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C27 Rheumatoid Arthritis

C27 Rheumatoid Arthritis. Objectives. Define rheumatoid arthritis (RA) Discuss general facts about arthritis Identify causes and risk factors Review the signs and symptoms How imaging is used in diagnoses of RA Treatment options Anti-inflammatory diets Conclusion. Thesis.

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C27 Rheumatoid Arthritis

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  1. C27 Rheumatoid Arthritis

  2. Objectives • Define rheumatoid arthritis (RA) • Discuss general facts about arthritis • Identify causes and risk factors • Review the signs and symptoms • How imaging is used in diagnoses of RA • Treatment options • Anti-inflammatory diets • Conclusion

  3. Thesis • Rheumatoid Arthritis is a systemic inflammatory disease which causes cartilage and bone destruction in primarily the aging population as well as females; however, treatment methods have greatly enhanced over the years improving the overall quality of life for people suffering from this debilitating disease.

  4. What is Rheumatoid Arthritis? • Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation in the affected parts of the body. • RA mainly attacks the joints • Hands, wrists, knees • Can cause chronic pain, loss of balance, and deformity • Can also affect other tissues throughout the body1 https://www.google.com/search?q=rheumatoid+arthritis&tbm=isch&tbs=rimg:Caa0R1KyCVfJIjgM1YDMObwCPwsAelHoSZhczXeWrNWu5TCCOZ2pWV8dpr8eTr7gwVwI5_16zHejB6q8Atn1g3rGJMyoSCQzVgMw5vAI_1EVN4sLFkmInQKhIJCwB6UehJmFwRzW3T_1krCVeEqEgnNd5as1a7lMBHzvSFhVSuwjioSCYI5nalZXx2mEYeET_14o7dzJKhIJvx5OvuDBXAgRo8tQ9nY5WJAqEgnn_1rMd6MHqrxGXnUsGi2MZdioSCQC2fWDesYkzEfsIBNd3kbjU&tbo=u&sa=X&ved=2ahUKEwj3n4PdyI_hAhUKeKwKHSsTAEkQ9C96BAgBEBs&biw=1438&bih=689&dpr=0.95#imgrc=74x8jiWJxzpwsM:

  5. Understanding the term “Arthritis” • Arthritis is very common but not well understood. It is not a single disease, rather, an informal way of referring to joint pain or joint disease. • Common arthritis joint symptoms include: • Swelling • Pain • Stiffness • Decreased range of motion • Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time.2 https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=EZaRXOC0J4HIsQXB3oiACQ&q=joint+pain&oq=joint+pain&gs_l=img.3..0l10.112556.118301..118497...0.0..0.115.942.7j3......1....1..gws-wiz-img.......0i67.ufOpiw7CbbI#imgdii=_9Mx_miHe03c5M:&imgrc=kFVia3rLu6gyXM:

  6. Things you should know about Arthritis • There are more than 100 different types of arthritis and related conditions. • People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. • More than 50 million adults and 300,000 children have some type of arthritis. • Most common in women and occurs more frequently as people get older.2 • The most common types include: • Osteoarthritis (OA) • Rheumatoid arthritis (RA) • Psoriatic arthritis (PsA) • Fibromyalgia and gout3

  7. Causes of RA • RA is triggered by exposure of an immunogenetically susceptible host to an arthritogenic antigen and is characterized by chronic inflammation and overgrowth of the synovial tissues, most often in the extremities.4

  8. Risk Factors • Sex • 70% of people diagnosed are women • Fluctuation in hormone levels can trigger onset • Certain contraceptives • After giving birth • Age • RA can occur at any age, but it most commonly between ages 30 and 40 years. • Family history • A blood test can be done to test for the rheumatoid facture • Smoking • Environmental exposures • Obesity(4,5)

  9. Signs and Symptoms • Unfortunately, it can sometimes be difficult to detect and diagnose RA because early symptoms are often subtle and nonspecific. • Early symptoms include: • Fatigue • Stiffness • Tenderness in joints • Symptoms appear differentlyin most patients and many mayhave periods of time where theyexperience no symptoms at all.5 https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=bJiRXOzQLea7tgWZopX4Aw&q=joint+tenderness&oq=joint+tenderness&gs_l=img.3..0j0i5i30l4j0i8i30l4j0i24.14760.17978..18211...0.0..0.170.1547.12j4......1....1..gws-wiz-img.......0i67.34N2MFJAhPI#imgrc=X0FyRlzE2z2r_M:

