Rheumatoid Arthritis

Definisi
Rheumatoid arthritis (RA) is a
systemic autoimmune disease of
unknown cause characterized by an
inflammatory synovitis that is
destructive to articular cartilage
Rheumatoid arthritis (RA) is a chronic
multisystem disease of unknown
cause

Etiology
The cause of RA remains unknown
It has been suggested that RA might be a
manifestation of the response to an
infectious agent
A number of possible causative agents have
been suggested, including Mycoplasma,
Epstein-Barr virus (EBV), cytomegalovirus,
parvovirus, and rubella virus, but
convincing evidence that these or other
infectious agents cause RA has not
emerged

Epidemiology
The incidence of RA increases with
advancing age, with peak onset
during the fourth and fifth decades
The female-to-male ratio is 2.5:1
Genetic factors also have a role, as
suggested by family association and
increased prevalence of HLA-DR1
and HLA-DR4

 RA is seen throughout the world and

affects all races
The incidence of RA is more than six
times greater in 60- to 64-year-old
women compared to 18- to 29-yearold women

 Clinical weakness and atrophy of

skeletal muscle are common.

Risk Factor

Age
Gender
Race
Genetic

Manifestation
arthritis is typically symmetric,
with early involvement more
common in the hands, wrists,
feet, and ankles
morning stiffness and stiffness
with inactivity (gel phenomena)
Generalized malaise and fatigue
also are noted at disease onset
Subcutaneous rheumatoid
nodules

 Pain, swelling, and tenderness may

initially be poorly localized to the
joints
Pain in affected joints, aggravated by
movement
The majority of patients will
experience constitutional symptoms
such as weakness, easy fatigability,
anorexia, and weight loss
Clinically, synovial inflammation
causes swelling, tenderness, and
limitation of motion

 Joint swelling results from

accumulation of synovial fluid,
hypertrophy of the synovium, and
thickening of the joint capsule

Pathogenesis dan
Pathophysiologi

Diagnosis
Anamnesa
Usia
Jenis kelamin
Kaku saat di pagi hari
Mengenai simetris pada sendi
Ada nodul rheumatoid?

 Pemeriksaan Fisik
Pemeriksaan Penunjang
No tests are specific for diagnosing RA
rheumatoid factors, which are
autoantibodies reactive with the Fc
portion of IgG, are found in more than
two-thirds of adults with the disease and
have classically been used to evaluate
patients with RA
Antibodies to CCP

 Normochromic, normocytic anemia is

frequently present in active RA
The white blood cell count is usually
normal, but a mild leukocytosis may be
present
The erythrocyte sedimentation rate
(ESR) is increased in nearly all patients
with active RA

 Synovial fluid analysis confirms the presence of

inflammatory arthritis, although none of the
findings is specific.
reduced viscosity,
increased protein content,
slightly decreased or normal glucose concentration.
The white cell count varies between 5 and 50,000/L;
PMNLs predominate.
A synovial fluid white blood cell count >2000/L with
>75% polymorphonuclear leukocytes is highly
characteristic of inflammatory arthritis, although not
diagnostic of RA.
Total hemolytic complement, C3, and C4 are markedly
diminished in synovial fluid relative to total protein
concentration as a result of activation of the classic
complement pathway by locally produced immune
complexes

Diagnosa Banding
Gout
SLE
Osteoarthritis

Tatalaksana

 Prinsip Tatalaksana
(1)
(2)
(3)
(4)
(5)

relief of pain,
reduction of inflammation,
protection of articular structures,
maintenance of function, and
control of systemic involvement

DMARDs
Combinations of DMARDs appear to be more
effective than single agents in controlling the
signs and symptoms of RA. A fourth group of
agents are the biologics, which include
TNG-neutralizing agents (infliximab, etanercept,
and adalimumab),
IL-1-neutralizing agents (anakinra),
those that deplete B cells (rituximab), and
those that interfere with T cell activation
(abatacept).

Glucocorticoid
Low-dose (<7.5 mg/d) prednisone is
a useful additive therapy to control
symptoms

Immunosupressor
The immunosuppressive drugs
azathioprine, leflunomide, cyclosporine,
and cyclophosphamide have been shown
to be effective in the treatment of RA
However, these agents appear to be no
more effective than the DMARDs.
Moreover, they cause a variety of toxic
side effects, and cyclophosphamide
appears to predispose the patient to the
development of malignant neoplasms

Prognosis