Rheumatoid arthritis

It is an auto immune disorder

It is associated with HLAD4 AND HLADR4
More common in females
Common age group affected is 3rd and 4th
decade.
PATHOLOGY:
1. Earliest change is swelling and
congestion of synovial membrane.
2. Effusion of synovial fluid in the joint
space.
3. Hypertrophy of synovial membrane
4. Pannus formation and
inflammatory granulation tissue.
5. Destruction of articular cartilage.
6. Ankylosis of the joint (immobile or
fixed joint) and deformities.

CLINICAL FEATURES:
ARTICULAR MANIFESTATION:
Early morning stiffness is characteristic
Rheumatoid arthritis affects almost all
synovial joints
Fever
Weight loss
Fatiguability
In advanced stage of the disease, there is
limitation of joint movements, joint
instability, subluxation or partial
displacement of the joint and deformities.
Examples for deformities:
Swan neck deformity
Button hole deformity etc..
Cyanosis of the finger tips due to vaso
spasm
Lymphadenopathy
Osteoporosis
Muscle weakness and wasting
Bursitis
Trigger finger
OCULAR MANIFESTATIONS:
Scleritis
Episcleritis
Kerato conjunctivitis sicca- sjogrens
syndrome (dry eye)
CARDIO-VASCULAR MANIFESTATION:
Aortic regurgitation
Pericarditis
Pericardial effusion
Heart block
Cardiomyopathy
PULMONARY MANIFESTATION:
Pleurisy
Pleural effusion
Fibrosing alveolitis- restrictive lung
disease
Caplans syndrome (rheumatoid arthritis
+pneumoconiosis)
NEUROLOGICAL MANIFESTATION:
Peripheral neuritis
Carpal tunnel syndrome
Tarsal tunnel syndrome
Spinal cord compression
HAEMATOLOGICAL MANIFESTATIONS:
Normocytic normochronic anaemia
Thrombocytopenia
Feltys syndrome ( rheumatoid
arthritis+splenomegaly+neuropenia)
COMPLICATIONS:
1. Septic arthritis due to
staphylococcus aureus.
2. Amyloidosis.
INVESTIGATIONS:
1. Elevated ESR
2. RA factor +ve or (Rose waller test
+ve)
3. CRP +ve
4. X-ray of the affected joint shows
narrowing of the joint space.
5. Synovial fluid examination-
therapeutic and diagnostic
6. Arthroscopy- endoscopy related to
joints
7. Synovial biopsy- removal and
examination of affected synovium.
TREATMENT:
1. Physical Rest By Splinting
2. NSAID-Eg; aspirin, brufen,
mefenamic acid, indomethacin,
diclofenacsodium,piroxicam, phenyl
butazone.
3. Intra articular injection of steroids.
4. Second line drugs or disease
modifying drugs
 a. Chloroquine phosphate.
b. Gold
c. Pencillamine
d. Dapsone (used for leprosy)
e. Captopril
f. Rifampicin
5. Systemic steroids if local steroids
do not work
6. Immune modulation therapy.
a. Methotrexate anti cancer drug
b. Cyclo phosphamide.
7. Medical synovectomy destroying
synovium with drugs like osmic acid.
8. Surgical treatment.
9. Physiotherapy.