  10. Signs and Symptoms • As the disease progresses, cortical erosion with joint space narrowing occurs because of the overgrowth of synovial tissue into the articular spaces. • This severe damage makes the joint unstable and leads to deformity caused by displacement of the bones in the joint. • The late stages of this condition may be quite severe, resulting in bone and cartilage destruction and subluxation or dislocation of the involved joint. • Eventually, the joints become fused which could result in a surgical intervention4 https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=8zGYXO_dPMb0tAW-tbuwCw&q=rheumatoid+arthritis&oq=Rh&gs_l=img.1.0.0i67j0l2j0i67j0l5j0i67.2246.4183..5961...0.0..0.152.449.1j3......1....1..gws-wiz-img._PBVd9SBb3E#imgrc=6XxRK9dDw2utfM:

  11. Signs and Symptoms • RA tends to affect the smaller joints in the body first. • Heavy inflammation of the joints can last for months at a time. https://www.collective-evolution.com/2016/01/26/how-to-put-rheumatoid-arthritis-into-remission/ Additionally, RA usually affects the body symmetrically, which means the same joints on both sides of the body will show symptoms at the same time. Over time, RA can cause joints to deform and shift out of place.6

  12. Diagnosis • RA can be difficult to diagnose because the early signs and symptoms mimic those of many other diseases. • During a physical exam, doctors will check joints for swelling, redness and warmth as well as reflexes and muscle strength. • New advancements in disease-modifying antirheumatic drugs (DMARD) and the availability of new biologic agents have enhanced the success of the management of RA. • Imaging tests that help track the progression of the disease are: • X-ray • MRI • Ultrasound6

  13. Diagnostic Imaging • In early RA, however, X-rays may appear normal although the disease is active- making the films useful as a baseline but not much help in getting a timely diagnosis and treatment. • The radiographic changes seen early in this disease are soft tissue swelling and osteoporosis of the affected bones.7 Subluxation at the 3rd metacarpophalangeal joint and marginal erosions at the heads of the 2nd- 4th metacarpals.7 https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=_AWYXIXEA6PgjwSCzLv4BQ&q=hand+x-rays+for+Rheumatoid+arthritis&oq=hand+x-rays+for+Rheumatoid+arthritis&gs_l=img.3...29043.37796..38419...0.0..0.161.1731.10j7......1....1..gws-wiz-img.GeaO1CXZdbM#imgrc=_ https://emedicine.medscape.com/article/401271-overview#a2

  14. X-ray Interpretation • Hand radiographs are typically done in 3 views; PA, oblique, lateral https://www.rheumtutor.com/rheumtutoring/approach-to-hand-x-rays/ This is the most commonly used view for interpretation. Finger deformities may not be noticed as patients are required to press their hands down firmly against the plate, while the X-Rays are shot from above.7

  15. Ball-Catcher’s (Norgaard’s) View • Hands are in a “ball catching” position • This is the best view to look for early erosions at the base corners of the proximal phalanges7 https://www.rheumtutor.com/rheumtutoring/approach-to-hand-x-rays/

  16. The ABCDS Approach • It is best to have a systemic approach to reading x-rays of the hand. The actual order is less important, but one useful strategy is the ABCDs approach. • Alignment • Bone • Mineralization, Periarticular Osteopenia • New bone formation: • Joint spaces • Erosions • Fractures • Cartilage • Joint spaces • Calcifications • Distribution of any changes • A pattern of joint involvement, symmetry • Soft tissues • Swelling, calcifications7

  17. Advantages of MRI • Assessment of peripheral joints for active inflammation, as well as inflammatory changes and post-inflammatory complications in the spine. • Detection of bone marrow edema, which is thought to be a precursor for development of erosions in early RA • Measurements of vascularization, thickness of synovium. • The multiplane, multislice capacity of MRI allows visualization of the area of interest in three orthogonal planes.8 https://www.google.com/search?q=MRI+for+RA&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjAipTvjpzhAhVF1qwKHb66A6kQ_AUIDigB&biw=842&bih=596&dpr=0.95#imgdii=G08J9PbKzlorKM:&imgrc=VEaUrxMM3HUOkM: https://www.google.com/search?q=MRI+for+RA&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjAipTvjpzhAhVF1qwKHb66A6kQ_AUIDigB&biw=842&bih=596&dpr=0.95#imgdii=urWUOGXgu4bx6M:&imgrc=VEaUrxMM3HUOkM:

