RHEUMATOID ARTHRITIS

an Autoimmune Mystery
A chronic disease characterized by the inflammation of the
lining of the joints, which is called the synovium.
Affects 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 bodys immune
system attacks the joint lining.

DEVELOPMENT
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.
CAUSES:
The exact cause of RA is unknown suspected causes are:
Bacterial Infection
Genetic Marker
Stress
Viral Infection

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.
Symmetrical, affects joints on both sides of the body.
Rheumatoid nodules.
Deformity of your joints over time.

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.
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
IMMUNE SYSTEM ROLE IN THIS RHEUMATOID
ARTHRITIS
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.
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.
These cells produce the Rheumatoid Factor, prostaglandins,
cytokines and other mediators.
Over time, the chemicals from the cells damage cartilage,
ligaments, tendons, and bone.
DIAGNOSIS OF RHEUMATOID ARTHRITIS
Clinical History
Physical Exams
Specific Lab Tests:
o CBC
o ESR
o CRP
o RA Factor
o Anti CCP
Imaging Studies
o X-Ray
o MRI
o Cat Scan
o Bone Scan
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.
ALTERNATIVE METHODS OF TREATMENT
Diet
Exercise
Acupuncture
Herbal Medicines
Massage
Stress Reduction Techniques prayer, meditation, hypnosis,
yoga, tai-chi
CONCLUSION
RA patients today can live a healthy and productive life.
Todays 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 bodys immune system attacks the synovial lining of the
joints which causes this disorder known as Rheumatoid
Arthritis.