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RHEUMATOID ARTHRITIS

dr. Ira Nong, M.Kes, Sp.OT

Carolyn Morse Jacobs, RN,


MSN, ONC 10/ 24/ 04
 Rheumatoid arthritis is an autoimmune disease.
 Is a chronic systemic, inflammatory disease
characterized by recurrent inflammation of
connective tissue, primarily of joints (diarthroidal)
and related structures.

 The cause of rheumatoid arthritis is not known


 Investigating possibilities of a foreign antigen, such as a
virus
Rheumatoid Arthritis
 Description
 Morning stiffness
 Arthritis of 3 or more joints
 Arthritis of hand joints
 Symmetric arthritis
 Rheumatoid nodules
 Serum rheumatoid factor
 Radiographic changes

 A person shall be said to


have rheumatoid arthritis if
he or she has satisfied 4 of
7 criteria, with criteria 1-4
present for at least 6
weeks
Pathophysiology Rheumatoid
Arthritis

 Normal antibodies (immunoglobulins)


become autoantibodies and attack
host tissues (RF)
 Neutrophils, T cells synovial fluid cells acitavted;
 Cystokines, interleukin-1 and TNR (tumor necrosing
factor) alpha; chrondroytes attack cartilage;
 Synovium digests cartilage; inflammatory molecules
released containing interleukin-1 and TNF alpha
Pathophysiology: Rheumatoid
Arthritis

 IgG/RF (HLA)= antigen-antibody complex


 Precipitates in synovial fluid
 Inflammatory response
 Cartilage connective tissue primarily
affected!
Comparison of RA and OA

RA Cause unknown; auto-immune factor


Onset sudden
Remissions
*Body parts affected, systemic, small joints, symmetrical
Causes redness, warmth, swelling of joints
Females, age 20-30; 3-1 ratio
OA Cause “wear and tear”, develops slowly
Non-systemic, weight bearing joints
Middle-aged and elderly, males 2-1 affected
Does not cause malaise
Begins after 40
Joint changes in OA

Normal Knee
structure

Moderately
advanced Advanced
osteoarthritis osteoarthritis
Deformities with Osteoarthritis

Carpometacarpocarpal joint of
thumb with subluxation of the
first MCP

Genuvarus

Herberden’s nodes
Joints changes with RA

 Early Pannus
• Granulation,
inflammation at
synovial
membrane,
invades joint,
softens and
destroys
cartilage
RA

Mod advanced Pannus


joint cartilage disappears,
underlying bone destroyed,
joint surfaces collapse

Fibrous Ankylosis
Fibrous connective tissue
replaces pannus; loss of joint otion

Bony Ankylosis
Eventual tissue and joint
calcification
Joint Changes RA

 Bilateral,  Subcutaneous
symmetrical, PIP’s, nodules
MCP’s  Genu valgum
 Thumb instability  Prominent
 Swan neck, metatarsal heads
boutonniere  Hammer toes
deformity  Mutlans deformity
 Tenosynovitis
Assessment RA
Deformities that
may occur with
RA

Synotenovitis
Ulnar drift
Swan neck
deformity
Boutonniere
deformity
Mutlans deformity
(rapidly progressing
RA)
Hitch-hiker thumb
Genu valgus
Subcutaneous nodules
(disappear and appear
without warning)
Hammer toes
Diagnostic Tests RA

ESR elevated

+ RA, ^ RA titer

CBC

C-reactive protein

Decrease serum complement

Synovial fluid inflammation

Joint and bone: swelling,inflammation


Xray: LESS
Medications RA
 ASA & NSAIDS
 Corticosteroids; low dose
 DMARDs (diverse group) of remitting agents:
including antimalarial (hydroxychloroquine:plaquenil)
*eye effects; Penicillamine (empty stomach);
 Immunosuppressive agents as methotrexate
and cyclosporine
 Biologic response modifiers
 Adalimumab (Humira)
 Infliximab (Remicade)
Treatment
 Surgery:
• Removal of inflamed
synovium
• Arthroplasty

 Physical therapy
Joint Protection: Do’s and Don’t’s