SlideShare a Scribd company logo
Rheumatoid arthritis is an auto
immune disease that is caused
by chronic inflammation of the
joints or in the membrane
surrounding the joints (the
synovial membrane)
 Rheumatoid arthritis (RA) is a chronic, systemic
autoimmune disorder whose major distinctive
feature is chronic, symmetrical and erosive
inflammation of the synovial tissue of the joints.
 The severity of the joint disease may fluctuate
over time, but progressive development of
various degrees of joint destruction, deformity
and disability is the most common outcome of
established disease.
• About 1% of the world’s population is afflicted by
rheumatoid arthritis.
• Onset is most frequent between the ages of 20
and 40, but people of any age can be affected.
• Women are three times more likely to get RA
than men, however women who are taking or
have taken oral contraceptives are less likely to
develop RA.
• Rheumatoid factor (RF), an
autoantibody directed against
immunoglobulin G (IgG)
• Antibodies against collagen,
Epstein-Barr virus, encoded
nuclear antigen
• Antikeratin antibody (AKA) &
anti-perinuclear factor (APF)
Genetic factors- People with RA are more likely to
have a gene called HLA- DR4, located on
chromosome 6.
Environmental factors- Infectious agents that may
induce RA are mycoplasma organisms, Epstein-
Barr virus, rubella virus and Streptococcus.
Smoking is also a major environmental risk factor.
Hormonal factors- During pregnancy, women
often experience a symptom improvement of RA,
due to increase in estrogen and progesterone
levels.
• The pathologic process involved in RA are
type 3( immune complex) and type 4( cell
mediated) reactions. If unarrested,
pathologic changes in RA pass through
four stages:
1. Synovitis
2. Pannus formation
3. Fibrous ankylosis
4. Bony ankylosis
Presentation of antigen to T cell
T and B cell proliferation
Activation of complement system
Activation of complex system &
release of lysosymes from
leukocytes
Proliferative inflammation
localized in joint capsule
Tissue thickens with edema
and congestion
SYNOVITIS
STAGE 1
PANNUS gradually develops
Extends over the articular surface
into joint anterior
Adheres tightly to underlying cartilage
by invasion and lysis
Interferes with cartilage nutrition
Pannus may extend over to
subchondral bone
Cartilage may become worn off and
become raw
STAGE 2
Subchondral bone erosion
Granulation tissue gets invaded with
tough fibrous tissue
Converted to scar tissue
Inhibits joint movements
Forms FIBROSIS ANKYLOSIS
Progress to bony ankylosis
STAGE 3
STAGE
4
1.Articular Manifestations
2.Extra Articular
Manifestations
 Early stages –
 Active inflammation of joints
 Hot, swollen and painful joints and
function may be decreased
 Soft tissue deformity and
contractures due to prolonged
immobilization
 Stiffness especially on first
wakening in the morning
 Later stages-
Deformity of hands and feet due
to misalignment resulting from
swelling, progressive joint
destruction or partial dislocation.
Muscle spasm and
weakness
 Others –
 Fever
 Rheumatoid nodules at joint capsules
 Fatigue
 Weakness
 Anorexia
 Weight loss
 Generalized aching
Rheumatoid nodules •Subcutaneous
•few millimetres to
a few centimetres
in diameter
•usually found over
bony prominences
ULNAR DRIFT
• Deviation of the MCP
(metacarpophalangeal) joints
of the fingers and medial
deviation of the wrist.
• Most marked in the little
finger and involves each
successive finger to a
lesser degree.
SWAN NECK DEFORMITY
• Hyperextension of PIP
(proximal interphalangeal) joint
with flexion of the MCP and
DIP (distal interphalangeal) joints.
• Results from contractures of
the intrinsic muscles and
tendons.
THE BOUTONNIERE
DEFORMITY
• Flexion of the PIP joints and
hyperextension of the DIP
joints.
• Due to rupture of the extensor
tendons over the fingers.
 Vasculitis:
 digital arteritis
 fever, skin lesions
 chronic leg ulcers
 peripheral neuritis
 necrotizing arteritis involving coronary,
mesenteric or renal vessels.
 Serositis:
 Lungs-
 Fibrosis of the lungs
 Pleural effusions
 Heart-
 Prone to atherosclerosis,
 Risk of myocardial infarction & stroke
 Others: pericarditis, endocarditis, left ventricular
failure, valvulitis and fibrosis.
 Eye-
 keratoconjunctivitis sicca
 Nervous system-
 Peripheral neuropathy
 Carpal tunnel syndrome caused by compression
