Professional Documents
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eumatoid
ritis
dr. MUKTI FAHIMI, Sp PD
INTRODUCTION
Rheumatoid Arthritis (RA) :
Early detection
Early treatment
PROGNOSIS
Mortality of RA 2-3 times than normal
population
Cause of death :
Infection and gastrointestinal
disorders
Prognostic factors:
Socio-demografic
Clinical feature
Laboratory findings
Radiographic changes
EPIDEMIOLOGY
5% in Women > 55
PATHOGENESIS of
RA
Environme
nt
Infection
Molecular
mimicry
Rheumatoid
Arthritis
PATOGENESIS
sinovial : dikenali
sebagai antigen spesifik
oleh sel T inflamasi
bahan bahan inflamasi
IL-1,TNF,IFN,IL-10
Kronik progresive
sinovial inflamasi &
destruksi sendi
hiperplasi sinovia ke
kartilago & tulang
panus
PATHOLOGICAL
EXAMINATION
Sinovial hyperplasia
Villi hypertrophy
>> A and B synoviocyte
Inflammatory cells
infiltration
Neovascularization
The worst : cartilage-pannus
junction
Late stage periarticular
damage & bone erosion
8
GEJALA KLINIS
Demam,Malaise,Anemia
Gejala klinik
Poliartritis
simetris
Fatigue
Loss of appetite,
Pemeriksaan fisik
weight loss,
sendi
bengkak (sinovitis)
flu-like symptoms,
tanda radang/inflamasi
depression,
Stadium lanjut
anemia
Early phase
Clinical features
simetric Poliarthritis
Late phase
diagnosis
Permasalahan
Keterlambatan Diagnosis sering terjadi
Most GP refer new arthritis patients to a
rheumatologist more than 3-6 months
Manifestasi
ekstraartrikuler
Kulit : nodul rheumatoid
Mata : keratokonjuctivitis sicca
Paru : intersisial lung diseases,pleuritis
Jantung : pericarditis, myocarditis
Ginjal : amiloidosis
CNS : C1-C2 subluxasi cervical myelopati
Hematologi : anemia , felty syndrome
Prediction of diseases
severity :
Large joint involment
higher overall joint count
upper extremities diseases
female
RF +
CRP/ESR
HLA DRB1
malaise/weakness
TUJUAN PENGOBATAN
Menekan
proses inflamasi
Mengurangi rasa nyeri
Mencegah deformitas
Memelihara produktivitas dan
aktivitas sehari-hari
PENGOBATAN FARMAKOLOGIS
1.
2.
3.
efek
anti
inflamasi
dan
imunosupresif sebagai bridging therapy dlm
mengatasi gejala sinovitis
Disease modifying anti rheumatic drugs (DMARD):
Penicillamine
Garam emas oral/intra muscular
Sulphazalazine
Antimalaria (choroquine & hydroxychloroquine)
Methotrexate
Azathioprine
Cyclosporine
Leflunomide
Digunakan sedini mungkin mencegah kerusakan sendi
Biologic Therapies
What is meant by the term Biologic
Therapy?
Double meaning:
Anti-Tnf medications
Etanercept (cytokine receptor fusion protein)
Infliximab (anti-cytokine antibody)
Adalimumab (anti-cytokine antibody)
Anti TNF
B Cell Depletion
Anti IL-6
TERIMA
KASIH