Rheumatoid Arthritis

Pathophysiology
Maj Muhammad Omair Riaz

Learning objectives
• • • • • What is Rheumatoid Arthritis (RA)? What is the pathophysiology of RA? What are its clinical features? How to diagnose? How to manage it?

16/05/2012

2

Dr Muhammad Omair Riaz

Sequence of Presentation
• • • • • • • • Introduction Epidemiology & history Etiology and risk factors Pathophysiology Clinical Features Complications Diagnosis Management
3 Dr Muhammad Omair Riaz

16/05/2012

16/05/2012

4

Dr Muhammad Omair Riaz

Introduction
Rheumatoid arthritis is a chronic inflammatory disorder that typically affects the small joints in hands and feet. Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.
Mayo Clinic. http://www.mayoclinic.com. Accessed 16 May 2012

16/05/2012

5

Dr Muhammad Omair Riaz

16/05/2012

6

Dr Muhammad Omair Riaz

Epidemiology (Disease burden)
• World • Pakistan Population: Disease burden: 3 per 10,000 population

180 Million 54000

16/05/2012

7

Dr Muhammad Omair Riaz

16/05/2012

8

Dr Muhammad Omair Riaz

History
• First known cases – 4500 BC • First historic case report – 123 AD • First modern description – 1800 by French physician Dr Augustin Jacob Landré-Beauvais (1772–1840)

16/05/2012

9

Dr Muhammad Omair Riaz

16/05/2012

10

Dr Muhammad Omair Riaz

Etiology
• Genetics No disease causing gene identified Disease susceptibility genes ? • Infections Viral Bacterial

16/05/2012

11

Dr Muhammad Omair Riaz

16/05/2012

12

Dr Muhammad Omair Riaz

Risk factors
Gender Women are more likely to develop RA Age Can occur at any age Most commonly 40-60 years Family history Smoking
16/05/2012 13 Dr Muhammad Omair Riaz

16/05/2012

14

Dr Muhammad Omair Riaz

Clinical features
• Tender, warm, swollen joints Initial small joint involvement often bilateral • Morning stiffness that may last for hours • Firm bumps of tissue under the skin on arms (rheumatoid nodules) • Fatigue, fever and weight loss

16/05/2012

15

Dr Muhammad Omair Riaz

16/05/2012

16

Dr Muhammad Omair Riaz

Complications
• • • • • Osteoporosis Carpal tunnel syndrome Heart problems Lung disease Eye manifestations

16/05/2012

17

Dr Muhammad Omair Riaz

Osteoporosis

16/05/2012

18

Dr Muhammad Omair Riaz

16/05/2012

19

Dr Muhammad Omair Riaz

Carpal tunnel syndrome

16/05/2012

20

Dr Muhammad Omair Riaz

16/05/2012

21

Dr Muhammad Omair Riaz

Heart Problems

16/05/2012

22

Dr Muhammad Omair Riaz

Lung disease

16/05/2012

23

Dr Muhammad Omair Riaz

Rheumatoid Arthritis & Pregnancy
No adverse effects on pregnancy outcomes Infact, disease severity actually DECREASES during pregnancy

16/05/2012

24

Dr Muhammad Omair Riaz

Eye manifestations

16/05/2012

25

Dr Muhammad Omair Riaz

16/05/2012

26

Dr Muhammad Omair Riaz

16/05/2012

27

Dr Muhammad Omair Riaz

Diagnosis
• • • • History Physical Examination Laboratory investigations X-Rays

16/05/2012

28

Dr Muhammad Omair Riaz

16/05/2012

29

Dr Muhammad Omair Riaz

Laboratory Investigations
• Blood Complete Picture with DLC & ESR • CRP • RA Factor • Anti-CCP Antibodies

16/05/2012

30

Dr Muhammad Omair Riaz

There is NO CURE for Rheumatoid Arthritis

16/05/2012

Dr Muhammad Omair Riaz

31

Management
• • • • • • NSAIDs Steroids DMARDs Immunosuppressants TNF-alpha inhibitors Other drugs Brufen Prednisone Azathioprine Methotrexate Etanerceptk

16/05/2012

32

Dr Muhammad Omair Riaz

16/05/2012

33

Dr Muhammad Omair Riaz

Physiotherapy & joint exercises are the BIGGEST help!
If all else fails, then SURGERY!

16/05/2012

Dr Muhammad Omair Riaz

34

Sign up to vote on this title
UsefulNot useful