of the median nerve by swelling around the
wrist.
 Anemia
Radiologic examination-
• This consists of X rays of both hands and of the
affected joints. The following features may be
present:
• Reduced joint space
• Erosion articular margins
• Subchondral cysts
• Soft tissue swelling
Blood tests-
• Elevated ESR
• Decreased Hb value
• Positive test for C reactive protein
• ANA (antinuclear antibodies) – seen in
15-20% clients
• Rheumatoid factor (RF)- It can be
detected in serum by following tests:
• Latex fixation test- positive in titre 1:20
• Rose- waaler test – agglutination test
sheeps RBC are used as carrier.
Synovial fluid examination-
• Arthroscopic examination shows
synovial fluid is cloudy, milky or dark
yellow
• contains numerous inflammatory
components
• reduced viscosity
• WBC count is as high as
50,000/mm3
1. Morning stiffness of >1 hour most mornings
for at least 6 weeks.
2. Arthritis and soft-tissue swelling of >3 of 14
joints/joint groups, present for at least 6
weeks
3. Swelling of atleast 1 wrist, MCP, or PIP joint,
present for at least 6 weeks
4. Symmetric arthritis, present for at least 6
weeks
5. Subcutaneous nodules in specific places
6. Presence of Rheumatoid factor
7. Radiological changes suggestive of joint
erosion
 four or more of the seven criteria must be
met before the disease is classified as RA.
The aims are-
• The induction of remission and its
maintenance: the disease’s activity is
brought under control by drugs.
• The preservation of joint functions and
prevention of deformities: during the activity
of disease and thereafter by physiotherapy
and splinting.
• Repair of the joint damage which already
exists: it will relieve pain or facilitate
functions. It sometimes requires surgical
interventions eg. Synovectomy.
MEDICAL
MANAGEMENT
ORTHOPAEDIC
MANAGEMENT
It has 3 goals:
• Prevention of joint deformity
• Preservation of joint function
• Reduction of inflammation and pain.
It consists of
• Rest
• Physical therapy (isometric exercises)
• Hot and cold application (moist, dry heat, cold
packs)
• Diet
• Drugs
 Drugs like NSAID’s
 Disease Modifying Anti- Rheumatic
Drugs(DMARD’s)
 Steroids
Never massage acutely inflamed
joint.
• Aspirin / sodium salicylate:
 They are analgesic, anti-
inflammatory, relatively safe and
inexpensive.
 Analgesia is achieved in small
doses and large doses are
needed to reduce inflammation.
 Frequent doses (3 to 4 times)
are required, even when pain is
not present to keep blood
salicylate level high.
• NSAID’s: if aspirin is ineffective NSAID’s
are given.
They are anti – inflammatory, analgesics
and antipyretics e.g.
 Phenylbutazone
 Indomethacin
 Ibuprofen
* to be taken with histamine receptor
antagonist.
• Corticosteroids
 Wysolone
 Prednisolone
• Intra- articular injections of corticosteroids
• Immunosuppressive (cytotoxic) agents:
Methotrexate,acts as an immunosuppresent,
blocking the inflammatory process of RA.
• No particular dietary
modification is required.
• The client is encouraged to eat
a nutritious diet rich in vitamins,
proteins, iron.
• If client is overweight, they are
taught to loose weight to relieve
stress on affected joints.
• Tendon transfers and
osteotomy:
 Prevents progressive deformity
which would be caused by muscle
spasm.
 Nodules or bony tumors can be
surgically removed.
 Osteotomy may improve the
function of deformed joints or limbs.
• Synovectomy:
 It helps in maintaining joint
functions.
 Early surgical removal of the
synovium helps prevent
recurrent inflammation.
• Joint replacement:
eg. Arthrodesis or arthroplasty( with or
without replacement of joint parts with
prosthesis).
 Arthrodesis( fusion) sacrifices function
of the joint but relieves pain in
severely damaged joints.
 Fusion may be performed on the
wrists to fix affected part in a
functional position so it can be used
more effectively.
• Arthrodesis –
surgical fusion of joints
• Hip arthroplasty: both joint
component is replaced
• Hemi arthroplasty: only one joint
component is replaced eg.
Replacement of head of femur
with metal prosthesis.
Thus the surgerical management is divided
into:
• Preventive surgery: eg synovectomy
• Palliative surgery: for relief eg tendon transfer
• Reconstructive surgery: for rehabilitation eg.
Arthroplasty, total joint replacement
Rhematoid arthiritis