  18. Advantages of Ultrasound • High availability, low cost, and high patient acceptance compared to MRI. • Assessment of peripheral joints for active inflammation. • Dynamic examination of peripheral joints, useful in the assessment of inflammatory changes. • Measurements of vascularization, thickness of synovium.8 https://www.google.com/search?biw=842&bih=596&tbm=isch&sa=1&ei=hiuYXLrvCozQtAWnh5rIDw&q=ultrasound+for+RA&oq=ultrasound+for+RA&gs_l=img.3...1759678.1764688..1764941...0.0..0.375.1686.4j6j1j1......1....1..gws-wiz-img.......0i8i30j0i8i7i30j0i24j0j0i10.9uouUDzsZGE#imgdii=6OnK4HvSuGvgsM:&imgrc=xs9xKyOCYuX3gM: https://www.google.com/search?biw=842&bih=596&tbm=isch&sa=1&ei=hiuYXLrvCozQtAWnh5rIDw&q=ultrasound+for+RA&oq=ultrasound+for+RA&gs_l=img.3...1759678.1764688..1764941...0.0..0.375.1686.4j6j1j1......1....1..gws-wiz-img.......0i8i30j0i8i7i30j0i24j0j0i10.9uouUDzsZGE#imgrc=1ve2Jw9H842dGM:

  19. Early Forms of Treatment • Gold therapy was one of the original medications developed specifically to treat RA and have been used for more than 75 years. • Gold injections are a compound called sodium aurothiomalate which contains gold. • They belong to a disease modifying anti-rheumatic drugs (DMARDs). • Given orally or by injections into muscle • Not really used anymore as a treatment option due to severe side effects.9 https://www.everydayhealth.com/rheumatoid-arthritis/treatment/gold-therapy-for-rheumatoid-arthritis/

  20. How is RA Treated? • Goal: • Reduce symptoms • Maintain remission • Prevent flares, complications • Prevent joint damage, disability • Maintain quality of life • Treatment is tailored to individual • Based on symptoms, coexisting conditions, lifestyle • Treatment is usually continuous • Combination of medication and non-medical therapy • Early treatment is key10

  21. Anti-inflammatory diet • One of the best measures a person can take to prevent or reduce inflammation is to try an anti-inflammatory diet. An anti-inflammatory diet involves eating certain foods and avoiding others in order to minimize the symptoms of chronic inflammatory diseases. • What is an anti-inflammatory diet? • An anti-inflammatory diet consists of foods that reduce inflammatory responses. This diet involves replacing sugary, refines foods with whole, nutrient-rich foods.11

  22. Lets see what you know! • Which one of the following would be considered an anti-inflammatory food? Soybean oil Gluten Turmeric Vegetableoil

  23. Correct https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=bDKYXOX6EZHasQXWoa-ICw&q=healthy+lifestyle+for+people+with+rheumatoid+arthritis&oq=healthy+lifestyle+for+people+with+rheumatoid+arthritis&gs_l=img.3...80963428.80979711..80980007...0.0..0.113.5044.39j15......1....1..gws-wiz-img.......0j0i67j0i8i30j0i24.FDfhX-TY3Ss#imgrc=_j-5sJzawg4YWM: Turmeric is a mustard-yellow spice that contains curcumin, which plays a vital role in reducing rheumatoid-related inflammations at a cellular level.12 Back Next

  24. Incorrect These foods can actually trigger flares in some inflammatory diseases.12 Back

  25. Do you think red wine can act as an anti-inflammatory? True False https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=wG6ZXPCCDsTetQWBmaSIAw&q=red+wine&oq=red+wine&gs_l=img.3..0l10.534483.535558..535774...0.0..0.127.756.7j1......1....1..gws-wiz-img.......0i67.tbw6kMOOnic#imgrc=6bFXQRWl5KJO9M:

  26. Correct Red wine, in moderation, can act as an anti-inflammatory in diseases like rheumatoid arthritis.11 Next

  27. Guess again! Red wine, in moderation, can act as an anti-inflammatory in diseases like rheumatoid arthritis.11 Back

  28. What to take away • Foods to eat • Dark leafy greens • Beans and lentils • Green tea • Avocado and coconut • Extra virgin olive oil • Turmeric and cinnamon • Dark chocolate • Foods to avoid • Processed meats • White bread • White pasta • Gluten • Processed snack foods • Excess alcohol • Too many carbohydrates Anti-inflammatory diets promote a reduction in inflammation. A person may be able to reduce their body’s inflammatory response by implementing some of these healthful dietary changes.11

  29. Anti-inflammatory diet tips • Eating a variety of fruits and vegetables • Reducing the amount of fast food eaten • Eliminating soda and sugary beverages • Carrying small anti-inflammatory snacks while on the go • Drinking more water11 https://nutritionfacts.org/2017/05/09/the-best-diet-for-rheumatoid-arthritis/

