Rheumatoid

Arthritis

By – Monish .A
Class:12-A
BONAFIDE CERTIFICATE

Registration Number: ________________

Certified to be the bonafide project work in BIOLOGY

done by MONISH. A , XII A of D.A.V. Senior
Secondary School, Mogappair. during the academic
year 2024-2025.

Signature of the Principal Signature of the Teacher

School seal designation PGT/TGT

Submitted for practical examination held on: __________ At

D.A.V. Senior Secondary School, Mogappair., Chennai
600050.

Internal Examiner External Examiner

ACKNOWLEDGEMENT

I sincerely record our appreciation to all who have

contributed in this project. I would like to extend my
sincere gratitude to our biology teacher Ms.
KRISHNAPRIYA .K who has helped me in the
endeavour and without her help and guidance the
project couldn't have been what it evolved to be.

I also thank our principal MS. NANDHINI .S for

providing us a chance to carry out this project.

We also thank our lab assistant MR. PANDIYAN L for

his support in completing our project. Lastly, we thank
our school D.A.V SENIOR SECONDARY
SCHOOL(BOYS) MOGAPPAIR chennai-50 for
providing us this opportunity.
Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic

(long-lasting) autoimmune disease that mostly
affects joints.

RA occurs when the immune system,

which normally helps protect the body from
infection and disease, attacks its own tissue,
including joints. In severe cases, it attacks
internal organs.

The disease causes pain, swelling,

stiffness, and loss of function in joints.

It is diagnosed by the presence of a

rheumatoid factor (a type of immunoglobulin
IgM)

Over long periods of time, the

inflammation associated with rheumatoid
arthritis can cause bone erosion and joint
deformity.
Case Study

Age: 30 years
Sex: Male
Weight :75 kg

Reason for Admission (patient came with

complaints of):
i. Pain and swelling in small joints of fingers (6
months)
ii. Pain in lumbar region radiating to right leg.
(6 months)
iii. Morning stiffness in joints of fingers and toes
for about 2 hours.
iv. Decreased grip in fingers.
v. Difficulty in standing.
vi. Diffused swelling present in all small
interphalangeal and meta-carpophalangeal
joints with redness.
History of the Patient

Family History- Not significant

Personal history- non-smoker, non-alcoholic,
vegetarian by diet

On Examination
• Patient is calm ,conscious and oriented.
• Respiratory sys-B/L -air entry is [Link]
abnormality detected.
• P/a- soft and non-tender, not distended.
• CNS-intact
• No visible deformity present.
• Diffused swelling present in all the small inter-
phalangeal and meta-carpophalangeal joint and
with redness of skin.
 Lab Investigation
Constituents Detected values Normal range

Hb(hemoglobin) 13.0 13-17gm%

ESR(erythrocyte 45 0-9
sedimentation rate)
It is a test that indirectly
measures the level of
certain proteins in the
blood

TLC (Total Leucocyte 11600 4000-10000/CU

Count) assesses the levels mm(cubic
of white blood cells (or millimeter)
leukocytes) in the
bloodstream.
CRP( c reactive protein Positive 0.0-6 mgm/L
test ) high CRP value 11.70
means there is
inflammation in the body
RA factor index 18.40 < 14 IU/mL
(rheumatoid arthritis factor
index)

TSH (thyroid 0.85 0.35-5.50 μIU/mL

stimulating hormone)
6-30 % of RA patients
have thyroid abnormilities
Calcium 8.35 8.0-10.5mg/dL
(general health)
Additional test :
Nerve conduction tests: neuropathy of left upper limb.

Diagnosis:
Disorder: rheumatoid arthritis
• Rheumatoid arthritis (RA) is a chronic inflammatory,
autoimmune disease of unknown aetiology which
primarily affects synovial joints.
• The flagship feature of RA is persistent symmetric
polyarthritis beginning in the joints of the hands and
feet.
• In general, pathology of the small joints in the hands
and feet are the first to be affected by RA. The most
common joints involved are the metacarpophalangeal
(MCP), wrist, proximal interphalangeal (PIP), knee,
metatarsophalangeal (MTP), but may also include the
shoulder, ankle, cervical spine, hip, elbow, and
temporomandibular joints2,3.
• The acutely affected joints show inflammation with
swelling, tenderness, and warmth, and pain with
decreased range of motion.
• If left untreated ,then the membrane thickens and
synovial fluid increases ,exerting pressure that
causes pain. The membrane then starts secreting
a abnormal granulation tissue called pannus, which
after accumulating on the surface of the cartilage
causes and erosion . as a result the fibrous tissues
attached with the bones become ossified ,making the
joint immovable .
Assessment
Subjective objective
✓ Pain and swelling in ✓ Inc. ESR
small joints of fingers
(6 months) ✓ [Link]

✓ Pain in lumbar region ✓ CRP-POSITIVE

radiating to right leg.
(6 months) ✓ RA FACTOR-
POSITIVE
✓ Morning stiffness in
joints of fingers and
toes for about 2 hours.

✓ Decreased grip in
fingers.

