficiency. The document provides guidance on clinical assessment, laboratory and electrodiagnostic testing, skin or nerve biopsy, and treatment approaches for peripheral neuropathy.
An apt yet detailed description of Polyarthritis for undergraduate level with basic definitions, classification, concept, clinical features along with descriptive images, diagnosis & assessment with distinguishing features along with differential diagnosis.
This document discusses different types of autoimmune encephalitis. It categorizes autoimmune encephalitis as either paraneoplastic, non-paraneoplastic, or associated with vasculitis. Within non-paraneoplastic autoimmune encephalitis, several specific types are described that are associated with antibodies against receptors like NMDA, GABA, AMPA, and LGI1. Clinical features, pathogenesis, diagnosis and treatment approaches are summarized for some of the major types like anti-NMDA receptor encephalitis. Long term management involves immunosuppression with steroids and other agents to prevent relapse, though neurologic sequelae may still occur in some patients.
Systemic sclerosis is an autoimmune connective tissue disease that affects the skin, blood vessels, and internal organs. There are two major subtypes: limited, characterized by skin changes limited to the hands, face, and CREST syndrome features; and diffuse, with generalized skin thickening. Systemic sclerosis causes fibrosis of skin and internal organs due to vascular dysfunction, immune dysregulation, and excessive collagen deposition. It commonly involves the lungs, gastrointestinal tract, kidneys, heart, and musculoskeletal system. Prognosis depends on the degree of internal organ involvement.
The document provides an overview of advancements in the treatment of rheumatoid arthritis. It discusses the disease characteristics and course, classification criteria, treatment objectives and guidelines, and various therapies including biologics. A case example is presented of a patient with joint pains and symptoms meeting classification criteria for rheumatoid arthritis.
Mixed Connective Tissue Disease By Farshid MokhberiFarshid Mokhberi
Mixed connective tissue disease (MCTD) was first identified in 1972 and involves overlapping features of systemic lupus erythematosus, scleroderma, and myositis. The cause is unknown but likely involves autoimmunity against the U1-70 kD small nuclear ribonucleoprotein. Diagnosis requires high levels of anti-U1 RNP antibodies and a positive antinuclear antibody test. While prognosis can be poor if pulmonary hypertension develops, MCTD is generally very responsive to treatment with glucocorticoids.
Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect the central nervous system and cause neuropsychiatric symptoms. Diagnosing neuropsychiatric SLE (NPSLE) is challenging due to its diverse manifestations. Genetic, autoantibody, and cytokine factors may contribute to NPSLE pathogenesis by disrupting the blood-brain barrier and causing inflammatory changes. Treatment involves immunosuppression but outcomes depend on the specific neuropsychiatric symptoms.
Adrenal insufficiency, also known as Addison's disease, is caused by destruction of the adrenal cortex leading to deficiencies in glucocorticoids and mineralocorticoids. It presents with non-specific symptoms like fatigue, weight loss, and low blood pressure. Diagnosis involves low cortisol levels in response to ACTH stimulation and high ACTH levels. Treatment is lifelong glucocorticoid and mineralocorticoid replacement. An adrenal crisis can result from infection or stress and requires immediate high dose glucocorticoid treatment in addition to intravenous fluids and glucose to prevent shock.
Definition and natural history of Lennox Gastaut syndromePramod Krishnan
Lennox-Gastaut syndrome (LGS) is a severe childhood epilepsy characterized by multiple seizure types including tonic seizures, atypical absence seizures, and drop attacks. It is defined by its clinical features, EEG findings of slow spike-wave discharges and bursts of fast activity during sleep, and associated cognitive impairment. LGS often develops from other childhood epilepsies like West syndrome and has a generally poor prognosis with intellectual disability and persistent seizures in most cases.
Rheumatoid arthritis is a systemic inflammatory disease that commonly affects the small joints of the hands and feet. It is characterized by symmetric polyarthritis, constitutional symptoms, rheumatoid nodules, and can involve various organ systems. Early diagnosis is important to prevent long-term joint damage and complications. The pathogenesis involves autoimmune processes leading to inflammation of the synovial membranes of joints. Diagnosis is based on clinical features and confirmation with serological markers such as rheumatoid factor and anti-CCP antibodies.
