Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, typically affecting the small joints in the hands and feet. It results in warm, swollen, and painful joints and symptoms often worsen with rest. While the cause is unknown, it involves the immune system attacking the synovium lining of joints, causing swelling and damage over time. Diagnosis involves evaluating symptoms, physical exam findings, and blood tests for rheumatoid factor or anti-CCP antibodies. Complications can include joint deformity and damage, as well as increased risk of osteoporosis, carpal tunnel syndrome, heart and lung problems.

1. Pbl 2 - Rheumatoid arthritis
Asem shadid - 2016
• Rheuma- (Greek,) bodily humour, flow
• Toid – Resembling
• Arthr – (From Greek Arthron) joint
• Itis – A condition involving the inflammation of

2. Obj .
• Structure of synovial joints
• Rheumatoid arthritis
• Diffrential diagnosis
• What causes rheumatoid arthritis?
• Risk factors
• Symptoms of rheumatoid arthritis:
• How is rheumatoid arthritis diagnosed?
• Complications of rheumatoid arthritis:

3. Structure of Synovial Joints
• Articular Capsule
• This is a fibrous capsule which is continuous with the periosteum of
articulating bones. It consists of two layers:
• Outer fibrous layer – made up white fibrous tissue, called the capsular
ligament. This holds together articulating bones and supports the synovium.
• Inner synovial layer (synovium) – a highly vascularised layer of connective
tissue. It absorbs and secretes synovial fluid, and is responsible for the
mediation of nutrient exchange between blood and joint.

4. Con .
• Articular Cartilage
• Accessory Ligaments
• Accessory ligaments are separate ligaments or part of joint capsule. They
are made up of bundles of dense regular connective tissue, which are
highly adapted for resisting strain. This prevents any extreme movements
that may damage the joint.
• Bursae
• A bursa is a small sac lined by synovial membrane and filled with synovial
fluid. They are placed at key points of friction in a joint, providing the joint
with free movement.

5. Rheumatoid arthritis
• Rheumatoid arthritis is an autoimmune disease that can cause
chronic inflammation of the joints and other areas of the body,
typically affects the small joints in your hands and feet.
• It typically results in warm, swollen, and painful joints. Pain and
stiffness often worsen following rest.
• Most commonly the wrist and hands are involved with typically the
same joints involved on both sides of the body.
• Often symptoms come on gradually over weeks to months.
• Unlike the wear-and-tear damage of osteoarthritis, rheumatoid
arthritis affects the lining of your joints, causing a painful swelling
that can eventually result in bone erosion and joint deformity.
• It is a systemic (whole body) disorder principally affecting synovial
tissues.

6. • Arthritis of joints involves inflammation of the synovial
membrane. Joints become swollen, tender and warm, and
stiffness limits their movement.
• Most commonly involved are the small joints of the hands,
feet and cervical spine, but larger joints like the shoulder and
knee can also be involved.

7. Risk factors
• Factors that may increase your risk of rheumatoid arthritis
include:
• Sex. Women are more likely to develop rheumatoid
arthritis.
• Age. Rheumatoid arthritis can occur at any age, but it most
commonly begins between the ages of 40 and 60.
• Family history. If a member of your family has rheumatoid
arthritis, you may have an increased risk of the disease.

8. What causes rheumatoid
arthritis?
• The cause of RA is not known.
• It is not known what triggers the onset of rheumatoid
arthritis.
• In RA, the focus of the inflammation is in the synovium, the
tissue that lines the joint. Immune cells release inflammation-
causing chemicals.These chemicals can damage cartilage and
bone.

9. types of Arthritis
• there are types of Arthritis and I will only mention the three most
commonly occurring ones to give you a bit of an idea or
understanding.
• Juvenile occurs in people during their physically formative years
before adulthood and seems to most often resolve itself by the time
adolescence and puberty are finished.
• Osteoarthritis is likely to be the type that immediately comes to
mind when you hear the word Arthritis. It occurs basically from
‘wear-and-tear’ of the joints, so it is frequently found in the older
generations and it eventuates in areas of high mobility over years
and years of use.
• Rheumatoid Arthritis is an autoimmune disease in which the body
attacks its own joints by incorrectly assuming the cells in these areas
are foreign. Inflammation arises at the joints due to the friction
caused by movement.

