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RHEUMATOID

ARTHRITIS
Muhammad Afif bin Mansor
Andini Pratiwi Islami
Supervisor :

Case
woman 26 years old come with pain
in her joint, especially in her fingers,
the pain is continous since 2
months ago. There are stiffness in
the morning is felt 1 hour and she
also had a fever since 2 days ago.

Physical Examination &


Laboratory
Physical examination : there are
tenderness and sign of inflammation at
the MCP 2,3,4 dextra et sinistra and PIP
2,3,4 dextra et sinistra
Laboratory findings :

LED I/II : 75 / 80
Rheumatoid factor : positive

Differential Diagnosis
Characterist
ic
Gender
Age

Rheumatoid
Arthritis
Female > Male
20 - 50 years old

Symptoms

Inflammation in
multiple joints,
morning stiffness >
30 mins

Location

Small joints (PIP,


MCP, MTP)

Symmetrical Symmetry
Pathological

Osteoarthritis

Gout Arthritis

Female > Male

Male > Female

> 50 years old

Men : >35 years


Women : after
menopause

Pain & swelling on


major weight
A type of arthritis
bearing joints,
that causes
stiffness,
inflammation,
crepitation,
usually in one
tenderness,
joint, that begins
morning stiffness < suddenly
30 mins
Weight bearing
1st Meta Tarsal
joints (genu, hip,
Phalangeal Joints
vertebra)
Asymmetry
Asymmetry

Rheumatoid Arthritis
Rheumatoid Arthritis is a chronic symmetrical
polyarthritis cause of mainly affecting
peripheral joint lead to synovial hypertrophy
and joint inflammation

Boutonniere
deformity of
thumb

Swan neck

Ulnar Deviation

innumerable intra-articular
erosions

Rheumatoid
nodule

Hammer
toe

Hallux Valgus
multiple subluxations of the
joints (white arrows)

Anamnesis

Onset of disease
The disease associate with systemic
involvement
Pain of the joint
History of medication
History of past illness
Family history
Social Routine

Physical Examination

Physical Examination it is crucial to assess any stiffness,


tenderness, pain of motion, swelling, deformity, limitation
of motion, extra-articular manifestations, rheumatoid
nodules.

Affected joint show inflammation with swelling,


tenderness, warmth, and decreased range of motion
(ROM).

Atrophy of the interosseous muscle and also deformity


such as ulnar deviation, boutonniere, swan-neck
deformity

Direct palpitation

Pain of motion.

Laboratory & Radiology

RF (positive)

Anticyclic citrullinated peptide antibody (anti-CCP) (elevated)

Anti-RA33

Erythrocyte Sedimentation Rate (increase)(inflammation)

C-Reactive Protein (high)(indicate inflammation or injury)

Leukosit

X-ray radiography

Clinical Manifestation
The ACR/EULAR classification system is a
score-based algorithm for rheumatoid
arthritis diagnosis which mainly consist
of :
Joint Involvement
Serology test result
Acute-phase reactant test result
Patient self-reporting of the duration of
signs 7 symptoms

Etiology
Gender
Age
Genetic
Sex

Hormone
RF Factor & Anti CCP
Infection
Smoking
Trauma

Pathophysiology

The pathogenesis of RA is not completely


understood. An external trigger (eg. smoking,
infection or trauma) that triggers an autoimmune
reaction.
Initiate by production of RF (autoantibody) and
immune complex antibody IgG dan IgM which lead
to T-cell activation
T-cell and macrophage induced inflammation
process continuosly
The chronic inflammation process by chemokine,
interleukins, histamin,prostaglandins release

Therapy
Pharmacological therapy
NSAIDs anti inflammation drugs and analgetic
(Meloxicam 7,5 mg/day or Piroxicam 20 mg/day)
DMARDs to slow or prevent structural
progression of RA, good for acute onset of RA
(Methotrexate 10 mg/week or Sulfasalazine
2x500 mg/day)
Non Pharmacological therapy
Therapeutic exercise
Cold/hot therapy to reduce pain
Education about the disease and therapy

THANK YOU