More Related Content

What's hot

Rheumatoid arthiritis
Rheumatoid arthiritisRheumatoid arthiritis
Rheumatoid arthiritis
SHARIQUE RAZA
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
Vignesvararajah Lokeesan
 
Rheumatoid Arthritis
Rheumatoid Arthritis Rheumatoid Arthritis
Rheumatoid Arthritis
Sreeja Saladi
 
Osteoarthritis ppt
Osteoarthritis pptOsteoarthritis ppt
Osteoarthritis ppt
Rupika Sodhi
 
rheumatoid arthritis
rheumatoid arthritisrheumatoid arthritis
rheumatoid arthritis
Ashwini Somayaji
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
Bapan Paul
 
RHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITIS
aishuanju
 
Rhemutoid arthritis
Rhemutoid arthritisRhemutoid arthritis
Rhemutoid arthritis
Soumya Ranjan Parida
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
drkmliau
 
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE
SYSTEMIC LUPUS ERYTHEMATOSUS (SLESYSTEMIC LUPUS ERYTHEMATOSUS (SLE
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE
PARUL UNIVERSITY
 
Rheumatoid arthritis current diagnosis and treatment
Rheumatoid arthritis current diagnosis and treatmentRheumatoid arthritis current diagnosis and treatment
Rheumatoid arthritis current diagnosis and treatment
Ankur Varshney
 
Osteoarthritis general
Osteoarthritis generalOsteoarthritis general
Osteoarthritis general
Vijay Kevlani
 
Ankylosing spondylitis,Causes,symptoms,diagnosis,management
Ankylosing spondylitis,Causes,symptoms,diagnosis,managementAnkylosing spondylitis,Causes,symptoms,diagnosis,management
Ankylosing spondylitis,Causes,symptoms,diagnosis,management
Dr.Md.Monsur Rahman
 
Arthritis
ArthritisArthritis
Arthritis
imrana tanvir
 
Osteomyelitis
OsteomyelitisOsteomyelitis
Osteomyelitis
Usman Shams
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
swathisravani
 
Ankylosing spondylitis
Ankylosing spondylitisAnkylosing spondylitis
Ankylosing spondylitis
Abigail Abalos
 
Gout
GoutGout
Gout
GoutGout
Osteoarthritis knee
Osteoarthritis  kneeOsteoarthritis  knee
Osteoarthritis knee
Narula Gandu
 

What's hot (20)

Rheumatoid arthiritis
Rheumatoid arthiritisRheumatoid arthiritis
Rheumatoid arthiritis
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
Rheumatoid Arthritis
Rheumatoid Arthritis Rheumatoid Arthritis
Rheumatoid Arthritis
 
Osteoarthritis ppt
Osteoarthritis pptOsteoarthritis ppt
Osteoarthritis ppt
 
rheumatoid arthritis
rheumatoid arthritisrheumatoid arthritis
rheumatoid arthritis
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
RHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITIS
 
Rhemutoid arthritis
Rhemutoid arthritisRhemutoid arthritis
Rhemutoid arthritis
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE
SYSTEMIC LUPUS ERYTHEMATOSUS (SLESYSTEMIC LUPUS ERYTHEMATOSUS (SLE
SYSTEMIC LUPUS ERYTHEMATOSUS (SLE
 
Rheumatoid arthritis current diagnosis and treatment
Rheumatoid arthritis current diagnosis and treatmentRheumatoid arthritis current diagnosis and treatment
Rheumatoid arthritis current diagnosis and treatment
 
Osteoarthritis general
Osteoarthritis generalOsteoarthritis general
Osteoarthritis general
 
Ankylosing spondylitis,Causes,symptoms,diagnosis,management
Ankylosing spondylitis,Causes,symptoms,diagnosis,managementAnkylosing spondylitis,Causes,symptoms,diagnosis,management
Ankylosing spondylitis,Causes,symptoms,diagnosis,management
 
Arthritis
ArthritisArthritis
Arthritis
 
Osteomyelitis
OsteomyelitisOsteomyelitis
Osteomyelitis
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
Ankylosing spondylitis
Ankylosing spondylitisAnkylosing spondylitis
Ankylosing spondylitis
 
Gout
GoutGout
Gout
 
Gout
GoutGout
Gout
 
Osteoarthritis knee
Osteoarthritis  kneeOsteoarthritis  knee
Osteoarthritis knee
 

Viewers also liked

Rhematoid Arthritis
Rhematoid ArthritisRhematoid Arthritis
Rhematoid Arthritis
Alifya Sasmi
 
Rhematoid artheroitis
Rhematoid artheroitisRhematoid artheroitis
Rhematoid artheroitis
Dr Nag Raj
 
RHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITIS
shruti87
 
Rhematoid Arthritis_CME symposium program abstracts and introduction written ...
Rhematoid Arthritis_CME symposium program abstracts and introduction written ...Rhematoid Arthritis_CME symposium program abstracts and introduction written ...
Rhematoid Arthritis_CME symposium program abstracts and introduction written ...
ckaczk
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
dhavalshah4424
 
rheumatic fever
rheumatic feverrheumatic fever
rheumatic fever
Kapil Dhital
 
SLE
SLESLE
Rheumatoid Arthritis Power Point
Rheumatoid Arthritis Power PointRheumatoid Arthritis Power Point
Rheumatoid Arthritis Power Point
steverluce
 
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...
Prof Dr Bashir Ahmed Dar
 
Systemic lupus erythematosus
Systemic lupus erythematosusSystemic lupus erythematosus
Systemic lupus erythematosus
Furqan Khan
 
Rheumatoid arthritis for undergraduates
Rheumatoid arthritis for undergraduatesRheumatoid arthritis for undergraduates
Rheumatoid arthritis for undergraduates
Dhananjaya Sabat
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
drake0766
 
LinkedIn SlideShare: Knowledge, Well-Presented
LinkedIn SlideShare: Knowledge, Well-PresentedLinkedIn SlideShare: Knowledge, Well-Presented
LinkedIn SlideShare: Knowledge, Well-Presented
SlideShare
 