Rheumatoid arthritis is a chronic inflammatory disease that commonly results in joint damage and physical disability. It is characterized by a symmetric, peripheral polyarthritis of unknown etiology that most frequently involves the small joints of the hands and feet. While the disease primarily affects the joints, it can also result in a variety of systemic manifestations involving other organ systems. The risk of rheumatoid arthritis is genetically influenced and increases with certain HLA-DRB1 alleles.
Approach to and recent advances in management of rheumatoid arthritisChetan Ganteppanavar
Rheumatoid arthritis is a chronic inflammatory disease that causes swelling and stiffness in the joints. It can affect other organs as well. The cause involves genetic and environmental factors. Treatment involves disease-modifying drugs like methotrexate to reduce inflammation and prevent further joint damage. Methotrexate is usually the first drug tried but combinations of medications may be needed to control symptoms and prevent long term disability. Monitoring is important to assess treatment effectiveness and adjust therapies as needed.
Approach to and recent advances in the management of rheumatoid arthritisChetan Ganteppanavar
Rheumatoid arthritis is a chronic inflammatory disease that causes joint damage. Genetic and environmental factors contribute to its development. It is characterized by symmetric polyarthritis of small joints in hands and feet. Recent advances in management include early treatment with disease-modifying drugs like methotrexate to reduce joint damage. Biologic drugs may be added if targets of remission or low disease activity are not met with conventional drugs alone. Treatment is aimed at controlling symptoms and preventing long-term disability.
Rheumatoid arthritis is a chronic inflammatory disease that causes joint damage and physical disability. It most commonly affects the small joints of the hands and feet, causing symptoms like morning stiffness. While primarily a disease of the joints, it can also affect other body systems, leading to extra-articular manifestations. Over time, if left untreated, it can cause deformities in the joints from progressive tissue destruction. Genetic and environmental factors both contribute to its development and severity.
Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation of the joints. It is characterized by progressive symmetric inflammation of affected joints, resulting in cartilage destruction, bone erosion, and disability. While it initially affects a few joints, many joints become involved over time. Treatment focuses on early, aggressive therapy to prevent joint damage and disability through a combination of medications like NSAIDs, glucocorticoids, and disease-modifying antirheumatic drugs. The goal is to achieve remission of clinical disease activity whenever possible.
Upper extremity arterial disease can be caused by large vessel occlusive diseases like atherosclerosis or embolism, or small vessel diseases like autoimmune disorders. Symptoms range from Raynaud's phenomenon to acute ischemia with pain and pallor. Evaluation involves vascular exams, imaging like ultrasound and angiography. Treatment depends on severity and includes medications for vasospasm, endovascular interventions for stenoses, or open surgery for severe occlusions.
This document summarizes several potential rheumatological emergencies that may present in patients with common rheumatic disorders. It describes conditions like septic arthritis in patients with rheumatoid arthritis, spinal fractures in ankylosing spondylitis patients, renal crisis in systemic sclerosis, alveolar hemorrhage in systemic lupus erythematosus, and hypokalemic paralysis in Sjogren's syndrome patients. It provides details on clinical presentations, diagnostic considerations, and importance of timely recognition and treatment for each emergency. The goal is to raise awareness among emergency physicians to facilitate early diagnosis and management of these potentially life-threatening rheumatic complications.
This document discusses cardiovascular involvement in various collagen vascular disorders, including systemic lupus erythematosus (SLE). It notes that up to 70% of SLE patients show cardiovascular involvement upon autopsy or echocardiography. Common manifestations include pericardial disease, valvular disease, coronary artery disease, and myocardial disease. Pericarditis is the most common cardiovascular manifestation in SLE, occurring in 22-54% of patients. Valvular abnormalities like thickening and regurgitation are also common. The document further discusses cardiovascular involvement in other disorders like antiphospholipid antibody syndrome, systemic sclerosis, and drug-induced lupus.
