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Rheumatoid Arthritis

Rheumatoid Arthritis . Helen Allcock 2008. Rheumatoid arthritis facts . Chronic autoimmune disease inflammation of the joints and other areas of the body. no known cure periods of disease flares and remissions.

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Rheumatoid Arthritis

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  1. Rheumatoid Arthritis Helen Allcock 2008

  2. Rheumatoid arthritis facts • Chronic autoimmune disease • inflammation of the joints and other areas of the body. • no known cure • periods of disease flares and remissions. • Damage to joints can occur early and does not correlate with the degree of pain, stiffness, or swelling present in the joints. • Chronic inflammation leads to the destruction of the cartilage, bone and ligaments causing deformity of the joints. Can cause permanent joint destruction and deformity. • Early treatment of rheumatoid arthritis results in better outcomes

  3. Preventing this

  4. Rheumatoid arthritis affects • The joints • swelling, pain, stiffness, and redness • In the joint is essentially a disease of the synovium • Periarticular tissue • tendons, ligaments, and muscles • Other organs in the body • Usually progressive with potential to cause joint destruction and functional disability.

  5. Demographics • 1% population • Women 3x men (more equal in elderly) • All races equally • Onset at any age, but most often between 40-60 • Genetic tendency

  6. What causes rheumatoid arthritis? • Inherited tendency (HLA-DR4) • Certain infections or factors in the environment might trigger • Environmental factors e.g. smoking • Lymphocytes, are activated and chemical messengers (cytokines such as tumour necrosis factor/TNF and interleukin-1/IL-1) are expressed in the inflamed areas resulting in inflammation in various organs of the body

  7. Inside joint

  8. Tissues affected by RA • Joints • Lungs (pulmonary effusion, fibrosing alveolitis, nodules) • Eyes (Sjogren’s, episcleritis, Scleritis) • Heart (pericarditis, mitral valve disease, conduction defects) • Skin (palmar erythema, cutaneous vasculitis, pyoderma granulosum, rheumatoid nodules- pressure sites. most often around the elbows and fingers)

  9. Diagnosis • Symptom pattern • Morning Stiffness: >1h, >6w • General malaise fatigue • Joint pattern • Symmetrical • >3 joints • wrists and knuckles also the knees and joints of the ball of the foot are often affected (many joints may be involved) Not usually in fingers (common OA site) • Involvement of other parts of the body • Rheumatoid Nodules (20%) • Positive tests • RF • X-ray

  10. Investigations: • full blood count (FBC) • Erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) • rheumatoid factor (RF) • X-ray hands/feet (not necessary before referral)

  11. Treatment of rheumatoid arthritis Optimally involves a combination of patient education and support, rest and exercise, joint protection, medications, and occasionally surgery.

  12. Medication • Simple Analgesics • NSAID • Second-line drugs • Methotrexate, Penicillamine, Sulphasalazine, Chloroquine, Gold • Steroid therapy • Biological therapies

  13. GP role • Initial diagnosis and referral • Share in DMARD monitoring • Awareness of patients on biological therapies • Referral to specialised services, physiotherapy, podiatry, OT, social services • Supporting patient and their family

  14. Hospital Role • The initial confirmation of diagnosis • Intermittent review to check condition controlled • Commencement and monitoring of DMARDs and biological therapy. • Access to specialised services, physiotherapy, podiatry, OT.

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