11. Rheumatoid Arthritis Versus
Osteoarthritis:
• The term "arthritis" means inflammation of the joints that
leads to pain. Generally, when people talk about "arthritis,"
they're referring to "osteoarthritis," as osteoarthritis is far
more common. The table below illustrates the differences
between RA and OA:

12. Symptoms of Rheumatoid
Arthritis:
• Smaller joints - those in the feet, ankles, hands, and wrists - are
generally affected first. As RA progresses, shoulders, jaw, hips,
elbows, knees, and neck may become involved.
• Generally, the symptoms are symmetric - joints are affected on each
side of the body.
• Common symptoms may include:
• Joint pain
• Joint swelling
• Joints that are tender to the touch
• Red and puffy hands
• Firm nodules under the skin on your arms
• Exhaustion
• Morning stiffness (may last hours)
• Fever
• Weight loss

13. • What Are RA Flares?
• Flares (also known as flare-ups) are intermittent bouts of
disease activity and symptoms that come and go. Flares can
be triggered by infections or stress. Sometimes, RA flares are
triggered by nothing. It's unclear as to what precisely triggers
the RA flare-up.
• Rheumatoid arthritis signs and symptoms may vary in severity
and may even come and go. Periods of increased disease
activity, called flares, alternate with periods of relative
remission — when the swelling and pain fade or disappear.
Over time, rheumatoid arthritis can cause joints to deform
and shift out of place.

14. How is rheumatoid arthritis
diagnosed?
• Around 70% of people can be diagnosed with RA by having a
positive Rheumatoid Factor. A blood test will show these
antibodies in the blood. A positive Rheumatoid Factor isn't a
definitive test to diagnose RA, and there will be some who
have no Rheumatoid Factor who do in fact have RA.
• Anti-CCP (anti-cyclic citrullinatedpeptide) is another antibody
present in the blood that is much more specific to RA patients.
Close to 98% of patients who test positive for this antibody
are diagnosed with RA.
• Scans and other diagnostic tools, including surgery, can be
used for diagnosing more complicated cases of RA.

15. Con .
• RA can be hard to detect because it may begin with subtle symptoms,
such as achy joints or a little stiffness in the morning. Also, many
diseases behave like RA early on. For this reason,Diagnosis of RA
depends on the symptoms and results of a physical exam, such as
warmth, swelling and pain in the joints. Some blood tests also can help
confirm RA. Telltale signs include:
• Anemia (a low red blood cell count)
• Rheumatoid factor (an antibody, or blood protein, found in about 80
percent of patients with RA in time, but in as few as 30 percent at the
start of arthritis)
• Antibodies to cyclic citrullinated peptides (pieces of proteins), or anti-
CCP for short (found in 60–70 percent of patients with RA)
• Elevated erythrocyte sedimentation rate (a blood test that, in most
patients with RA, confirms the amount of inflammation in the joints)
• X-rays can help in detecting RA, but may not show anything abnormal in
early arthritis.

16. Complications of Rheumatoid
Arthritis:
• The joint damage RA causes can disfigure and damage the
ends of bones, making it nearly impossible to complete
activities of daily living. It may be harder to do even the
simplest activities.
• Since RA is an autoimmune disease, it causes problems with
the skin, eyes, lungs, heart, and other organs.
• The medications used for treatment can cause side effects and
living with a chronic condition such as RA can cause
depression and anxiety.
• Rashes, ulcers, vision loss, lesions, and lack of tears are all
complications that can be traced back to the RA diagnosis.

17. Con .
Rheumatoidarthritis increasesyourriskof
developing:
• Osteoporosis. Rheumatoid arthritis itself, along with some
medications used for treating rheumatoid arthritis, can
increase your risk of osteoporosis — a condition that weakens
your bones and makes them more prone to fracture.
• Carpal tunnel syndrome. If rheumatoid arthritis affects your
wrists, the inflammation can compress the nerve that serves
most of your hand and fingers.
• Heart problems. Rheumatoid arthritis can increase your risk
of hardened and blocked arteries, as well as inflammation of
the sac that encloses your heart.
• Lung disease. People with rheumatoid arthritis have an
increased risk of inflammation and scarring of the lung tissues,
which can lead to progressive shortness of breath.

18. Thanks …
• Asem shadid