This document summarizes the neurologic presentations of several systemic vasculitides:
1) Temporal arteritis (TA) commonly causes headaches, jaw pain, vision loss, and neuropathy. It primarily affects cranial arteries in those over 50.
2) Takayasu arteritis most often presents in young women and causes strokes, aneurysms, and ischemia from occlusion of the aorta and its branches.
3) The document reviews the pathophysiology, diagnostic criteria, and treatments of these two vasculitides as examples of neurologic involvement in systemic inflammatory vessel diseases.
Rhematoid arthritis is systemic autoimmune inflammatory disorder of unknown etiology affecting multiple organ systems. These ppt includes comprehensive management of it.
Subarachnoid hemorrhage is bleeding into the subarachnoid space surrounding the brain. It accounts for 5% of strokes but has high mortality and disability rates. The main causes are aneurysms (85%) and hypertension is a major risk factor. Patients present with sudden severe headache, vomiting, and possible loss of consciousness. Grading systems assess severity based on symptoms and imaging findings. Management involves stabilizing the patient, treating complications, and potentially clipping or coiling the aneurysm to prevent rebleeding. Anesthesia aims to control blood pressure rises during intubation and carefully monitor the patient.
This document discusses acute rheumatic fever, which results from an autoimmune response to a streptococcal infection. It mainly affects the heart, joints, brain, and skin. Major symptoms include arthritis, carditis (heart inflammation), chorea, and subcutaneous nodules. Carditis is the most serious manifestation as it can lead to rheumatic heart disease. Diagnosis involves the revised Jones criteria. Treatment aims to prevent recurrent infections with long-term antibiotic prophylaxis. Repeated episodes increase the risk of permanent heart valve damage over many years. The disease remains an important public health issue in developing nations.
This document provides information on mixed connective tissue disease (MCTD). It discusses the definition, etiology, pathophysiology, diagnosis, treatment and prognosis of MCTD. MCTD is a rare autoimmune disease with overlapping features of at least two connective tissue diseases like SLE, SSc, PM and DM. It is characterized by the presence of anti-U1 RNP antibodies. Symptoms can affect multiple organ systems. Diagnosis involves assessing clinical features and antibody levels. Treatment aims to control symptoms and is tailored based on organ involvement. Prognosis varies, with some patients experiencing complete resolution while others face life-threatening complications like pulmonary hypertension.
Rheumatic fever is a non-suppurative systemic disease that occurs as a delayed complication of untreated or ineffectively treated streptococcal pharyngitis. It primarily affects children between 5-15 years of age and is characterized by migratory polyarthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. If not properly treated, it can lead to rheumatic heart disease, which involves permanent damage to the heart valves and is the most serious complication. Treatment involves bed rest, anti-inflammatory medications, antibiotics to prevent recurrent infections, and possibly cardiac surgery for severe valve damage.
Rheumatoid arthritis is a common autoimmune disease that causes inflammation in the joints. It can lead to joint damage, deformity, disability, and reduced life expectancy if left untreated. It is characterized by symmetric inflammation of small and medium-sized joints. Extra-articular manifestations can include lung, heart, eye, and skin involvement. Diagnosis is based on symptoms, laboratory tests for rheumatoid factor and anti-CCP antibodies, and imaging of affected joints. Early, aggressive treatment is important to prevent long-term damage.
Rheumatoid arthritis is a chronic autoimmune disease that causes inflammation and deformity of the joints. It can also affect the cervical spine, causing neck pain and potentially serious neurological complications like spinal cord compression if left untreated. Physical therapy focuses on preserving joint mobility and muscle strength, while medications aim to reduce inflammation and slow disease progression. Surgery may be considered in rare cases where neurological issues are imminent due to severe spinal instability or subluxation.