Slideshare ppt
Slideshare pptSlideshare ppt
Slideshare ppt
Mandy Suzanne
 
Serum globulin electrophoresis process
Serum globulin electrophoresis processSerum globulin electrophoresis process
Serum globulin electrophoresis process
accessbiologicals
 
Antibodies Productions
Antibodies ProductionsAntibodies Productions
Antibodies Productions
University of MARA Technology
 
Osteochondrosis
OsteochondrosisOsteochondrosis
Osteochondrosis
Omega Cantrell
 
Structural evolution of globulin protein
Structural evolution of globulin proteinStructural evolution of globulin protein
Structural evolution of globulin protein
Vijay Raj Yanamala
 
types of WBC
types of WBCtypes of WBC
types of WBC
Rakhi Adarsh
 
Osteochondrosis
OsteochondrosisOsteochondrosis
Osteochondrosis
Thorsang Chayovan
 

Viewers also liked (20)

Rhematoid Arthritis
Rhematoid ArthritisRhematoid Arthritis
Rhematoid Arthritis
 
Rhematoid artheroitis
Rhematoid artheroitisRhematoid artheroitis
Rhematoid artheroitis
 
RHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS
RHEUMATOID ARTHRITIS
 
Rhematoid Arthritis_CME symposium program abstracts and introduction written ...
Rhematoid Arthritis_CME symposium program abstracts and introduction written ...Rhematoid Arthritis_CME symposium program abstracts and introduction written ...
Rhematoid Arthritis_CME symposium program abstracts and introduction written ...
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
rheumatic fever
rheumatic feverrheumatic fever
rheumatic fever
 
SLE
SLESLE
SLE
 
Rheumatoid Arthritis Power Point
Rheumatoid Arthritis Power PointRheumatoid Arthritis Power Point
Rheumatoid Arthritis Power Point
 
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...
RHEUMATOID ARTHRITIS BY DR BASHIR AHMED DAR ASSOCIATE PROFESSOR MEDICINE SOPO...
 
Systemic lupus erythematosus
Systemic lupus erythematosusSystemic lupus erythematosus
Systemic lupus erythematosus
 
Rheumatoid arthritis for undergraduates
Rheumatoid arthritis for undergraduatesRheumatoid arthritis for undergraduates
Rheumatoid arthritis for undergraduates
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
LinkedIn SlideShare: Knowledge, Well-Presented
LinkedIn SlideShare: Knowledge, Well-PresentedLinkedIn SlideShare: Knowledge, Well-Presented
LinkedIn SlideShare: Knowledge, Well-Presented
 
Slideshare ppt
Slideshare pptSlideshare ppt
Slideshare ppt
 
Serum globulin electrophoresis process
Serum globulin electrophoresis processSerum globulin electrophoresis process
Serum globulin electrophoresis process
 
Antibodies Productions
Antibodies ProductionsAntibodies Productions
Antibodies Productions
 
Osteochondrosis
OsteochondrosisOsteochondrosis
Osteochondrosis
 
Structural evolution of globulin protein
Structural evolution of globulin proteinStructural evolution of globulin protein
Structural evolution of globulin protein
 
types of WBC
types of WBCtypes of WBC
types of WBC
 
Osteochondrosis
OsteochondrosisOsteochondrosis
Osteochondrosis
 

Similar to Rhematoid arthiritis

rheumatoid arthritis details ins and outs
rheumatoid arthritis details ins and outsrheumatoid arthritis details ins and outs
rheumatoid arthritis details ins and outs
Bosan Khalid
 
14-180530185343.pdf
14-180530185343.pdf14-180530185343.pdf
14-180530185343.pdf
Bucky10
 
Rheumatoid Arthritis
Rheumatoid ArthritisRheumatoid Arthritis
Rheumatoid Arthritis
yuyuricci
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
Rounak Bhandari
 
ATHRITIS Presentation, diqgnosis an.pptx
ATHRITIS Presentation, diqgnosis an.pptxATHRITIS Presentation, diqgnosis an.pptx
ATHRITIS Presentation, diqgnosis an.pptx
okumuatanas1
 
Rheumatoid arhtritis (1)
Rheumatoid arhtritis (1)Rheumatoid arhtritis (1)
Rheumatoid arhtritis (1)
Kavya
 
Rheumatoid arthritis nov 2020
Rheumatoid arthritis nov 2020Rheumatoid arthritis nov 2020
Rheumatoid arthritis nov 2020
Mukiza1
 
Ra conference may 2017
Ra conference may 2017Ra conference may 2017
Ra conference may 2017
Gregorio Cortes-Maisonet, MD, CHCP
 
Osteoarthritis
OsteoarthritisOsteoarthritis
connective tissue diseases.pptx
connective tissue diseases.pptxconnective tissue diseases.pptx
connective tissue diseases.pptx
MohammedAbdela7
 
A case presentation on juvenile idiopathic arthritis
A case presentation on juvenile idiopathic arthritisA case presentation on juvenile idiopathic arthritis
A case presentation on juvenile idiopathic arthritis
Dr. Tanvir
 
Disesases of locomotor system
Disesases of locomotor systemDisesases of locomotor system
Disesases of locomotor system
DrRavi Jain
 
