2 Rheumatoid arthritis (RA) is a chronic systemic inflammatory disorder that may affect many tissues and organs—skin, blood vessels, heart, lungs, and muscles—but principally attacks the joints, producing a non-suppurative proliferative and inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints.
3 Although the cause of RA remains unknown, autoimmunity plays a pivotal role in its chronicity and progression.About 1% of the world's population is afflicted by RA, women two to three times more often than men. It is most common in those age 40 to 70, but no age is immune.
4 :* Pathophysiology Unknown antigen stimulates CD4+ T lymphocytes. Active CD4+ T lymphocytes;stimulates macrophages to release IL1 and TNF.Release RANKL which stimulates osteoclasts leading to bone destruction.IL-1 and TNF stimulates synovial cells leading to:Synovial cell proliferation and formation of pannaus.Production of prostaglandins (pain sensation) and matrix metalloproteinases that cause cartilage destruction.
10 Symmetric peripheral polyarthritis: 3 or more Joints for >6 weeksSmall JointsHands & feetsPeripheral to ProximalLeads to deformity & destruction of Joints.
11 Morning stiffness: Morning or after Prolonged Inactivity. Bilateral > 1 hour.Better with movementPain with movement of joint
12 Physical Examination: Decreased grip strengthCarpal tunnel syndrome(condition characterized by pain and numbing or tingling sensations in the hand and caused by compression of a nerve in the carpal tunnel at the wrist.Ulnar deviation
17 Rheumatoid arthritis showing inflammatory cell infiltrate in the synovium
18 3. Laboratory investigations: Rhumatoid Factor:Positive in 70-80% of patients.- - IgM or IgG- If IgM+ve : more severe disease & poorer outcome.Acute Phase reactants:ESR, CRP monitoring disease activity