This document provides an overview of rheumatoid arthritis (RA), including its definition, pathogenesis, clinical manifestations, investigations, assessment, monitoring, and management. RA is a chronic inflammatory disease that commonly affects the small joints in a symmetrical pattern. It is characterized by proliferative synovitis driven by autoimmune and inflammatory processes. Clinical features may include joint stiffness, swelling, and pain as well as systemic symptoms. Investigations include labs showing inflammation, rheumatoid factor or CCP antibodies, and characteristic findings on x-ray such as erosions. The goal of management is remission and minimal disease activity using treatments like DMARDs and biologics tailored to disease severity and prognosis.
an overview of Lupus for journalist
Lupus has a wide spectrum of manifestation. Some mild but in most cases it has a high impact of life and quality of life
Similar to extra articular manifestation of rheumatoid arthritis.pptx (20)
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. INTRODUCTION
A chronic inflammatory disease of unknown
etiology marked by a symmetric, peripheral
polyarthritis and systemic disease
3. EPIDEMIOLOGY
Incidence : between 25-55 years of age after which it plateaus
until the age of 75 and then decreases.
RA affects ~0.5–1% of the adult population worldwide
Prevalence of RA in India is 0.20-0.75%
RA occurs more commonly in females than in males, with a 2–3:1
ratio
4. ETIOLOGY
Aetiology is unknown
Autoimmune disease in which the body’s immune system
mistakenly attacks the joints
5. GENETIC FACTORS:
Increased incidence in first degree relatives(2-20 times higher
than the general population)
Genetic factors are estimated to account for up to 60% of
disease susceptibility
Strong association between susceptibility to RA and certain
HLA haplotypes (HLA-DR4 & HLA-DRB1)
6. ENVIROMENT FACTORS
Smoking tobacco increases the risk of developing
rheumatoid arthritis ( relative risk 1.5-3.5)
Certain infections: Strains of streptococci
Epstein-Barr virus (EBV)
7. PATHOLOGY
The pathologic hallmarks of RA are
synovial inflammation and
proliferation, focal bone erosions,
and thinning of articular cartilage
Chronic inflammation leads to
synovial lining hyperplasia and the
formation of pannus
Pannus destroys the articular
cartilage and subchondral bone,
producing bony erosions
8. CLINICAL FEATURES
CONSTITUTIONAL: weight loss, fever(101°F), fatigue,
malaise, depression, cachexia
Early morning joint stiffness lasting more than 1 h that eases
with physical activity
RA have a higher number of tender and swollen joints
9. o Earliest involved joints - small joints of the hands & feet :
may be monoarticular, oligoarticular (≤4 joints), or
polyarticular (>5 joints)
o Wrists, MCP & PIP joints: most frequently involved joints
o Large joints involved: knees & shoulders are often affected in
established disease
o Spine usually spared except cervical spine, which may cause
compressive myelopathy & neurologic dysfunction
10. Hyperextension of PIP & flexion of
DIP joint (SWAN-NECK
DEFORMITY)
Flexion of the PIP & hyperextension
of DIP joint (BOUTONNIERE
DEFORMITY)
Subluxation of 1st MCP joint &
hyperextension of the first
interphalangeal joint lead to Z-
deformity
Ulnar deviation results from
subluxation of the MCP joints
CLASSICAL HAND SIGN IN
RHEUMATOID ARTHRITIS
11. EXTRAARTICULAR MANIFESTATIONS
Subcutaneous nodule
Subcutaneous nodules have been reported to occur
in 30–40% of patients and more commonly in those
with the highest levels of disease activity positive
test for serum RF and radiographic evidence of
joint erosions
Firm; non tender; adherent to periosteum
&tendons on palpation
Develop in areas of repeated trauma (E.g. :
forearm, sacral prominences, Achilles tendon)
Also in lungs, pleura, pericardium & peritoneum
Nodules are typically benign. Can be associated
with infection ulceration and gangrene.
12. PULMONARY MANIFESTATIONS
Pleuritis : most common pulmonary manifestation of RA
Pleural effusions: exudative, increased monocytes and neutrophils
Interstitial lung disease(ILD) Diagnosed by HRCT
13. Usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP)
are the main histologic and radiologic patterns of ILD.
UIP causes progressive scarring of the lungs that, on chest CT scan, produces
honeycomb changes in the periphery and lower portions of the lungs. NSIP are
relatively symmetric and bilateral ground-glass opacities with associated fine
reticulations, with volume loss and traction bronchiectasis.
