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ARTHRITIS RHEUMATOID

ARTHRITIS RHEUMATOID. Eko Aribowo. ACRFP. RHEUMATOID ARTHRITIS. Chronic erosive sinovitis Poliartritis, potentially disabling More frequent in famela Extra articular manifestation » considered to be a systemic autoimmune disease. Batasan:.

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ARTHRITIS RHEUMATOID

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  1. ARTHRITIS RHEUMATOID Eko Aribowo

  2. ACRFP RHEUMATOID ARTHRITIS • Chronic erosive sinovitis • Poliartritis, potentially disabling • More frequent in famela • Extra articular manifestation » considered to be a systemic autoimmune disease

  3. Batasan: Artritis Reumatoid (AR) merupakan penyakit inflamasi sistemik kronik yang terutama mengenai sendi diartrodial Termasuk penyakit otoimun dengan etiologi yang tidak diketahui

  4. Kriteria diagnosis (ACR, 1987): • Kaku pagi, sekurangnya 1 jam • Artritis pada sekurangnya 3 sendi • Artritis pada sendi pergelangan tangan, MCP & PIP • Artritis yang simetris • Nodul reumatoid • Faktor reumatoid serum posistif • Gambaran radiologik yang spesifik • Untuk diagnosis AR, diperlukan 4 dari 7 kriteria tersebut diatas. Kriteria 1 - 4 harus minimal diderita selama 6 minggu • Diagnosis banding : • Spondiloartropati seronegatif • Sindrom Sjogren

  5. Activated Lymphocytes RestingT Cell G0 G1 S ­ DNA Synthesis ­ DHODH

  6. PATHOGENESIS OF RHEUMATOID ARTHRITIS The immunological role in inflammatory process: ANTIGEN IN SYNOVIUM (determinant HLA expression) APC IL-1 IL-2 Ag Trimolecular complex     Phagocytosis Y T cell ¥ Y Y Y Ab Y Limfokin, Inflammation mediator aktivation, proliferation of T cell B cell

  7. A First exposure to antigen (sensitizing dose) Second (or prolonged) exposure to antigen (challenge dose) B Antigen Antigen Selection of specific lymphocytes Secondary immune response         B lymphocytes Specific antibody 1 + weeks Primary transformation Immune response Antigen antibody complexes (immune complexes) circulate in blood (systemic) or form at site of antigen entry (local) Plasma cells Humoral immune response Immune complex deposition in tissues Complement activation Acute inflammation mediated by C3a, C5a;Necrosis (tissue damage) mediated by C6789 Production of specific antibody *IgG, IgM, rarely IgA)

  8. ACRFP NORMAL SYNOVIUM vs AR Normal Rheumatoid synovitis bursitis cartilage Hyperplasia of Lyning cell bone tendinitis pannus Polimorf exudation synovitis Mononuclear infiltration fibrosis monocyte

  9. ACRFP

  10. ESTABLISHED THE DIAGNOSIS • Evaluation • Disease aktivity/spread of synovitis • Structural damage • Functional status / psychosocial • Start the treatment • Education • Physiotherapy and occupational theraphy, etc. • Analgesic —» NSAIDs • Local steroid or oral (Prednison ≤ 10 mg) ACRFP Disease activity evaluation ACR GUIDELINEFOR THE TREATMENT OF AR

  11. Disease Activity evaluation Disease activity monitoring Start the DMARDs Consult to Rheumatologist Disease activity monitoring • Change the therapeutic plan • Consult to Rheumatologist • Change NSAIDs • Change / add the DMARDs • Local or oral steroid • Rehabilitation • ¥ • SURGERY Disease activity monitoring continously ACRFP ACR GUIDELINE FOR THE TREATMENT OF AR Spontaneous remission (uncommon) Active persistant disease Disease reactivation Remission or under controlled Active persistant disease Disease reactivation Remission or under controlled

  12. SOME DISEASE-MODIFYING ANTI-RHEUMATIC DRUGs (DMARDs) DMARDs • Methotrexate • Hydroxychloroquine • Sulphasalazine • Leflunomide • Azathioprine • Cyclosporine • Gold SHOULD BE MONITORED Haematologic, liver, lung Ofthalmologic Haematologic, GI Haematologic, liver Haematologic, liver Kidney, Blood pressure Haematologic, kidney

  13. SYSTEMIC LUPUS ERYTHEMATOSUS(SLE)

  14. Definisi A chronic inflammatory connective tissue disorder of unknown cause that can involve joints, kidneys, serous surfaces, and vessel walls and that occurs predominantly in young women but also in children

  15. Pathology, Symptoms, and Signs Articular symptoms, ranging from intermittent arthralgias to acute polyarthritis, In long-standing disease, capsular insertional erosions at the metacarpophalangeal joints with marked secondary joint deformity Cutaneous lesions include characteristic malar butterfly erythema; discoid lesions (see Discoid Lupus Erythematosus, below); and erythematous, firm, maculopapular lesions of the face, exposed areas of the neck, upper chest, and elbows Generalized or focal alopecia is common during active phases of SLE. Purpura may develop secondary to thrombocytopenia or necrotizing angiitis of small vessels Photosensitivity occurs in 40% of patients.

  16. Recurrent pleurisy, with or without effusion. Lupus pneumonitis is rare, Pericarditis is often present More serious rare complications are coronary artery vasculitis or fibrosingmyocarditis Generalized adenopathy is common, Histologically, the spleen may show periarterial fibrosis (onion skin lesion)

  17. CNS involvement can cause headaches, personality changes, stroke, epilepsy, psychoses, and organic brain syndrome Cerebral or pulmonary artery thrombosis or embolism, although rare, is associated with anticardiolipin antibodies Renal involvement may be benign and asymptomatic or relentlessly progressive and fatal

  18. The most common manifestation is proteinuria The histopathology of the renal lesion varies from a focal, usually benign glomerulitis to a diffuse membranoproliferativeglomerulonephritis Acute lupus hemophagocytic syndrome is a rare presentation of SLE, with fever and fulminantpancytopenia

  19. Diagnosis ANA test (antinuclear anti body) Anti DS DNA

  20. Kriteria ACR (1982) : • Ruam malar • Ruam diskoid • Fotosensitifitas • Ulserasi di mulut atau nasofaring • Artritis • Serositis, yaitu pleuritis atau perikarditis • Kelainan ginjal, yaitu proteinuria persisten > 0,5gr/hari, atau adalah silinder sel • Kelainan neurologik, yaitu kejang-kejang atau psikosis • Kelainan hematologik, yaitu anemia hemolitik, atau lekopenia atau limfopenia atau • trombositopenia • Kelainan imunologik, yaitu sel LE positif atau anti DNA posistif, atau anti Sm positif atau • tes serologik untuk sifilis yang positif palsu. • Antibodi antinuklear (Antinuclear antibody, ANA) positif • Diagnosis ditegakkan bila didapatkan 4 dari 11 kriteria diatas

  21. Treatment Management of idiopathic SLE depends on its manifestations and severity Corticosteroid Azathioprine cyclophosphamide

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