Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the...
-
Upload
richard-hopkins -
Category
Documents
-
view
213 -
download
0
Transcript of Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the...
![Page 1: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/1.jpg)
Rheumatoid Arthritis(RA)
Dr. Gehan Mohamed
![Page 2: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/2.jpg)
Learning objectives:
At the end of this lecture the student should be able to :
understand definition,genetic predisposition of RA. Discuss pathophysiology, clinical features of RA. Identify Diagnostic Criteria ,Laboratory Features and
bad prognostic Features of Rheumatoid Arthritis.
![Page 3: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/3.jpg)
RA
Systemic inflammatory autoimmune disorder
Age incidence : 40-70 years of age
![Page 4: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/4.jpg)
Genetics
Patients which have HLA-DRB have Increased risk for : RA development. Increased joint damage Increased joint need for surgery
![Page 5: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/5.jpg)
Pathophysiology
![Page 6: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/6.jpg)
Role of Immunolog in RA Macrophages:
Produce cytokines Cytokines (TNF-α) cause
systemic features Release chemokines recruit
PMNs into synovial fluid/membrane
TNF-α & IL-1: Proliferation of T cells Activation of B cells Initiates
proinflammatory/joint-damaging processes
TH-1 cells: Mediate disease processes Activate B cells
B cells: Release cytokines Plasma cells that produce
Ab
Osteoclasts induce: Bone erosion Juxta-articular & Systemic
osteoporosis
![Page 7: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/7.jpg)
Pathophysiology
Swelling of Synovial lining Angiogenesis
Pannus formation in form of : Synovial thickening/hyperplasia Inflammatory vascularized tissue Generation of Metalloproteinases
Cytokine release Infiltration of leukocytes Change in cell-surface adhesion molecules & cytokines Destruction of bone & cartilage
![Page 8: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/8.jpg)
Sequence of events :
Proliferation of synovial membrane cells with inflammatory cell infiltrate
Destruction of joints Disability
![Page 9: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/9.jpg)
Diagnosis:1- clinical criteria2- investigations
![Page 10: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/10.jpg)
1- Diagnostic Criteria
Symmetric peripheral polyarthritis Morning Stiffness >1 hour Extraarticular manifestations Rheumatoid nodules
![Page 11: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/11.jpg)
Symmetric Peripheral Polyarthritis 3 or more Joints for >6 weeks Intermittent or Migratory involvement
Small Joints Hands & Feet Peripheral to Proximal
Leads to Deformity & Destruction of Joints Erosion of cartilage and bone
![Page 12: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/12.jpg)
Stiffness Morning or after Prolonged Inactivity Bilateral > 1 hours
Reflects severe joint inflammation Better with movement Pain with pressure to joint Pain with movement of joint Swelling due to hypertrophy of synovium Effusion Hottness Redness
![Page 13: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/13.jpg)
Physical Exam Decreased grip strength Carpal tunnel syndrome(condition
characterized by pain and numbing or tingling sensations in the hand and caused by compression of a nerve in the carpal tunnel at the wrist.
Ulnar deviation Boutonniere/Swan neck deformities Extensor tendon rupture
![Page 14: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/14.jpg)
![Page 15: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/15.jpg)
Extraarticular Involvement
Myalgia, fatigue, low-grade fever, weight loss, depression.
Anemia Rheumatoid nodules Pleuropericarditis Neuropathy
Scleritis Splenomegaly Vasculitis
![Page 16: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/16.jpg)
Rheumatoid Nodules
Extensor surfaces elbows
Very Specific Only occur in ~30% Late in Disease
![Page 17: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/17.jpg)
Investigations
![Page 18: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/18.jpg)
Arthrocentesis
Confirm diagnoses Differentiate between inflammatory & noninflammatory Labs:
White blood cell count if WBC >2000/µL indicates inflammatory arthritis
Gram stain & Culture
Arthroscopy Evaluate ligamentous & cartilaginous integrity Biopsy Infection: aspirate thick
![Page 19: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/19.jpg)
Rheumatoid arthritis : showing inflammatory cell infiltrate in the synovium
![Page 20: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/20.jpg)
Laboratory Features
Rhumatoid Factor 70-80% of pts.
- Lab manifestations up to 10 years before clinical
- IgM or IgG - If IgM+ve : more severe disease & poorer
outcome.
Overlap with Hepatitis C Virus. Acute Phase reactants
ESR, CRP monitoring disease activity
![Page 21: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/21.jpg)
Radiology
Evaluate disease activity & joint damage
Bony decalcification
![Page 22: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/22.jpg)
Radiological Studies
Plain Films Bilateral hands & feet
Color Doppler U/S & MRI Early signs of damage i.e. Erosions Bone Edema - even with normal findings on
radiography
![Page 23: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/23.jpg)
![Page 24: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/24.jpg)
![Page 25: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/25.jpg)
DiseaseSeverity
![Page 26: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/26.jpg)
Arthralgias >3 inflamed joints Mild functional limitation Minimally elevated ESR & CRP No erosions/cartilage loss No extraarticular disease
Mild Disease
![Page 27: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/27.jpg)
Moderate Disease
6-20 Inflamed joints Moderate functional limitation Elevated ESR/CRP Radiographic evidence of
inflammation No extraarticular disease
![Page 28: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/28.jpg)
Severe Disease
>20 persistently inflamed joints Rapid decline in functional capacity Radiographic evidence of rapid
progession of bony erosions & loss of cartilage
Extraarticular disease
![Page 29: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/29.jpg)
bad prognostic Features
RF +ve Early development of multiple inflamed joints
and joint erosions Severe functional limitation Female HLA epitope presence Lower socioeconomic status & Less education Persistent joint inflammation for >12 weeks
![Page 30: Rheumatoid Arthritis(RA) Dr. Gehan Mohamed. Learning objectives: At the end of this lecture the student should be able to : understand definition,genetic.](https://reader030.fdocuments.in/reader030/viewer/2022032415/56649f095503460f94c1e048/html5/thumbnails/30.jpg)
Differential diagnosis of arthritis
Seronegative polyarthritis Psoriatic arthritis Osteoarthritis SLE Paraneoplastic syndrome Crystal-induced arthritis
Tophaceous gout Pseudogout