Seropositive arthritis ppt
Seropositive arthritis pptSeropositive arthritis ppt
Seropositive arthritis ppt
Saurabh Chahar
 
Rheumatoid arthritis
Rheumatoid arthritis Rheumatoid arthritis
Rheumatoid arthritis
Zahirulkhan1
 
Arthritis and Rhematic diseases
Arthritis and Rhematic diseasesArthritis and Rhematic diseases
Arthritis and Rhematic diseases
Dr. Sanjib Kumar Das
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
government hospital
 
Introduction ,pathogenesis , clinical manifestations of rheumatoid
Introduction ,pathogenesis , clinical manifestations of rheumatoidIntroduction ,pathogenesis , clinical manifestations of rheumatoid
Introduction ,pathogenesis , clinical manifestations of rheumatoid
Pramod Yspam
 
Rheumatoid arthitis
Rheumatoid arthitisRheumatoid arthitis
Rheumatoid arthitis
krishna bhatt
 
Recent Advances In The Management Of Juvenile Idiopathic Arthritis
Recent Advances In The Management Of Juvenile Idiopathic ArthritisRecent Advances In The Management Of Juvenile Idiopathic Arthritis
Recent Advances In The Management Of Juvenile Idiopathic Arthritis
Naveen Kumar Cheri
 
Rheumatoid arthritis
Rheumatoid arthritis Rheumatoid arthritis
Rheumatoid arthritis
Jaskaran Sandhu
 

Similar to Rhematoid arthiritis (20)

rheumatoid arthritis details ins and outs
rheumatoid arthritis details ins and outsrheumatoid arthritis details ins and outs
rheumatoid arthritis details ins and outs
 
14-180530185343.pdf
14-180530185343.pdf14-180530185343.pdf
14-180530185343.pdf
 
Rheumatoid Arthritis
Rheumatoid ArthritisRheumatoid Arthritis
Rheumatoid Arthritis
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
ATHRITIS Presentation, diqgnosis an.pptx
ATHRITIS Presentation, diqgnosis an.pptxATHRITIS Presentation, diqgnosis an.pptx
ATHRITIS Presentation, diqgnosis an.pptx
 
Rheumatoid arhtritis (1)
Rheumatoid arhtritis (1)Rheumatoid arhtritis (1)
Rheumatoid arhtritis (1)
 
Rheumatoid arthritis nov 2020
Rheumatoid arthritis nov 2020Rheumatoid arthritis nov 2020
Rheumatoid arthritis nov 2020
 
Ra conference may 2017
Ra conference may 2017Ra conference may 2017
Ra conference may 2017
 
Osteoarthritis
OsteoarthritisOsteoarthritis
Osteoarthritis
 
connective tissue diseases.pptx
connective tissue diseases.pptxconnective tissue diseases.pptx
connective tissue diseases.pptx
 
A case presentation on juvenile idiopathic arthritis
A case presentation on juvenile idiopathic arthritisA case presentation on juvenile idiopathic arthritis
A case presentation on juvenile idiopathic arthritis
 
Disesases of locomotor system
Disesases of locomotor systemDisesases of locomotor system
Disesases of locomotor system
 
Seropositive arthritis ppt
Seropositive arthritis pptSeropositive arthritis ppt
Seropositive arthritis ppt
 
Rheumatoid arthritis
Rheumatoid arthritis Rheumatoid arthritis
Rheumatoid arthritis
 
Arthritis and Rhematic diseases
Arthritis and Rhematic diseasesArthritis and Rhematic diseases
Arthritis and Rhematic diseases
 
Rheumatoid arthritis
Rheumatoid arthritisRheumatoid arthritis
Rheumatoid arthritis
 
Introduction ,pathogenesis , clinical manifestations of rheumatoid
Introduction ,pathogenesis , clinical manifestations of rheumatoidIntroduction ,pathogenesis , clinical manifestations of rheumatoid
Introduction ,pathogenesis , clinical manifestations of rheumatoid
 
Rheumatoid arthitis
Rheumatoid arthitisRheumatoid arthitis
Rheumatoid arthitis
 
Recent Advances In The Management Of Juvenile Idiopathic Arthritis
Recent Advances In The Management Of Juvenile Idiopathic ArthritisRecent Advances In The Management Of Juvenile Idiopathic Arthritis
Recent Advances In The Management Of Juvenile Idiopathic Arthritis
 
Rheumatoid arthritis
Rheumatoid arthritis Rheumatoid arthritis
Rheumatoid arthritis
 

More from jasleenbrar03

RIGHTS OF MENTALLY ILL PATIENTS.pptx
RIGHTS OF MENTALLY ILL PATIENTS.pptxRIGHTS OF MENTALLY ILL PATIENTS.pptx
RIGHTS OF MENTALLY ILL PATIENTS.pptx
jasleenbrar03
 
Principles of mental health nursing
Principles of mental health nursingPrinciples of mental health nursing
Principles of mental health nursing
jasleenbrar03
 
Circadian rhythms
Circadian rhythmsCircadian rhythms
Circadian rhythms
jasleenbrar03
 
