Rhumatoid Arthtritis

8/2/2019 Rhumatoid Arthtritis

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RHEUMATOID ARTHRITIS

Saurabh Garg


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Rheumatoid Arthritis

Chronic multisystemic inflammatory disease of

unknown etiology

Affects the Synovial Membranes of multiple joints

Female : Male ratio 3:1

Most frequent during 4th and 5th decade


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PATHOGENESIS


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Normal Synovial Joint

Articular cartilage

Synovium Membrane

Lamellar bone

Subchondral bone

Type A cell: mphage like,

protective role

Type B cell:

fibroblast

like, produce

matrix and

synovial fluidVessel

Synovial Membrane:only 1-2 cells thick


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Thickened Synovium

Lymphocytic Infiltrate

Neovascularization

EARLY CHANGES IN RA

Major type of cells in synovium are T-cells and macrophages whereas in synovial fluid

neutrophils are neutrophils


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Destruction of Joint Cartilage and Bone

Proliferating synovial lining => Pannus

Proliferating synovial lining comes in

contact with the cartilage matrix and bone

there is degradation of the cartilage and

erosion of the bone surface (by matrix

metalloproteinases and other proteases

produced by synovial cells)

Chondrocytes themselves

IL-1 and TNF-alpha also stimulate production of

metalloproteinase by Chondrocytes of the

articular cartilage. In response to these

cytokines, chondrocytes decrease type IIcollagen and proteoglycan synthesis and

increase synthesis of metalloproteinases that

contribute to the degradation of collagen and

proteoglycans.

Neutrophils in Synovial Fluid

The main inflammatory cells of the

synovial fluid are neutrophils.

Cytokines such as transforming growth

factor beta (TGF-beta) and interleukin 8(IL-8) attract neutrophils.

Neutrophils may undergo degranulation

and cause some damage to surrounding

tissues.

Osteoclasts

Osteoclasts may be activated by

inflammatory mediators

including IL-1, TNF and PGE2

bone

cartilage


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Clinical presentation

usually presents insidiously;

prodromal syndrome of malaise, weight loss and vague

periarticular pain and stiffness may be seen less commonly, the onset is acute, triggered by a stressful

situation such as infection, trauma, emotional strain or in

the postpartum period.

the joint involvement is characteristically symmetric withassociated stiffness, warmth tenderness and pain


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Clinical Features

the stiffness is characteristically worse in the morning and

improves during the day; its duration is a useful indicator

of the activity of the disease.

the usual joints affected by rheumatoid arthritis are the

metacarpophalangeal joints, the PIP joints, the wrists,

knees, ankles and toes.

Entrapment syndromes may occur especially carpal tunnel

syndrome


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After months to years, deformities can occur; the

most common are

ulnar deviation of the fingers

swan neck deformity, which is hyperextension of the distalinterphalangeal joint and flexion of the proximal

interphalangeal joint

boutonniere deformity, which is flexion of the distal

interphalangeal joint and extension of the proximalinterphalangeal joint

valgus deformity of the knee


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Extra-articular manifestations

Rheumatoid nodules

Vasculitis

Ocular manifestations

Keratoconjunctivitis sicca, episcleritis, scleritis, glaucoma

Pulmonary manifestations Pleural involvement, Fibrosing alveolitis , Obliterative

bronchiolitis Feltys Syndrome

- RA with Splenomegaly and neutropenia


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Extra-articular manifestations

Cardiac involvement Constrictive pericarditis

Renal involvement Secondary amyloidosis

Neurologic manifestations Mononeuritis multiplex, entrapment neuropathies, peripheral

neuropathies

Hematological Anemia

Thrombocytosis


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THANK YOU

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Rhumatoid Arthtritis