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RHEUMATOID ARTHRITIS Diseases and Conditions

RHEUMATOID ARTHRITIS Diseases and Conditions

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RHEUMATOID ARTHRITIS Diseases and Conditions

RHEUMATOID ARTHRITIS

Definition:

systemic chronic inflammatory disease affecting many tissues produce nonsupurative proliferative synovitis that frequently progress to destroy articular cartilage and underlying bone extraarticular tissues that can involve are skin ,heart ,blood vessels,muscles,lungs.rheumatoid arthritis is more common in women between the age of 20-40 years.

CLINICAL SYMPTOMS

its a systematic bilateral arthritis,affecting small joints of the hand,wrist,knee, and elbow. distal interphalangeal joints are spared.proximal interphalangeal joints and metacarpophalangeal joints and upper cervical region are mostly involved.in this patients ,morning stiffness more than half an hour.mainly bilateral rheumatic nodules are present.

morphological patterns

chronic synovitis,synovial cell hyperplasia,dense perivascular inflammatory cell infiltrates,increase vascularity due to angiogenesis,neutrophils and aggregates of organising fibrin on synovium ,increase osteoclast activity. pannus formation is present.pannus formation is proliferative synovial linning cells mixed with inflammatory cells,granulation tissue,fibrous connective  tissues. eventually, pannus fills the joint and forms fibrosis that leads to calcification and fusion of joints.

RADIOGRAPHIC FINDINGS

joints effusions,juxta-articular osteopenia with erosion and narrowing of joints spaces and loss of articular cartilage.
radial deviation of the wrist ,ulnar deviation of fingers.swan neck deformity and boutonniere deformity.

RHEUMATIC SUBCUTANEOUS NODULES

rheumatic subcutaneous nodules are present on the extensor surface of forearm and other visas.these nodules are firm,tender,oval a randed masses as large as2cm in diameter. these nodules are a central focus of fibrinoid necrosis surrounded by a palisade of macrophages which is rimmed by granulation tissues and lymphocytes.in rheumatoid arthritis ,high RH factor is present.

PATHOGENESIS

in RA, activation of CD4+helper T_cells that produces cytokines that activate macrophages and B-cells. in this ,TNF and IL-1 are present.tnf is involved in WBCs recruitment ,IL-1 is involved in the proliferation of synovium. infectious agents like EPV,micro bacteria also involved.

GENETIC INVOLMENT

HLA DR4 is the important gene involved in its pathogenesis.

CLINICAL COURSE

weakness,malaise,low-grade fever,systematic polyarthritis,morning stiffness,vascular involvement,arthritis first appears

insidiously,with aching and  the stiffness of joints.

DIAGNOSIS

radiographs,synovial fluid with decrease viscosity,poor mucus ,clot formation and inclusions bearing neutrophils.

OTHER TYPES

juvenile Rheumatoid arthritis,infectious arthritis suppurative arthritis,Lyme arthritis.

BRIEF DESCRIPTION

juvenile RA

it is a disorder affecting large joints, before the age of 16 years and persist for more than 6 weeks.TH1,TH17 which activates b cells, macrophages, and  fibroblasts that inturn activates TNF,IL-1 and IL-6 which eventually destroy articular cartilage.

infectious RA

in this microorganisms lodge in joints during hematogeneous dissemination that can form abscess.its very dangerous type

Suppurative arthritis

step to,step half,s.aureus salmonella,E.coli are causative agents.fever,leukocytosis elevated erythrocyte sedimentation rate are cardinal signs.

Lyme arthritis

it is caused by the infection caused by borrelia Bergdorf Eri transmitted by deer ticks of the exodus Ricinus complex.

TREATMENT

this is just recommended treatment,before taking drugs,consult your physician. DMARDs are used in the earlier stage of RA,in first 3 months of disease that may involve in slowing the disease progression.NSAIDs or corticosteroids may also involve for relieving pain. in chronic patients,DMARDs, and anti-TNF drugs are used.

DMARDs

methotrexate,leflunomide,hydroxychloroquine ,sulfasalazine.

ANTI-TNF drugs

adalimumab,certolizumab,etanercept,golimumab,infliximab.

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