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RHEUMATOID
ARTHRITIS
University of Charleston
Suzannah Boggs
Nursa-110-01B
Professor March
11/17/2024
  Definition/Etiology

TOPICS  Clinical Manifestations

 Pathophysiology of Disease
WE
 Complications
WILL
 Treatment to Improve Human
DISCUSS Flourishing

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SAMPLE FOOTER TEXT
 ETIOLOGY OF
RHEUMATOID
ARTHRITIS
Rheumatoid arthritis (RA) is a chronic (ongoing)
autoimmune disease that causes pain, swelling and stiffness in the
lining of your joints (synovium). It most commonly affects the
joints in your fingers, hands, wrists, knees, ankles, feet and toes.
RA usually occurs in the same joints on both sides of your body,
which makes it different from some other types of arthritis.

Uncontrolled inflammation damages cartilage, which normally

acts as a “shock absorber” in your joints. In time, this can deform
your joints. Eventually, your bone itself erodes. This can lead to
the fusion of your joint(s).

Specific cells in your immune system (your body’s infection-

fighting system) aid the process in deforming your joints. These
substances are produced in your joints but also circulate and cause
symptoms throughout your body. In addition to affecting your
joints, rheumatoid arthritis sometimes affects other parts of your
body, including your: skin, eyes, mouth, lungs, and heart (Johns
Hopkins, 2020)

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CLINICAL MANIFESTATIONS
OF RHEUMATOID ARTHRITIS
Symptoms of rheumatoid arthritis may include:

• Pain, swelling, stiffness and tenderness in more than one joint

• Stiffness, especially in the morning or after sitting for long periods

• Pain and stiffness in the same joints on both sides of your body

• Fatigue (extreme tiredness)

• Weakness

• Fever

RA affects everyone differently. In some people, symptoms develop over

several years. In other people, rheumatoid arthritis symptoms progress
rapidly. Many people have time with symptoms (flares) and then time
without any symptoms (remission).

Early signs of rheumatoid arthritis include tenderness or pain in small joints

like those in your fingers or toes. Or you might notice pain in a larger joint
like your knee or shoulder. These early signs of RA are like an alarm clock
set to vibrate. It might not always be enough to get your attention. But the
early signs are important because the sooner you’re diagnosed with RA, the
sooner your treatment can begin. Also, prompt treatment lowers your risk of
developing permanent, painful joint damage (Johns Hopkins, 2020).
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 PATHOPHYSIOLOGY OF
RHEUMATOID ARTHRITIS
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. In addition, synovial cells
synthesize joint lubricants such as hyaluronic acid, as well as collagens and fibronectin that constitute the structural
framework of the synovial interstitium.
• 1. Synovial lining or intimal layer: Normally, this • 2. Subintimal area of synovium: This is where the
layer is only 1-3 cells thick. In RA, this lining is synovial blood vessels are located; this area normally has
greatly hypertrophied (8-10 cells thick). Primary very few cells. In RA, however, the subintimal area is
cell populations in this layer are fibroblasts and heavily infiltrated with inflammatory cells, including T and
macrophages (Mayo Foundation, 2023). B lymphocytes, macrophages, mast cells, and mononuclear
cells that differentiate into multinucleated osteoclasts. The
intense cellular infiltrate is accompanied by new blood
vessel growth (angiogenesis). In RA, the hypertrophied
synovium (also called pannus) invades and erodes
contiguous cartilage and bone. As such, it can be thought of
as a tumor-like tissue, although mitotic figures are rare and,
of course, metastasis does not occur. 5
 DIAGNOSTICS
Diagnosing rheumatoid arthritis (RA) can take time. Like other forms of
arthritis, a diagnosis is based largely on the findings from a medical exam
and your symptoms. These may include joint pain, tenderness and swelling
that affects the same joint or joints on both sides of your body (like both
wrists or both knees); fatigue and fever. Lab tests and imaging tests can
help your doctor make the diagnosis.

Imaging tests, along with the physical exam and laboratory tests, can help
identify RA. These imaging tests may be used to diagnose RA.

• X-ray. X-rays can show bone damage, characteristic of RA, where they
meet at joints. They are a common tool in diagnosis; however, because
damage from inflammation develops over time and may not be visible
via X-ray early on, it may not be useful for diagnosing early RA.

• Magnetic resonance imaging (MRI). MRI is procedure in which radio

waves and a powerful magnet linked to a computer are used to create
3D images of structures inside the body. MRI can show changes in
cartilage and bone that are indicative of RA.

• Ultrasound. Ultrasound, or sonography, uses sound waves to create

pictures of structures inside the body. This may be used to view
changes in bones and cartilage suggestive of RA before any changes
show up on X-ray. Other benefits of ultrasound include its relatively
low cost and the fact it doesn’t expose the body to radiation, like X-ray.

