Definition, etiology, pathophysiology, clinical manifestations, pharmacological and non pharmacological treatments. Musculoskeletal disorders. Useful for D.pharm, b.pharm,medical and pharm d students.

1. MUSCULOSKELETAL
DISORDERS
RHEUMATOID ARTHRITIS
A PRESENTATION BY
AMAN KUMAR
LECTURER
GCRG COLLEGE OF PHARMACY

2. DEFINITION
Rheumatoid= Rheum=Fluid.
Arthritis=Arthron=Joint; Itis=Inflammation.
• Chronic.
• Auto-immune disorder.
• Joints becomes painful and swollen.
"Rheumatoid arthritis is a chronic autoimmune disorder that cause the joints to
become painful, swollen, warm, stiff and deformed."
• It is an autoimmune disease in which the immune system of the body attacks its
own tissues (cartilage & joint linings).
• The disease usually occurs between 30-50 years of age. However, disease has
also been reported in children between 7-15 years of age.
• In Rheumatoid arthritis, the synovial membrane becomes thickened and
inflamed and cartilages are eroded (broken/deformed).
[Synovial cavity= cavity around bone joints in which synovial fluid is filled;
Synovial fluid= a type of fluid which reduces friction between bone joints;
Synovial membrane= membrane around synovial cavity].

4. ETIOLOGY OF RA
The exact cause of rheumatoid arthritis is unknown.
1. Immunological Reaction: Rheumatic arthritis is considered an autoimmune
disease in which the body loses its ability to distinguish between synovial and
foreign tissues. In RA, the immune system attacks healthy tissue in the joints.
2. Environmental Factors: Environmental factors such as infections or trauma
are thought to trigger the development of RA.
3. Release of inflammatory chemicals: Release of inflammatory chemicals
like Interleukin , Nuclear factors etc leads to inflammation of joints.
4. Gender (Sex): Women are more likely than men to develop rheumatoid
arthritis.
5. Age: Rheumatoid arthritis can occur at any age, but it most commonly begins
in middle age (30-50 years). Juvenile RA occurs at the age of 7-15 years.
6. Family History: If a member of family has rheumatoid arthritis, you may
have an increased risk of disease.
7. Excess weight (Obesity): People who are overweight appear to be at a
somewhat higher risk of developing rheumatoid arthritis.

5. PATHOPHYSIOLOGY OF RA
Antigen.
T lymphocytes (T-cells) binding to antigen and t-cell activation.
B cell activation leading to formation of IgM antibody.
Antigen-Antibody Reaction.
Formation of Immune complex.
Release of Inflammatory chemicals (e.g., IL, NF etc) from inflammatory cells.
Inflammatory damage to synovial cavity.
Destruction (erosion) of cartilage.
Inflammation leads to swelling in synovial membrane and pain around joints.
RHEUMATOID ARTHRITIS

6. CLINICAL MANIFESTATION OF
RA
• Painful and swollen joints.
• Temperature may be raised.
• Morning stiffness in joints.
• Fatigue.
• Fever .
• Flare: A flare is the sudden appearance,
increase, or worsening of rheumatoid arthritis
symptoms such as pain, inflammation, redness
& heat.

7. DIAGNOSIS OF RA
• Blood test for detecting the presence of IgM
antibody.
• X-ray imaging of bone joints.
• Synovial fluid analysis.

8. TREATMENT OF RA
Non-pharmacological Treatment:
• Take maximum rest, preferably during night.
• Carry out gradual exercise to maintain joint strength.
• Take healthy diet.
Pharmacological Treatment:
1. Anti-inflammatory Drugs: To control swelling and
inflammation. Examples: Aspirin, Ibuprofen, Diclofenac and
Indomethacin.
2. Corticosteroids: To control pain. Example: Prednisone
3. Chloroquine & Hydrochloroquine: Inactivates the enzymes
released by neutrophils and provide relief from inflammation.
4. Antirheumatic drugs: Gold compound, penicillamine .
5. Surgery: Surgery is last option and decision is based upon
affected joints, stage of disease and age of patient.

9. THANK YOU