Rheumatoid arthritis is an inflammatory form of arthritis that causes joint pain and damage. . It can also damage some organs. It can be a disabling and painful condition. such as the lungs and skin. systematic autoimmune disorder that causes the immune system to attack the joints.Rheumatoid Arthritis is an autoimmune disease of unknown origin that affects 1% of the population. where it causes inflammation (arthritis) and destruction. which can lead to substantial loss of functioning and mobility. Rheumatoid arthritis (RA) is a chronic.

The inflammation causes the release of proteins that. such as bacteria and viruses move from your bloodstream into the membranes that surround your joints (synovium). Genetic (inherited) factors: scientists have discovered that certain genes known to play a role in the immune system are associated with a tendency to develop rheumatoid arthritis. tendons and ligaments near your joint. Eventually. bone. still others have these genes but never develop the disease. the joints loses its shape and alignment. .CAUSES Autoimmune Factor: occurs when white blood cells whose usual job is to attack unwanted invaders. it may be destroyed. Gradually. Some people with rheumatoid arthritis do not have these particular genes. The proteins can also damage the cartilage. over months or years cause the synovium to thicken. The blood cells appear to play a role in causing the synovium to become inflamed.

Women are more likely to develop rheumatoid arthritis than men. pregnancy may improve the disease. Breastfeeding may aggravate the disease. and the disease may flare after a pregnancy.  Lifestyle choices  Hormonal factor: Some scientists also think that a variety of hormonal factors may be involved. . Environmental factors: Many scientists think that something must occur to trigger the disease process in people whose genetic makeup makes them susceptible to rheumatoid arthritis.

Chondrocyte proliferation.Predisposing Factor Gender (female) Age (20-50 y/o) Precipitating Factor Diet Lifestyle Occupation Swelling in small joints. No cartilage invasion Subchondral bonde erosin. effusions. Cell proliferation. Laxity of ligaments Synovitis. pannus invasion of the cartilage. pain. swollen. contractures. and fatigue Warm. Angiogenesis in synovial lining Neutrophil accumulation in synovial fluid. Early pannus invasion. associated with pain. Degredation of cartilage by proteinase Rheumatoid Arthritis . decreased ROM. systemic complication. stiffness. Presentation of antigen T cells T and B cell proliferation. and decreased motion with possible rheumatoid nodules Increase in severity of physical sign and symptoms Joint instability. Chondrocyte invasion.

Joint Pain Swelling Warmth Erythema Lack of function Join stiffness in the morning .

creating soft tissue deformity.. and raynaud s phenomenon (cold and stress-induced vasospasm causing episodes of digital blanking or cyanosis).In early stage of disease. and painful are not easily moved. anemia. swollen. . fatigue. The deformity may caused by mis alignment resulting from swelling. progressive joint destruction or the subcluxation (partial dislocation) that occurs when one boneslips over another and eliminates the joint space. limitation in function can occur when there is active inflammation of the joints. Immobilization for extended periods can lead to contractures. lymph nodes enlargement. Deformity of the hands and feet are common in RA. even before bony changes occur. weight loss. Most common are fever.

milky. sensory changes lymph node enlargement.  The ESR is significantly elevated in RA.  The patient is also assessed for extra-articular changes.  The Red Blood Cell count and C4 complement component are decreased.  C-reactive protein and anti-nuclear antibody (ANA) test result may also be positive  Arthrocentesis shows synovial fluid that is cloudy. and fatigue. these often include weight loss. The history and physical examination address manifestation such as bilateral and symmetric stiffness. tenderness. swelling and temperature changes in the joints. or dark yellow and contains numerous inflammatory components .

 Cyclo-oxygenase is an enzyme that is involved the antiinflammatory process.  Treatment with the DMARDs (antimalarials. Early Rheumatoid Arthritis  Medical Management begins with therapeutic doses of salicylates or NSAIDs. these medications provide both antiinflammatory and analgesic effects. gold. However.they are associated withincreased risk of cardiovascular disease and must be used with caution. penicillamine. When used in full therapeutic dosages. . or sulfasalazine) begin with 3 months of disease onset .

 Etanercept. Opiod analgesic agents are avoidedbaceause of the potential for continuing need for pain relief. a key cytokine known to play a role in the disease process in RA.infliximab. adalimumab and golimumab inhibit the function of TNF-alpha.  Another analgesia may be prescribed for periods of . If symptoms are aggressive methotrexate mau be considered because of its success in preventing both joint destruction and long term disability. extreme pain. whereas anakinra inhibit the function of interleukine-1.

 Relaxation techniques  Heat and cold application .