RHEUMATOID

ARTHRITIS
3ND MEETING

DEFINITION
systemic disease characterized by
symmetrical inflammation of joints yet
may involve other organ systems.
including rheumatoid nodules, vasculitis, eye inflammation, neurologic
dysfunction, cardiopulmonary disease, lymphadenopathy, and
splenomegaly, can be manifestations of the disease.

EPIDEMIOLOGY
Occur in 1-2 of 100
peoples.

RISK

HIGH RISK

70 th

EPIDEMIOLOGY

6 times more common among dizygotic twins

and nontwin children of parents with
rheumatoid.

CLINICAL PRESENTATION

SYMPTOMS
Joint pain and stiffness of more than 6 weeks duration. May also experience
fatigue, weakness, low-grade fever, loss of appetite. Muscle pain and
afternoon fatigue may also be present. Joint deformity is generally seen late
in the disease

CLINICAL PRESENTATION

SIGNS
Tenderness with warmth and swelling over affected joints usually involving
hands and feet. Distribution of joint involvement is frequently symmetrical.
Rheumatoid nodules may also be present.

CLINICAL PRESENTATION

SIGNS

Joint deformity

CLINICAL PRESENTATION

LABORATORY TEST
Rheumatoid factor (RF) detectable in 60% to 70%.
Anticyclic citrullinated peptide (anti-CCP) antibodies have similar
sensitivity to RF (50% to 85%) but are more specific (90% to 95%) and
are present earlier in the disease.
Elevated erythrocyte sedimentation rate and C-reactive protein are
markers for inflammation.
Normocytic normochromic anemia is common as is thrombocytosis
Joint fluid aspiration may show increased white blood cell counts
without infection, crystals.
Joint radiographs may show periarticular osteoporosis, joint space
narrowing, or erosions.

TREATMENT
DESIRED OUTCOME

The primary objective is to improve or

maintain functional status, improving
quality of life

TREATMENT
NONPHARMACOLOGIC
Rest,
occupational therapy,
physical therapy,
use of assistive devices,
weight reduction,
and surgery.

PHARMACOLOGIC
TREATMENT

Dipiro, pathophysiology approach, 2008, page 1511 (1544)

PHARMACOLOGIC
TREATMENT
Clinical monitoring for drugs

Dipiro, pathophysiology approach, 2008, page 1511 (1544)

PHARMACOLOGIC
TREATMENT
Nsaid dose

Dipiro, pathophysiology approach, 2008, page 1512 (1545)

PHARMACOLOGIC
TREATMENT
algorithm

Dipiro, pathophysiology approach, 2008, page 1512 (1545)

Selamat Bekerja

CASE
Pasien Ch. A. 81 kg, 176 cm sedang dirawat di
bangsal 2A. Penyebab masuk rumah sakit
adalah pasien jatuh di kamar mandi sewaktu
ingin pergi shalat subuh. Pasien merupakan
pasien rawat jalan dengan penyakit rheumatoid
sekitar 9-10 tahun yang lalu. Sekarang usianya
31 tahun. Obat-obatan yang pernah dikonsumsi
adalah metotrexat (MTX) tetapi dia lupa
dosisnya.sering mengkonsumsi antalgin untuk
mengatasi nyerinya. Dari hasil diagnose dokter
pasien mengalami rheumatoid. Saran dokter
adalah memberikan pasien terapi MTX, tetapi
pasien menolak, sehingga pasien diberikan
obat pulang berupa prednisone 5 mg dengan
dosis 3 kali sehari.