Genetics in psychobiology
Genetics in psychobiologyGenetics in psychobiology
Genetics in psychobiology
jasleenbrar03
 
Toxic shock syndrome
Toxic shock syndromeToxic shock syndrome
Toxic shock syndrome
jasleenbrar03
 
Experimental research design
Experimental research designExperimental research design
Experimental research design
jasleenbrar03
 
Alcoholism
AlcoholismAlcoholism
Alcoholism
jasleenbrar03
 
Grief and grief reactions
Grief and grief reactionsGrief and grief reactions
Grief and grief reactions
jasleenbrar03
 
Psychiatric terminologies
Psychiatric terminologiesPsychiatric terminologies
Psychiatric terminologies
jasleenbrar03
 
Leadership in nursing
Leadership in nursingLeadership in nursing
Leadership in nursing
jasleenbrar03
 
Endo tracheal Suctioning
Endo tracheal SuctioningEndo tracheal Suctioning
Endo tracheal Suctioning
jasleenbrar03
 
Nursing records & reports
Nursing records & reportsNursing records & reports
Nursing records & reports
jasleenbrar03
 
Critical thinking in nursing
Critical thinking in nursingCritical thinking in nursing
Critical thinking in nursing
jasleenbrar03
 
Histrionic personality disorder
Histrionic personality disorderHistrionic personality disorder
Histrionic personality disorder
jasleenbrar03
 
CAI & CAL
CAI & CALCAI & CAL
CAI & CAL
jasleenbrar03
 
Models of curriculum dvelopment
Models of curriculum dvelopmentModels of curriculum dvelopment
Models of curriculum dvelopment
jasleenbrar03
 
Nurse patient relationship and johari window
Nurse patient relationship and johari windowNurse patient relationship and johari window
Nurse patient relationship and johari window
jasleenbrar03
 
Freud theory
Freud theoryFreud theory
Freud theory
jasleenbrar03
 
Standards, challenges and scope of psychiatric nursing
Standards, challenges and scope of psychiatric nursingStandards, challenges and scope of psychiatric nursing
Standards, challenges and scope of psychiatric nursing
jasleenbrar03
 
Infection control
Infection controlInfection control
Infection control
jasleenbrar03
 

More from jasleenbrar03 (20)

RIGHTS OF MENTALLY ILL PATIENTS.pptx
RIGHTS OF MENTALLY ILL PATIENTS.pptxRIGHTS OF MENTALLY ILL PATIENTS.pptx
RIGHTS OF MENTALLY ILL PATIENTS.pptx
 
Principles of mental health nursing
Principles of mental health nursingPrinciples of mental health nursing
Principles of mental health nursing
 
Circadian rhythms
Circadian rhythmsCircadian rhythms
Circadian rhythms
 
Genetics in psychobiology
Genetics in psychobiologyGenetics in psychobiology
Genetics in psychobiology
 
Toxic shock syndrome
Toxic shock syndromeToxic shock syndrome
Toxic shock syndrome
 
Experimental research design
Experimental research designExperimental research design
Experimental research design
 
Alcoholism
AlcoholismAlcoholism
Alcoholism
 
Grief and grief reactions
Grief and grief reactionsGrief and grief reactions
Grief and grief reactions
 
Psychiatric terminologies
Psychiatric terminologiesPsychiatric terminologies
Psychiatric terminologies
 
Leadership in nursing
Leadership in nursingLeadership in nursing
Leadership in nursing
 
Endo tracheal Suctioning
Endo tracheal SuctioningEndo tracheal Suctioning
Endo tracheal Suctioning
 
Nursing records & reports
Nursing records & reportsNursing records & reports
Nursing records & reports
 
Critical thinking in nursing
Critical thinking in nursingCritical thinking in nursing
Critical thinking in nursing
 
Histrionic personality disorder
Histrionic personality disorderHistrionic personality disorder
Histrionic personality disorder
 
CAI & CAL
CAI & CALCAI & CAL
CAI & CAL
 
Models of curriculum dvelopment
Models of curriculum dvelopmentModels of curriculum dvelopment
Models of curriculum dvelopment
 
Nurse patient relationship and johari window
Nurse patient relationship and johari windowNurse patient relationship and johari window
Nurse patient relationship and johari window
 
Freud theory
Freud theoryFreud theory
Freud theory
 
Standards, challenges and scope of psychiatric nursing
Standards, challenges and scope of psychiatric nursingStandards, challenges and scope of psychiatric nursing
Standards, challenges and scope of psychiatric nursing
 
Infection control
Infection controlInfection control
Infection control
 

Recently uploaded

A Classical Text Review on Basavarajeeyam
A Classical Text Review on BasavarajeeyamA Classical Text Review on Basavarajeeyam
A Classical Text Review on Basavarajeeyam
Dr. Jyothirmai Paindla
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Jim Jacob Roy
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
Health Advances
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
Earlene McNair
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
suvadeepdas911
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
rightmanforbloodline
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
PsychoTech Services
 
The Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in IndiaThe Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in India
Swastik Ayurveda
 