The presence of ILD confers a poor prognosis
Responds better to immunosuppressive therapy .
Pulmonary nodules are also common and may be solitary or multiple.
Caplan’s syndrome is a rare subset of pulmonary nodulosis characterized by the
development of nodules and pneumoconiosis following silica exposure.
Copd is also a common findings in RA
14.
15. CARDIAC
Pericardium is the most frequent site of cardiac involvement in RA. Clinical
manifestations occur in <10% of the affected individuals
Myocarditis can be either granulomatous or interstitial
Atrial fibrillation risk is increased in RA including IHD and stroke risk is also
increased.
Rheumatoid nodules: They may develop in pericardium, myocardium and
vulvular structures
Up to 20% of patients with RA may have asymptomatic pericardial effusions on
16. • The most common cause of death in patients with RA is cardiovascular disease
• The incidence of coronary artery disease and carotid atherosclerosis is higher in
RA patients than in the general population
• Congestive heart failure (including both systolic and diastolic dysfunction) occurs
at an approximately twofold higher rate in RA than in the general population
18. VASCULITIS
Rheumatoid vasculitis typically occurs in patients with long-standing disease, a
positive test for serum RF or anti–cyclic citrullinated peptide (CCP) antibodies, and
hypocomplementemia
Cutaneous vasculitis:The cutaneous signs are petechiae, nailfold lesions,
palpable purpura, digital infarcts, gangrene, livedo reticularis, and in severe cases
large, painful lower extremity ulcerations typically seen over medial or lateral
malleoli
19.
20.
21. PERIPHERAL VASCULAR DISEASE
Atherosclerotic peripheral vascular disease: The risk is more
in RA then in otherwsise healthy individuals
Venous thromboembolic disease: There is two fold increase in
patients with RA then in healthy individual
22. Sjogren’s syndrome:
Secondary Sjögren’s syndrome is defined by the presence of either
keratoconjunctivitis sicca (dry eyes) or xerostomia (dry mouth) in association with
RA. Approximately 10% of patients with RA have secondary Sjögren’s.
23. NEUROLOGIC DISEASE
Vasculitic neuropathy: Results from infarction of individual
peripheral nerves by vasculitis in the vasa nervorum
Sensory neuropathy: 40% of patients have sensory
neuropathy
20% mixed motor and sensory neuropathy
Both mononeuritis multiplex and a distal symmetric sensory or
sensorimotor neuropathy can occur. Early in the process
nerve involvement is likely to involve one side
24.
25. OCULAR MANIFESTATIONS
Episcleritis
Scleritis: Diffuse anterior scleritis is the most
common form
Peripheral ulcerative keratitis
Keratoconjunctivitis
26.
27.
28.
29. HEMATOLOGIC
A normochromic, normocytic anemia often develops in patients with RA and is
the most common hematological abnormality.
The degree of anemia parallels the degree of inflammation, correlating with the
levels of serum C-reactive protein (CRP) and erythrocyte sedimentation rate
(ESR).
Felty’s syndrome is defined by the clinical triad of neutropenia, splenomegaly
and nodular RA occurs in the late stages of severe RA
T-cell large granular lymphocyte leukemia (T-LGL) also occurs in association
with RA which is characterized by a chronic, indolent clonal growth of LGL cells,
leading to neutropenia and splenomegaly.
30. As opposed to Felty’s syndrome, T-LGL may develop early in the course of
RA
Leukopenia can often be a side effect of drug therapy
The most common histopathologic type of lymphoma is a diffuse large B-cell
lymphoma. The risk of developing lymphoma increases if the patient has high
levels of disease activity or Felty’s syndrome
31. Skeletal:
• Osteoporosis is more common in patients with RA with an
incidence rate of nearly double that of the healthy population
and a prevalence of approximately one-third in
postmenopausal women with RA
• There is also an increased risk of fragility fracture with a
greater risk among women
32. • The inflammatory milieu of the joint probably spills over into
the rest of the body and promotes generalized bone loss by
activating osteoclasts
• Both trabecular and cortical bone are affected by the
inflammatory response, with cortical sites more susceptible
to bone loss
• Chronic use of glucocorticoids and disability-related
immobility also contribute to osteoporosis
• Hip fractures are more likely to occur in patients with RA and
are significant predictors of increased disability and mortality
33. Neurological and psychiatric manifestatioin :
Central nervous system:
Cervical myelopathy- Cervical myelopathy resulting from atlantoaxial
subluxation, atlantoaxial impaction
Central nervous system vasculitis:
Clinical manifestations- Headache and mental status changes with seizure
cranial nerve palsies blindness, paralysis,dementia ,aphasia, gait disorders
and intracranial hemorrhage.
