Rheumatoid Arthritis RA

-Is a chronic,systemic inflammatory disorder that may affect many tissues and organs (multisystemic disease)

-Rheumatoid arthritis can also produce diffuse inflammation in the lungs,membrane around the heart (pericardium),the membranes of the lungs (pleura),and white of the eye (sclera),and also nodular lesion,most common in subcutaneous tissue (DIP)

-RA is considered a systemic autoimmune disease / about 1% of the worlds population is afficted by rheumatoid arthritis,women three times more often than men / onset is most frequent between the ages of 40-50yrs,but people of any age can be affected

-Symptoms & Signs :

*Joints (known as synovitis)- is inflammation of the synovial membrane that lines joints

.joint become swollen,tender and warm,and stiffness limites their movement

.The affected joints being swollen,warm,painful and stiff,paraticulary early in the morning on waking or following prolonged inactivity and releived by activity

.RA nearly always affects multiple joints (polyarthritis), most commonly small joints of the hands,feet and cervical spine

.In RA,the joints are often affected in a symmetrical fashion (bilateral),and may be asymmetrical

*Skin (rheumatoid nodule) is the feature most characteristic of rheumatoid arthritis

.erythema nodosum (painful,rash ‘anterior to tipia’)

.labular panniculitis

.atrophy of digital skin

.palmar erythema

*Lungs

.fibrosis of the lungs

.pleural effusions (exudate)

*Kidneys

.renal amyloidosis

*Heart and Blood vessels

.athreosclerosis

.risk of MI (heart attack) and stroke

.pericarditis

.endocarditis

.left ventricular failure

.valvulitis and fibrosis

*Ocular

.keratoconjunctivitis episcleritis

*Hepatic

.felty`s syndrome (hepatosplenomegaly- pancytopenia)

*Hematological

.anemia

.neutropenia

.thrombocytosis

.lymphoma

*Neurological

.carpa; tunnel syndrome (M.C problem)

*Constitutional symptoms

.fatigue

.low grade fever

.malaise

.morning stiffness

.loss of appetite

.loss weight

*Other

.Episcleritis may occur

.Amyloidosis is a recognized complication

-Joints may be involved in rheumatoid arthritis :

.Proximal interphalangeal joints

.Knee joints

.Wrist joints

.Ankle joints

+Distal interphalangeal joints (don`t affect)

-Diagnosis :

.X-rays (in RA, there may be no changes in the early stages of the disease)

.Blood tests (presence of rheumatoid factor-A negative RF does not rule out RA/positive RF is bad prognosis-this test is not very specific / anti-CCP is more specific)

-Laboratory findings :

.RF or anti-CCP (cyclic citrullinated peptide)

.anemia

.ESR or CRP

.X-ray

.synovial fluid analysis

+RF (is also seen in other diseases) :

.siogren`s syndrome (Positive tests for rheumatoid factor commonly occur in Sjogren's syndrome)

.hepatitis C

.chronic infections

-Criteria :

.tow or more swollen joints

.morning stiffness (>1hr) for 6 weeks

.the detection of RF (RF positive or anti-CCP)

.ESR or CRP

-Treatment :

.disease-modifying antirheumatic drugs (DMARDs) the best initial DMARDs is MTX

.NSAID

.rest and physical activity

.pharmacological such as (azathioprine,ciclosporin,D-penicillamine,gold salts,hydroxychloroquine ‘antimalaria’,lefulunomide,methotrexate MTX,minocycline,sulfasalazine SSZ,cyclophosphamide)

Date: 2016-04-22; view: 518