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in IndiaTop 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Swastik Ayurveda
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
Swastik Ayurveda
 
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...
rightmanforbloodline
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
BrissaOrtiz3
 
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
Donc Test
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
Dr. Jyothirmai Paindla
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Tina Purnat
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
AksshayaRajanbabu
 

Recently uploaded (20)

A Classical Text Review on Basavarajeeyam
A Classical Text Review on BasavarajeeyamA Classical Text Review on Basavarajeeyam
A Classical Text Review on Basavarajeeyam
 
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdfOsteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
 
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptxEar and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune DiseaseCell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
 
Chapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptxChapter 11 Nutrition and Chronic Diseases.pptx
Chapter 11 Nutrition and Chronic Diseases.pptx
 
Aortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 BernAortic Association CBL Pilot April 19 – 20 Bern
Aortic Association CBL Pilot April 19 – 20 Bern
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...
 
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPromoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
 
The Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in IndiaThe Best Ayurvedic Antacid Tablets in India
The Best Ayurvedic Antacid Tablets in India
 
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in IndiaTop 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
 
Best Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and IndigestionBest Ayurvedic medicine for Gas and Indigestion
Best Ayurvedic medicine for Gas and Indigestion
 
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...
 
Netter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdfNetter's Atlas of Human Anatomy 7.ed.pdf
Netter's Atlas of Human Anatomy 7.ed.pdf
 
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
 
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptxshare - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
 
Abortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentationAbortion PG Seminar Power point presentation
Abortion PG Seminar Power point presentation
 