34. Rheumatoid nodules:
Rheumatoid nodules have been reported in patients with cerebral
leptomeninges and within the choroid plexus
Extra dural nodules in the spinal canal may cause compression and spinal
stenosis
Rheumatoid meningitis:
Characterized by inflammatory infiltrate of the meninges or aseptic
meningitis
Progressive multifocal leukoencephalopathy: PML, associated with
polyoma John Cunningham (JC) virus has been reported although risk is
very small.
35. PERIPHERAL NERVOUS SYSTEM
Carpal tunnel syndrome due to
compression of the median nerve
commonly associated with pain and
paraesthesia and less commonly with
weakness
Tarsal tunnel syndrome: Due to
compression of the tibial nerve. It may
result from tenosynovitis, inflammation
of FR or valgus deformities. Atrophy and
weakness of intrinsic foot muscles occur
in advance disease.
Distal sensory neuropathy: Symmetric
paresthesias and burning sensations
tend to be worse in the feet than in the
hands. Decreased or absent deep
tendon reflexes.
Combined sensorimotor neuropathy:
Due to ischemic neuropathy. Both
symmetric and asymmetric mononeuritis
multiplex have been described.
Compressive neuropathy
Non compressive
neuropathy
36. PSYCHIATRIC DISEASE
Depression is common in patients with RA and symptoms of
depression are associated with increased pain, fatigue and
disability
37. RENAL
• Direct effects of RA on kidney are rare and include focal
glomerulonephritis usually of mesangioproliferative type or
membranous type without rapid progression of renal
dysfunction
• Patients with long standing inflammatory disease may
develop secondary amyloidosis
38. MUSCLE DISORDERS
Myopathy:
1. Disuse atrophy: Sarcopenia low muscle mass and low skeletal
muscle strength or low physical performance. Occurs frequently in
older adults
2. Glucocorticoid induced myopathy- proximal muscle weakness
without significant serum muscle enzyme elevations
3. Myositis :Inflammatory myositis
39. DIAGNOSIS
Clinical diagnosis of RA is largely based on signs and
symptoms
Laboratory diagnosis
Radiographic imaging
40. LABORATORY FEATURES
Elevated ESR or CRP
Detection of serum RF and anti-CCP antibody
Serum IgM RF has been found in 75–80% of patients with RA
Anti-CCP antibody : specificity 95%
helps distinguishing RA from other
Arthritis
41. SYNOVIAL FLUID ANALYSIS
Reflects an acute inflammatory state
Synovial fluid white blood cell (WBC):5000 and 50,000
wbc/μL
Synovial fluid analysis:
Most useful for confirming an inflammatory arthritis (as
opposed to osteoarthritis)
To exclude infection or a crystal-induced arthritis such as
gout or pseudogout
43. MRI
Detecting changes in the soft tissues such as synovitis,
tenosynovitis, and effusion
ULTRASOUND INCLUDING POWER COLOUR
DOPPLER
It can also reliably detect synovitis, including increased joint
vascularity indicative of inflammation
45. TREATMENT
Primary Objectives –
Target is low disease activity or remission
Reduction of inflammation and pain
Preservation of function
Prevention of deformity
47. NSAIDS
NSAIDs exhibit both analgesic and anti-inflammatory properties
Symptomatic relief in RA
Do not prevent erosions/alter disease progression
Not appropriate for monotherapy
Used in conjunction with DMARDs
S/E: Gastritis and PUD as well as impairment of renal function
48. CORTICOSTEROIDS
Anti-inflammatory effect in RA & slow rate of erosion
Low-dose corticosteroids – as a bridge to reduce disease
activity until the slower acting DMARDs take effect
Adjunctive therapy for active disease that persists despite
treatment with DMARDs
10 mg of prednisone or equivalent per day is appropriate for
articular disease
49. CORTICOSTEROIDS
Higher doses use : to manage extra-articular manifestations –
eg: pericarditis, necrotizing scleritis
Intra-articular corticosteroids – if one or two joints are highly
inflamed. – Triamcinolone, 10–40 mg
S/E: Osteoporosis and PUD
50. DMARDS
Ability to slow or prevent structural progression of RA
The conventional DMARDs include
Hydroxychloroquine
Sulfasalazine
Methotrexate
Leflunomide
They exhibit a delayed onset of action of ~6–12 weeks
51.