• Computed tomagraphy (CT) scan. A CT scan is an imaging procedure

that combines a series of X-ray images to create cross-sectional images
of parts of the body. Studies show CT scans may be effective for
SAMPLE FOOTER TEXT
viewing early bone erosions that occur with RA (Arthritis Foundation)
 TESTING OF DISEASE

• Erythrocyte sedimentation • C-Reactive Protein (CRP). This Rheumatoid factor

rate (ESR or sed rate). The measures levels of CRP, a protein (RF). Rheumatoid factor is a protein
ESR can gauge how much produced by the liver that signals made by the immune system which
inflammation is in your body inflammation. High CRP levels are may attack healthy tissues. High
by measuring how quickly red common in RA and other levels of rheumatoid factor could
blood cells (erythrocytes) inflammatory forms of arthritis. help your doctor make a diagnosis of
separate from other cells in the Because a high CRP may be present RA. However, RF levels may also be
blood and collect as sediment with many diseases and conditions, a high in other autoimmune diseases,
in the bottom of a test tube. high CRP in itself does not mean you so an RF test alone cannot be used to
Because inflammation can be have arthritis or identify which form diagnose RA (Arthritis Foundation).
caused by conditions other than you may have. The results must be
RA, the results must be interpreted in the context of your
considered along with those of symptoms as well as the results of
other tests when making an RA other tests.
diagnosis.

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 COMPLICATIONS

Rheumatoid arthritis increases your risk of developing:

• Abnormal body composition. The proportion of fat to lean mass is often

• Osteoporosis. Rheumatoid arthritis itself, along with some
higher in people who have rheumatoid arthritis, even in those who have a
medications used for treating rheumatoid arthritis, can increase your
normal body mass index (BMI).
risk of osteoporosis — a condition that weakens your bones and
makes them more prone to fracture. • Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the
• Rheumatoid nodules. These firm bumps of tissue most commonly inflammation can compress the nerve that serves most of your hand and
form around pressure points, such as the elbows. However, these fingers.
nodules can form anywhere in the body, including the heart and • Heart problems. Rheumatoid arthritis can increase your risk of hardened
lungs.
and blocked arteries, as well as inflammation of the sac that encloses your
• Dry eyes and mouth. People who have rheumatoid arthritis are heart.
much more likely to develop Sjogren's syndrome, a disorder that
• Lung disease. People with rheumatoid arthritis have an increased risk of
decreases the amount of moisture in the eyes and mouth.
inflammation and scarring of the lung tissues, which can lead to progressive
• Infections. Rheumatoid arthritis itself and many of the medications shortness of breath.
used to combat it can impair the immune system, leading to
increased infections. Protect yourself with vaccinations to prevent • Lymphoma. Rheumatoid arthritis increases the risk of lymphoma, a group
of blood cancers that develop in the lymph system. 8
diseases such as influenza, pneumonia, shingles and COVID-19
TREATMENT: NSAIDS

• The major effect of these agents

(NSAIDs) is to reduce acute
inflammation thereby decreasing
pain and improving function. All of
these drugs also have mild to
moderate analgesic properties
independent of their anti-
inflammatory effect. It is important
to note however that these drugs
alone do not change the course of
the disease of rheumatoid arthritis
or prevent joint destruction
(cleveland Clinic, 2024).
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 TREATMENT:
CORTICOSTEROIDS

- Corticosteroids (such as
prednisone; methylprenisolone,
Medrol®) have both anti-
inflammatory and
immunoregulatory activity. They
can be given orally,
intravenously, intramuscularly
or can be injected directly into
the joint. Corticosteroids are
useful in early disease as
temporary adjunctive therapy
while waiting for DMARDs to
exert their antiinflammatory
effects (Cleveland Clinic, 2024)
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 TREATMENT: DMARDS

• Although both NSAIDs and DMARD agents • Methotrexate is now considered the first-line
improve symptoms of active rheumatoid arthritis, DMARD agent for most patients with RA. It has a
only DMARD agents have been shown to alter the relatively rapid onset of action at therapeutic doses
disease course and improve radiographic outcomes. (6-8 weeks), good efficacy, favorable toxicity
DMARDs have an effect upon rheumatoid arthritis profile, ease of administration, and relatively low
that is different and may be slower. In most cases, cost. When looking at groups of patients on
when the diagnosis of rheumatoid arthritis is different DMARDS, the majority of patients
confirmed, DMARD agents should be started. The continue to take Methotrexate after 5 years, far
presence of erosions or joint space narrowing on x- more than other therapies reflecting both its
rays of the involved joints is a clear indication for efficacy and tolerability. Methotrexate is effective
DMARD therapy, however one should not wait for in reducing the signs and symptoms of RA, as well
x-ray changes to occur (Cleveland Clinic, 2024). as slowing or halting radiographic damage.

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 REFERENCES
Rheumatoid arthritis treatment options. Johns Hopkins Arthritis Center. (2020, April 14).
[Link]
Mayo Foundation for Medical Education and Research. (2023, January 25). Rheumatoid arthritis.
Mayo Clinic. [Link]
causes/syc-20353648
Testing for rheumatoid arthritis: Arthritis foundation. Testing for Rheumatoid Arthritis | Arthritis
Foundation. (n.d.). [Link]
Ra Pathophysiology • Johns Hopkins Arthritis Center. Johns Hopkins Arthritis Center. (2019, March
27). [Link]
What is rheumatoid arthritis (RA)?. Cleveland Clinic. (2024b, November 8).
[Link]

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THANK YOU FOR
VIEWING

Suzannah Boggs 11/17/24 suzannahboggs@uc