✓ Difficulty in standing.
Diffused swelling
present in all small
interphalangeal and
meta-carpo phalangeal
joints with redness.
Based on subjective and objective information the
patient was diagnosed with rheumatoid arthritis.
Treatment :
While there is no cure for rheumatoid arthritis,
physiotherapy, and medication can help slow the
disease's progression. Most cases can be managed with
a class of medications called anti-rheumatic drugs .

Medicine given at hospital.

Therapeutic goals :
Short term:
To provide symptomatic relief to the patient from
pain of joints and lumbar region .
To reduce inflammation .
Long term :
To prevent or control joint damage.
To preserve function of joints.
To decrease mortality.
To improve quality of life.

Monitoring parameters
Liverfunction tests.
CBC (for leucopania
,thrombocytopenia, anemia)
blood calcium levels.
Serumin albumin tests

Discharge medication:
1. Tab. Myelin-G 1*BD
2. Tab. Defkors 6 mg 1*BD
3. Cap. CYRA-D 1*OD (BBF)
4. Tab. Methotrexate 7.5 mg 1*week
5. Tab. HCQ 200 mg 1*OD
6. Tab. SAZO 500 mg 1*BD
7. Tab. Oxuba 200 mg 1*BD
8. Tab. Revozyme 1*OD

Patient counselling
1. Exercise regularly to relieve pain and improve
activity of joints.
2. Take adequate rest. It will help in reducing
inflammation.
3. Prolonged inactivity may lead to stiffness and loss of
joint motion, as well as muscle wasting and
osteoporosis. Therefore there should be an
appropriate balance of rest and exercise.
4. Avoid unnecessary stress.
5. Adhere to the medication.
6. Tab. Methotrexate is to be taken is to be taken once a
week.
7. Do not avoid symptoms like nausea, vomiting,
mouth ulcers, dizziness, shortness of breath, easy
bruising or bleeding etc.
8. Do not worry If your skin color and urine color
appears yellow orange as it is because of
sulfasalazine.
9. Do not drive or handle machinery after taking Tablet
Myelin-G.
10. Avoid prolonged exposure to sunlight and use
sunscreen (SPF 15 or higher) when outdoor.
11. Keep Tab. Defkors away from persons having
Chicken pox, Measles & if you do catch them,
immediately report about it to Physician.

About few medicines :

Tab. Myelin-G 1*BD
Myelin G Tablet is a combination medicine used for the
treatment of neuropathic pain. This medicine decreases
pain by modulating calcium channel activity of the
nerve cells.
Tab. Defcort 6 mg 1*BD
Defcort 6 Tablet belongs to a group of medicines called
steroids. It is used for the treatment of various diseases
and conditions such as inflammatory conditions,
autoimmune conditions, and cancer.
Defcort 6 Tablet works by inhibiting the release of
substances that cause swelling or by changing how the
immune system works.
Methotrexate 7.5 mg
Mtx 7.5mg Tablet may treat rheumatoid arthritis by
suppressing the immune system, preventing it from
attacking the body's cells. This helps reduce the
inflammation that causes swollen and stiff joints in
rheumatoid arthritis, or damage to bowel in Crohn's
disease.
Tab. Aceceloflam-SP 1*BD
Acecloflam SP Tablet is a combination medicine used
to relieve pain and swelling in various conditions like
muscle pain, joint pain, and postoperative pain. Thus, it
effectively alleviates pain and inflammation in
conditions like rheumatoid arthritis .

Prevention
1. Don't smoke.
2. Eat a Mediterranean diet high in vegetables, fruit,
olive oil, nuts and wholegrains.
3. Exercise 20-30 minutes a day.
4. Avoid high salt in your diet.
Add more fish and omega-3 to your diet.
Pathophysiology
Rheumatoid arthritis is best characterized as an
immune mediated inflammatory disease (IMID).
Synovium

The synovium, in normal joints, is a thin delicate lining

that serves several important functions. The synovium
serves as an important source of nutrients for cartilage
since cartilage itself is avascular.

1. Synovial lining or intimal layer: Normally, this layer

is only 1-3 cells thick. In RA, this lining is greatly
hypertrophied (8-10 cells thick). Primary cell
populations in this layer are fibroblasts and
macrophages.

2. Subintimal area of synovium: This is where the

synovial blood vessels are located; this area normally
has very few cells. In RA, however, the subintimal area
is heavily infiltrated with inflammatory cells, including
T and B lymphocytes, macrophages, mast cells, and
mononuclear cells that differentiate into multinucleated
osteoclasts.

Synovial Cavity

The synovial cavity is normally only a “potential” space

with 1-2ml of highly viscous (due to hyaluronic acid)
fluid with few cells. In RA, large collections of fluid
(“effusions”) occur which are, in effect, filtrates of
plasma (and, therefore, exudative – i.e., high protein
content). The synovial fluid is highly inflammatory.
However, unlike the rheumatoid synovial tissue in
which the infiltrating cells are lymphocytes and
macrophages but not neutrophils, in synovial fluid the
predominant cell is the neutrophil.

Conclusion:
RA symptoms worsen in “flares” due to a trigger such
as stress, environmental factors (such as cigarette
smoke or viral infections), too much activity, or
suddenly stopping medications. In some cases, there
may be no clear [Link] goal of treatment is to
control the disease so it is in remission or near
remission, with no signs or symptoms of the disease