52. BIOLOGICS DMARDS
Biologics are genetically engineered from a living
organism, such as a virus, gene or protein, to simulate the
body’s natural response to infection and disease
Biologics are typically reserved for people whose arthritis
has not responded adequately to traditional disease-
modifying anti rheumatic drugs (DMARDs)
53. IMPORTANT POINTS
Biologics are effective
Biologics may increase risk of infection
(Patients should be screened for tuberculosis and other
infections before starting a biologic)
Biologics are usually given by Injection or IV
Biologics require a strict follow-up schedule
Biologics are expensive
54. HOW DO BIOLOGICS TREAT RHEUMATOID ARTHRITIS
Inhibit specific components of the immune system that
play pivotal roles in inflammation
To treat moderate to severe rheumatoid arthritis that has
not responded adequately to other treatments
Slow down the progression of rheumatoid arthritis when
1st line drugs have failed
55. BIOLOGICS IN RA
Cytokines such as TNF-α ,IL-1,IL-6 etc. are key mediators of
immune function in RA and have been major targets of
therapeutic manipulations in RA
56. Various biologicals approved in RA are:-
Anti TNF agents : Infliximab, Etanercept, Adalimumab
IL-1 receptor antagonist : Anakinra
IL-6 receptor antagonist : Tocilizumab
Anti CD20 antibody : Rituximab
T cell co-stimulatory inhibitor : Abatacept
JAK lnhibitor : Tofacitinib
61. IL-6 RECEPTOR ANTAGONIST
TOCILIZUMAB
Humanized anti IL-6 monoclonal Ab that specifically inhibits
the action of 1L-6
It is reserved for Resistant RA
CBC should be monitoring
at regular interval
62. T-CELL CO-STIMULATION INHIBITOR
ABATACEPT
It is recombinant fusion protein
MOA: inhibits activation of T cell
Used when there is inadequate response to DMARDS or in
combination with MTX or LEFLUNOMIDE
63. RITUXIMAB -B CELL DEPLETION THERAPY
Monoclonal antibody directed against CD20
MOA: It works by depleting B cells, which in turn, leads
to a reduction in the inflammatory response by unknown
mechanisms. These mechanisms may include a reduction
in autoantibodies, inhibition of T cell activation, and
alteration of cytokine production
64. Used in resistant RA in Combination therapy with
Methotrexate
65. JANUS KINASE ENZYME INHIBITOR
Tofacitinib
MOA: Targets inflammation signaling pathway that transduce
the positive signals of cytokines and other inflammatory
mediators
66. DAS28 is a simplified version of DAS44 that evaluates just 28 joints. It does not include the
ankles or joints in the feet.
The DAS28 score is arrived at using:
1.The number of swollen joints (out of the 28),
2.The number of tender joints (out of the 28),
3.The C reactive protein (CRP) or erythrocyte sedimentation rate (ESR) lab test results
4.Answers to a patient health assessment questionnaire
A mathematical formula is used to calculate the overall score. DAS28 can range from 0 to
9.4.
