SPOTTERS
MEDICINE
RHEUMATOID ARTHRITIS
🔹 Definition:
Rheumatoid
arthritis is a chronic, systemic autoimmune disease that primarily
affects synovial joints, causing symmetrical, inflammatory
polyarthritis and progressive joint destruction.
🔹 Etiology:
- Autoimmune response
- Genetic predisposition – HLA-DR4, HLA-DR1
- Environmental triggers (e.g.,
smoking, infections)
🔹 Pathogenesis:
- Autoantibodies like Rheumatoid
Factor (RF) and anti-CCP target synovium
- Chronic synovitis → pannus
formation → cartilage destruction → joint deformity
- Inflammatory cytokines: TNF-α,
IL-1, IL-6 involved
🔹 Clinical Features:
- Symmetrical joint pain, swelling, morning stiffness
>1 hour
- Common joints: MCP, PIP, wrists,
knees, ankles
- Extra-articular features:
- Rheumatoid nodules
- Fatigue, anemia
- Vasculitis, pleuritis,
pericarditis
- Eye involvement (scleritis,
keratoconjunctivitis)
🔹 Deformities (late stage):
- Swan neck deformity
- Boutonnière deformity
- Ulnar deviation
- Z deformity of thumb
🔹 Diagnosis:
- Clinical criteria (ACR/EULAR)
- Rheumatoid Factor (RF) – positive in 70–80%
- Anti-CCP antibodies – more specific
- Elevated ESR, CRP
- X-ray: joint space narrowing,
erosions, osteopenia
🔹 Differential Diagnosis:
- Osteoarthritis
- SLE
- Psoriatic arthritis
- Viral arthritis (e.g.,
parvovirus)
🔹 Treatment:
Symptomatic
Relief:
- NSAIDs
(e.g., diclofenac, ibuprofen)
- Low-dose corticosteroids
Disease-Modifying
Anti-Rheumatic Drugs (DMARDs):
- Methotrexate (first-line)
- Sulfasalazine, Leflunomide,
Hydroxychloroquine
Biologics:
- Anti-TNF agents: Etanercept,
Infliximab
- IL-6 inhibitors: Tocilizumab
- Others: Rituximab, Abatacept
Non-Pharmacological:
- Physiotherapy, occupational
therapy
- Joint protection, splints
Surgery:
- Joint replacement in severe
deformity
🔹 Complications:
- Joint destruction and disability
- Rheumatoid vasculitis
- Felty’s syndrome (RA +
splenomegaly + neutropenia)
- Osteoporosis, amyloidosis
🔹 Prognosis:
- Variable; early diagnosis and
treatment with DMARDs improves outcome
- Progressive disability if
untreated
DR.C.GANESAN
M.D.,
PROFESSOR OF
MEDICINE
No comments:
Post a Comment