Rheumatoid Arthritis “An Autoimmune Mystery”

1. Rheumatoid Arthritis“An Autoimmune Mystery” Cynthia Anderson

2. Dedicated to the memory of my late brother in law, Sherman F. Grace 1945-1991. He never let RA stop him from having a full productive life.

3. What is Rheumatoid Arthritis? A chronic disease characterized by the inflammation of the lining of the joints, which is called the synovium. Affects 2.1 million Americans between the ages of 20 and 50, but also affects young children and adults over 50 More common in women than men. Known as an autoimmune disease because the body’s immune system attacks the joint lining.

5. History of Rheumatoid Arthritis • 1858 – Dr Alfred Baring Garrod, named the condition Rheumatoid Arthritis. • 1895 – X-Ray was discovered. • 1912 – Dr. Frank Billings introduced the concept of focal infection. • In the 1920’s, physicians suspected the cause of RA was bacterial infection, they used gold and malaria drugs.

6. In 1940, was the turning point • Scientists discovered that RA was associated with a malfunction of the immune system. • Rheumatoid Factor was discovered simultaneously in Norway and Columbia Presbyterian Medical Center in New York. • 1949 – Dr. Phillip Hench treated arthritic patients successfully with Cortisone.

7. What is the cause of this disease? The exact cause of RA is unknown. Suspected causes are: Bacterial Infection Genetic Marker Stress Viral Infection

8. Symptoms of RA Patients • Fatigue. • Stiffness, especially in early morning and after sitting a long period of time. • Low Grade Fever, Weakness. • Muscle pain and pain with prolonged sitting. • Symetrical, affects joints on both sides of the body. • Rheumatoid nodules. • Deformity of your joints over time.

11. Juvenile Rheumatoid Arthritis • Causes joint inflammation and stiffness for more than six weeks in a child of 16 years of age or less. • There are three types, classified by the number of joints involved and symptoms. • Pauciarticular, the most common, four joints or fewer are affected.

12. JRA • Polyarticular, where five or more joints are affected. • Systemic, besides joint swelling, a fever and light skin rash is present. • Symptoms are similar to adults, joint swelling, pain, and stiffness in the morning or after a nap. It commonly affects the knees and joints in the hands and feet

13. In RA, for some unknown reason, the immune system considers its own joint tissues foreign. White blood cells that normally protect the body, migrate to the joint cavity. Synovium becomes inflammed and engorged with fluid, causing synovitis. Lymphocytes, Macrophages, continue to enter the joint cavity and multiply, differentiate, and release inflammatory mediators, cytokines, leukotrienes, and prostaglandins. How does the immune system play a role in this disease

14. Within weeks the synovium becomes thickened. • The mass of synovial tissue that spreads over the top of cartlidge in a rheumatoid joint is called a pannus, made of white blood cells: macrophages, B&T Cells, neutrophils, plasma cells, NK cells, and T Helper cells.

15. These cells produce the Rheumatoid Factor, prostaglandins, cytokines and other mediators. • Over time, the chemicals from the cells damage cartilage, ligaments, tendons, and bone.

17. Diagnosis Of RA • Clinical History • Physical Exams • Specific Lab Tests CBC ESR CRP RA Factor Anti CCP

18. Imaging Studies X-Ray MRI Cat Scan Bone Scan

20. Conventional Methods of Treatment • Nonsteroidal Anti Inflammatory Drugs (NSAIDs) – Aspirin, Ibuprofen, COX-2 inhibitor. • Corticosteroids – Cortisone • Disease Modifying Antirheumatic Drugs (DMARDs) – Methotrexate, Injectable Gold, Hydroxychloroquine. • Biologic Response Modifiers – Enbrel, Remicade, Humira.

21. Alternative Methods of Treatment • Diet • Exercise • Acupuncture • Herbal Medicines • Massage • Stress Reduction Techniques – prayer, meditation, hypnosis, yoga, tai-chi.

22. The Bottom Line!!

23. Conclusion • RA patients today can live a healthy and productive life. Today’s medicines used can relieve pain and swelling and in some cases put the disease in remission, preventing bone damage or deformity. • It is only a matter of time when researchers will find the reason why the body’s immune system attacks the synovial lining of the joints which causes this disorder known as Rheumatoid Arthritis.

24.   References Arthritis Foundation. “Disease Center.” Arthritis Foundation. 2004. 24 Aug. 2005. < http://www.arthritis.org/conditions/DiseaseCenter/RA/ra_overview.asp>. Arthritis Foundation. Good Living with Rheumatoid Arthritis. Atlanta: Arthritis Foundation, 2004. Lahita, Robert G. M.D. Rheumatoid Arthritis – Everything You Need to Know. New York: Avery, 2001 Mayo Clinic. “Rheumatoid Arthritis.” Mayo Clinic.com. Mayo Foundation for Medical Education and Research. 8 April. 2005. 10 Oct. 2005 http://www.mayoclinic.com/invoke.cfm?id=DS00020>. National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Questions and Answers About Juvenile Rheumatoid Arthritis.” National Institute of Health. 2001 July. 10 Oct. 2005. <http://www.niams.nih.gov/hi/topics/juvenile_arthritis/juvarthr.htm>. Oxford Journals. “Alfred Baring Garrod.” Heberden Historical Series. British Society for Rheumatology. 2001. 28 Oct. 2005. <http://rheumatology.oxfordjournals.org/cgi/content/full/40/10/1189?eaf>. Parham, Peter. The Immune System. New York: Garland Science Publishing, 2005. Shlotzhauer, Tammi L. M.D. and James McGuire M.D. Living with Rheumatoid Arthritis. Baltimore: John Hopkins University Press, 2003.