1 / 24

RHEUMATOID ARTHRITIS (RA)

RHEUMATOID ARTHRITIS (RA). Introduction. RA is a chronic, systemic inflammatory disorder of unknown etiology characterized by the manner in which it involved joints. Progressive joint destruction and deformity leads to variable degrees of incapacitation .

jbarrows
Download Presentation

RHEUMATOID ARTHRITIS (RA)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. RHEUMATOID ARTHRITIS(RA)

  2. Introduction • RAis a chronic, systemic inflammatory disorder of unknown etiology characterized by the manner in which it involved joints. • Progressive joint destruction and deformityleads to variable degrees of incapacitation. • F:M=2-3:1 40-60 years old

  3. Etiology • Genetic factorsHLA-DR4 • Infection

  4. Etiology • Rheumatoid factors (RF) are antibodies with specificity for antigenic determinates on the Fc portion of human or animal IgG. Currently, the most popular notion that RF arise as antibodies to “altered”autologous IgG.

  5. Ab Ab HLA pathogen

  6. Pathology • Synovitis edema, cell proliferation Rheumatoid pannus, a vascular granulation tissue composed of proliferation fibroblasts, numerous small blood vessels, and various numbers of inflammatory cells. • Vasculitis a widespread necrotizing arteritis of small and medium sized arteries

  7. Pathology • Rheumatoid nodules Characteristic histologic changes in nodules showing granulomatous foci with central zones of cell necrosis, surrounded by a palisade of proliferated mononuclear and peripheral fibrosis and chronic inflammatory cell infitration.

  8. Clinical features The onset of RA is frequently heralded by prodromal symptoms such as fatigue, anorexia, weight loss, weakness and generalized aching and stiffness. *Joint disease * Extraarticular manifestations

  9. Clinical features • Joint disease The small joints of the hands, the wrists, knees, and feet are most commonly involved. It usually is bilateral, symmetrical, and polyarticular.

  10. Clinical features • Joint disease • Morning stiffness • Swelling • Typical hand deformities • Limited joint motion

  11. Clinical features • Extraarticular manifestations • Rheumatoid nodules • Vasculitis • Pleuropulmonary manifestations • Cardiac manifestations • Neuropathy • Sjogren’s syndrome • Sicca features: Xerostomia & Xerophthalmia

  12. Xerostomia (Dry Mouth) Xerophthalmia (Dry Eyes)

  13. Rheumatoid Vasculitis RA Deformities

  14. Laboratory Tests for RA

  15. Laboratory findings • Anemia of moderate degree • ESR  a useful parameter for assessing response to therapy • C-reactive protein  • RF(usually IgM) • CIC  , complements  • ANA • Anti-CCP (cyclic citrullinated peptide)

  16. Rheumatoid Factor • Antibodies to Fc portion of IgG • 75-80% of Patients have during course of disease • Useful for prognosis

  17. Rheumatoid Factor • IgG Molecule • Fc Portion Autoantibodies (IgM) directed against the Fc Fragment of IgG An Antibody to an Antibody Their Role in RA is not understood Antigen Binding Groove

  18. Rheumatoid Factor • RFs are human auto-Abs that react with the Fc portion of normal polyclonal IgG. • Most routine clinical assays for RF detect only IgM RFs, although RFs can be any class of immunoglobulin • Named thus because their first description was in patients with rheumatoid arthritis

  19. Rheumatoid Factor • RF test is approximately 65%-75% sensitive for the diagnosis • The presence of RF, even in high titers or large amounts, is not specific for RA

  20. Condition Assoc . With(+) Tests for RF • Rheumatologic Diseases • Rheumatoid arthritis (~70%) • Sjögren’s syndrome (~90%) • Lupus (~20%) • Cryoglobulinemia syndrome (90%) • Lung Diseases • Interstitial fibrosis • Silicosis • Infections • Hepatitis C virus • Acute viral infections • Endocarditis • Tuberculosis • Miscellaneous • Sarcoidosis • Malignancies • Aging

  21. Laboratory findings • Synovial fluid • Radiology Bony decalcification localized to or most marked adjacent to the involved joints and not just degenerative changes • Rheumatoid nodules

More Related