Rhematoid arthiritis

  • 1.
  • 2. Rheumatoid arthritis is an auto immune disease that is caused by chronic inflammation of the joints or in the membrane surrounding the joints (the synovial membrane)
  • 3.  Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder whose major distinctive feature is chronic, symmetrical and erosive inflammation of the synovial tissue of the joints.  The severity of the joint disease may fluctuate over time, but progressive development of various degrees of joint destruction, deformity and disability is the most common outcome of established disease.
  • 4.
  • 5. • About 1% of the world’s population is afflicted by rheumatoid arthritis. • Onset is most frequent between the ages of 20 and 40, but people of any age can be affected. • Women are three times more likely to get RA than men, however women who are taking or have taken oral contraceptives are less likely to develop RA.
  • 6. • Rheumatoid factor (RF), an autoantibody directed against immunoglobulin G (IgG) • Antibodies against collagen, Epstein-Barr virus, encoded nuclear antigen • Antikeratin antibody (AKA) & anti-perinuclear factor (APF)
  • 7. Genetic factors- People with RA are more likely to have a gene called HLA- DR4, located on chromosome 6. Environmental factors- Infectious agents that may induce RA are mycoplasma organisms, Epstein- Barr virus, rubella virus and Streptococcus. Smoking is also a major environmental risk factor. Hormonal factors- During pregnancy, women often experience a symptom improvement of RA, due to increase in estrogen and progesterone levels.
  • 8. • The pathologic process involved in RA are type 3( immune complex) and type 4( cell mediated) reactions. If unarrested, pathologic changes in RA pass through four stages: 1. Synovitis 2. Pannus formation 3. Fibrous ankylosis 4. Bony ankylosis
  • 9. Presentation of antigen to T cell T and B cell proliferation Activation of complement system Activation of complex system & release of lysosymes from leukocytes Proliferative inflammation localized in joint capsule Tissue thickens with edema and congestion SYNOVITIS STAGE 1
  • 10. PANNUS gradually develops Extends over the articular surface into joint anterior Adheres tightly to underlying cartilage by invasion and lysis Interferes with cartilage nutrition Pannus may extend over to subchondral bone Cartilage may become worn off and become raw STAGE 2
  • 11. Subchondral bone erosion Granulation tissue gets invaded with tough fibrous tissue Converted to scar tissue Inhibits joint movements Forms FIBROSIS ANKYLOSIS Progress to bony ankylosis STAGE 3 STAGE 4
  • 13.  Early stages –  Active inflammation of joints  Hot, swollen and painful joints and function may be decreased  Soft tissue deformity and contractures due to prolonged immobilization  Stiffness especially on first wakening in the morning
  • 14.
  • 15.  Later stages- Deformity of hands and feet due to misalignment resulting from swelling, progressive joint destruction or partial dislocation. Muscle spasm and weakness
  • 16.  Others –  Fever  Rheumatoid nodules at joint capsules  Fatigue  Weakness  Anorexia  Weight loss  Generalized aching
  • 17. Rheumatoid nodules •Subcutaneous •few millimetres to a few centimetres in diameter •usually found over bony prominences
  • 18. ULNAR DRIFT • Deviation of the MCP (metacarpophalangeal) joints of the fingers and medial deviation of the wrist. • Most marked in the little finger and involves each successive finger to a lesser degree.
  • 19. SWAN NECK DEFORMITY • Hyperextension of PIP (proximal interphalangeal) joint with flexion of the MCP and DIP (distal interphalangeal) joints. • Results from contractures of the intrinsic muscles and tendons.
  • 20. THE BOUTONNIERE DEFORMITY • Flexion of the PIP joints and hyperextension of the DIP joints. • Due to rupture of the extensor tendons over the fingers.
  • 21.
  • 22.  Vasculitis:  digital arteritis  fever, skin lesions  chronic leg ulcers  peripheral neuritis  necrotizing arteritis involving coronary, mesenteric or renal vessels.
  • 23.  Serositis:  Lungs-  Fibrosis of the lungs  Pleural effusions  Heart-  Prone to atherosclerosis,  Risk of myocardial infarction & stroke  Others: pericarditis, endocarditis, left ventricular failure, valvulitis and fibrosis.
  • 24.  Eye-  keratoconjunctivitis sicca  Nervous system-  Peripheral neuropathy  Carpal tunnel syndrome caused by compression of the median nerve by swelling around the wrist.  Anemia
  • 25. Radiologic examination- • This consists of X rays of both hands and of the affected joints. The following features may be present: • Reduced joint space • Erosion articular margins • Subchondral cysts • Soft tissue swelling
  • 26.
  • 27. Blood tests- • Elevated ESR • Decreased Hb value • Positive test for C reactive protein • ANA (antinuclear antibodies) – seen in 15-20% clients • Rheumatoid factor (RF)- It can be detected in serum by following tests: • Latex fixation test- positive in titre 1:20 • Rose- waaler test – agglutination test sheeps RBC are used as carrier.
  • 28. Synovial fluid examination- • Arthroscopic examination shows synovial fluid is cloudy, milky or dark yellow • contains numerous inflammatory components • reduced viscosity • WBC count is as high as 50,000/mm3
  • 29. 1. Morning stiffness of >1 hour most mornings for at least 6 weeks. 2. Arthritis and soft-tissue swelling of >3 of 14 joints/joint groups, present for at least 6 weeks 3. Swelling of atleast 1 wrist, MCP, or PIP joint, present for at least 6 weeks 4. Symmetric arthritis, present for at least 6 weeks
  • 30. 5. Subcutaneous nodules in specific places 6. Presence of Rheumatoid factor 7. Radiological changes suggestive of joint erosion  four or more of the seven criteria must be met before the disease is classified as RA.
  • 31.
  • 32. The aims are- • The induction of remission and its maintenance: the disease’s activity is brought under control by drugs. • The preservation of joint functions and prevention of deformities: during the activity of disease and thereafter by physiotherapy and splinting. • Repair of the joint damage which already exists: it will relieve pain or facilitate functions. It sometimes requires surgical interventions eg. Synovectomy.
  • 34. It has 3 goals: • Prevention of joint deformity • Preservation of joint function • Reduction of inflammation and pain.
  • 35. It consists of • Rest • Physical therapy (isometric exercises) • Hot and cold application (moist, dry heat, cold packs) • Diet
  • 36. • Drugs  Drugs like NSAID’s  Disease Modifying Anti- Rheumatic Drugs(DMARD’s)  Steroids Never massage acutely inflamed joint.
  • 37. • Aspirin / sodium salicylate:  They are analgesic, anti- inflammatory, relatively safe and inexpensive.  Analgesia is achieved in small doses and large doses are needed to reduce inflammation.  Frequent doses (3 to 4 times) are required, even when pain is not present to keep blood salicylate level high.
  • 38. • NSAID’s: if aspirin is ineffective NSAID’s are given. They are anti – inflammatory, analgesics and antipyretics e.g.  Phenylbutazone  Indomethacin  Ibuprofen * to be taken with histamine receptor antagonist.
  • 39. • Corticosteroids  Wysolone  Prednisolone • Intra- articular injections of corticosteroids • Immunosuppressive (cytotoxic) agents: Methotrexate,acts as an immunosuppresent, blocking the inflammatory process of RA.
  • 40. • No particular dietary modification is required. • The client is encouraged to eat a nutritious diet rich in vitamins, proteins, iron. • If client is overweight, they are taught to loose weight to relieve stress on affected joints.
  • 41. • Tendon transfers and osteotomy:  Prevents progressive deformity which would be caused by muscle spasm.  Nodules or bony tumors can be surgically removed.  Osteotomy may improve the function of deformed joints or limbs.
  • 42. • Synovectomy:  It helps in maintaining joint functions.  Early surgical removal of the synovium helps prevent recurrent inflammation.
  • 43. • Joint replacement: eg. Arthrodesis or arthroplasty( with or without replacement of joint parts with prosthesis).  Arthrodesis( fusion) sacrifices function of the joint but relieves pain in severely damaged joints.  Fusion may be performed on the wrists to fix affected part in a functional position so it can be used more effectively.
  • 44. • Arthrodesis – surgical fusion of joints
  • 45. • Hip arthroplasty: both joint component is replaced • Hemi arthroplasty: only one joint component is replaced eg. Replacement of head of femur with metal prosthesis.
  • 46. Thus the surgerical management is divided into: • Preventive surgery: eg synovectomy • Palliative surgery: for relief eg tendon transfer • Reconstructive surgery: for rehabilitation eg. Arthroplasty, total joint replacement