  30. Click each link below to learn more about their anti-inflammatory properties. Cherries Blackstrap Molasses Fish oil

  31. Cherries https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=QnOZXLvQBoPusQWh4764DQ&q=cherries&oq=cherries&gs_l=img.3..0l10.115257.116865..117107...0.0..0.104.720.7j1......1....1..gws-wiz-img.......0i67.2ZLlKSDEi5o#imgrc=V7WQ1o7wT94HTM: Cherries are highly enriched in antioxidants, which protect your bodies cells from the harmful effects of free radicals; research has found that a diet rich in cherries can lower inflammation by 50 percent.12 Back

  32. Blackstrap Molasses https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=2XCZXJ6aEsSgswWB4KvgDw&q=blackstrap+molasses&oq=blackstra&gs_l=img.1.0.0l10.246935.249921..252030...0.0..0.115.903.5j4......1....1..gws-wiz-img.......0i67j0i10.LHQH5iTTjEw#imgrc=i--s4n974FW5IM: Since blackstrap is rich in vitamins and nutrients such as magnesium, medical experts believe that it can work wonders in relieving joint pain associated with rheumatoid arthritis.12 Back

  33. Fish oil https://www.google.com/search?biw=1438&bih=689&tbm=isch&sa=1&ei=1nGZXPfLEYeWtQWY3IGYCw&q=fish+oil&oq=fish+oil&gs_l=img.3..0l10.359714.362063..362477...0.0..0.115.764.6j2......1....1..gws-wiz-img.......0i67.BqmVCedbqfI#imgrc=9UiwCZMfAsPVnM: Fish oil is found in sardines, salmon, anchovies, trout, herring, and mackerel, and helps in decreasing inflammation and suppressing the symptoms of rheumatoid arthritis.12 Back Next

  34. Conclusion • RA is a chronic potentially debilitating disease that can effect people at any age but primarily in women and the aging population. • RA primarily affects joints but may have systemic manifestations • It can be difficult to detect early on but with a variety of imaging modalities a treatment plan can be formulated that best suites the individual. • Early treatment as well as living a healthy lifestyle is key for reducing the progression of the disease. • RA affects millions of people all at varying degrees. It is important for people to understand this disease as well as other types of arthritis so that those at risk can have a better opportunity to get an early diagnosis or make healthier life choices.

  35. Sources • Centers for Disease Control and Prevention. Rheumatoid Arthritis. Centers for Disease Control and Prevention. https://www.cdc.gov/ arthritis/ basics/rheumatoid-arthritis.html. Published March 16, 2004. Accessed March 7, 2019. • Arthritis Foundation. What is Arthritis? Arthritis Foundation. https://www.arthritis.org/about- arthritis/understanding-arthritis/what-is-arthritis.php. Updated October 13, 2017. Accessed March 7, 2019. • Arthritis Foundation. Sources of Arthritis. Arthritis Foundation. https://www.arthritis.org/living-with-arthritis/pain-management/understanding/types-of-pain.php. Updated October 13, 2017. Accessed March 7, 2019. • Kowalczyk, N. Radiographic Pathology for Technologists. Columbus, Ohio: Elsevier Mosby;2014. • Mayo Clinic. Rheumatoid arthritis- Symptoms and causes, and complications. Mayo Clinic. https://www.mayoclinic.org/ diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648. Published March, 1 1997. Updated December 5, 2018. Accessed March 7, 2019. • Ezerioha, Mathew MD. Let’s Dig Into Everything about RA. Rheumatoid Arthritis Support Network. https://www.rheumatoidarthritis.org/ra/#causes. Updated September 13, 2018. Accessed March 18, 2019.

  36. Sources • Carmona, Raj. Approach to Hand X-rays. Rheum Tutor. https://www.rheumtutor.com/ rheumtutoring/approach-to-hand-x-rays/. Accessed. March 23, 2019. • Sudol-Szopinska, I. Rheumatoid arthritis: what do MRI and ultrasound show. Journal of Ultrasonography. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392548/. Published March 31, 2017. Accessed March 23, 2019. • Arthritis Research UK. Gold injections. Arthritis Research UK. file:///C:/Users/Rebecca/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/Gold-injections_2246-13-2%20(3).pdf. Published November 2013. Accessed March 23, 2019. • Kennish, L. MD, Rheumatologist. Living with Rheumatoid Arthritis. Slide Presentation. New Jersey. Health and Medicine, 2015. • Fletcher, J. Anti-inflammatory diet: What to know. Medical News Today. https://www.medicalnewstoday.com/articles/320233.php. Updated December 3, 2017. March 25, 2019. • Rheumatoid Arthritis Diet. Findatopdoc. Video. FindaTopDoc Media. 2017

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