Generally, a DAS28 score of 1 :
•More than 5.1 indicates high disease activity
•Between 3.2 and 5.1 indicates moderate disease activity
•Between 2.6 and less than 3.2 indicates low disease activity
•Lower than 2.6 indicates disease remission
67. •Sternoclavicular joints (2), which connect the collarbone and
the breastbone
•Acromioclavicular joints (2), which connect the acromion to
the clavicle
•Shoulders (2)
•Elbows (2)
•Wrists (2)
•Large knuckles (10) also called the
metacarpophalangeal (MCP) joints
•Middle knuckles (10), also called proximal interphalangeal
(PIP) joints
•Knee (2)
68. 2021 American College of Rheumatology Guideline for
the Treatment of Rheumatoid Arthritis
69. RECOMMENDATIONS FOR DMARD-NAIVE PATIENTS
WITH MODERATE-TO-HIGH DISEASE ACTIVITY
DMARD monotherapy Methotrexate is strongly recommended over
hydroxychloroquine or sulfasalazine for DMARD naive patients with
moderate-to-high disease activity
Methotrexate is conditionally recommended over leflunomide for DMARD-
naive patients with moderate-to-high disease activity
Methotrexate monotherapy is strongly recommended over bDMARD or
tsDMARD monotherapy for DMARD-naive patients with moderate-to-high
disease activity
70. • Methotrexate monotherapy is conditionally recommended
over dual or triple csDMARD therapy for DMARD-naive
patients with moderate-to-high disease activity
• Methotrexate monotherapy is conditionally recommended
over methotrexate plus a tumor necrosis factor (TNF)
inhibitor for DMARD-naive patients with moderate-to-high
disease activity
• Initiation of a csDMARD without short-term glucocorticoids is
conditionally recommended over initiation of a csDMARD
with short-term glucocorticoids for DMARD-naive patients
with moderate-to-high disease activity
71. Initiation of a csDMARD without longerterm (≥3 months)
glucocorticoids is strongly recommended over initiation of a
csDMARD with longer-term glucocorticoids for DMARD-naive
patients with moderate-to-high disease activity
72. RECOMMENDATIONS FOR ADMINISTRATION OF
METHOTREXATE
Oral methotrexate is conditionally recommended over subcutaneous
methotrexate for patients initiating methotrexate
Initiation/titration of methotrexate to a weekly dose of at least 15 mg
within 4 to 6 weeks is conditionally recommended over initiation/
titration to a weekly dose of <15mg
A split dose of oral methotrexate over 24 hours or weekly subcutaneous
injections, and/or an increased dose of folic/folinic acid, is conditionally
recommended over switching to alternative DMARD(s) for patients not
tolerating oral weekly methotrexate
73. Switching to subcutaneous methotrexate is conditionally
recommended over the addition of/ switching to alternative
DMARD(s) for patients taking oral methotrexate who are not
at target
75. Subcutaneous nodules
Methotrexate is conditionally recommended over alternative DMARDs for patients with subcutaneous
nodules who have moderate-to-high disease activity. Switching to a non-methotrexate DMARD is
conditionally recommended over continuation of methotrexate for patients taking methotrexate with
progressive subcutaneous nodules.
Pulmonary disease
Methotrexate is conditionally recommended over alternative DMARDs for the treatment of inflammatory
arthritis for patients with clinically diagnosed mild and stable airway or parenchymal lung disease who have
moderate-to-high disease activity.
Heart failure
Addition of a non–TNF inhibitor bDMARD or tsDMARD is conditionally recommended over addition of a
TNF inhibitor for patients with NYHA class III or IV heart failure and an inadequate response to
csDMARDs. Switching to a non–TNF inhibitor bDMARD or tsDMARD is conditionally recommended over
continuation of a TNF inhibitor for patients taking a TNF inhibitor who develop heart failure.
76. Lymphoproliferative disorder
Rituximab is conditionally recommended over other DMARDs for
patients who have a previous lymphoproliferative disorder for which
rituximab is an approved treatment and who have moderate-to-high
disease activity.
77. SURGERY
Synovectomy of wrist or finger tendon sheaths for pain relief or to prevent
tendon rupture when medical interventions have failed
Osteotomy
Athroplasty