RHEUMATOID ARTHRITIS
Presented by
Zeenath Anjum
Assistant Professor
Deccan School of pharmacy
INTRODUCTION
Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory
disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be
a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not
adequately treated. The hallmark feature of this condition is persistent symmetric polyarthritis (synovitis)
that affects the hands and feet, though any joint lined by a synovial membrane may be involved. Extra-
articular involvement of organs such as the skin, heart, blood vessels, lungs and eyes can be significant.
Or
• Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disorder of unknown etiology
characterized by polyarticular symmetric joint involvement and systemic manifestations.
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AETIOLOGY
• The cause of rheumatoid arthritis remains unclear with hormonal, genetic and
environmental factors playing a key role. Genetic factors contribute 53–65% of
the risk of devel oping this disease. The HLA-DR4 allele is associated with
both the development and severity of rheumatoid arthritis. Cigarette smoking is
a strong risk factor for developing rheumatoid arthritis.
EPIDEMIOLOGY
Approximately 1% of the population worldwide is affected by
rheumatoid arthritis, with females being two to three times more
commonly affected. The prevalence of rheumatoid arthritis increases
with age in both sexes; nearly 5% of women and 3% of men over the
age of 65 years are affected by the disease. The peak age of incidence
is about 30–50 years in women and slightly older in men. Rheumatoid
arthritis also affects young children and its classification and treatment
differs slightly from adults.
CLINICAL PRESENTATION
• Nonspecific prodromal symptoms developing over weeks to months include fatigue,
weakness, low-grade fever, anorexia, and joint pain. Stiffness and myalgias may precede
development of synovitis.
• Joint involvement tends to be symmetric and affect small joints of the hands, wrists, and feet;
elbows, shoulders, hips, knees, and ankles may also be affected.
• Joint stiffness typically is worse in the morning, usually exceeds 30 minutes, and may persist
all day.
• On examination, joint swelling may be visible or apparent only by palpation. Tissue is soft,
spongy, warm, and may be erythematous. Joint deformities may involve sub luxations of
wrists, metacarpophalangeal joints, and proximal interphalangeal joints (swan neck deformity,
boutonnière deformity, and ulnar deviation).
• Extra-articular involvement may include rheumatoid nodules, vasculitis, pleural effusions,
pulmonary fibrosis, ocular manifestations, pericarditis, cardiac conduction abnormalities, bone
marrow suppression, and lymphadenopathy.
EXTRA-ARTICULAR MANIFESTATIONS
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DIAGNOSIS
• The American College of Rheumatology (ACR) and the European League Against Rheumatism
(EULAR) revised criteria for diagnosis of RA in 2010. These criteria are intended for patients
early in their disease and emphasize early manifestations. Late manifestations (bone erosions,
subcutaneous nodules) are no longer in the diagnostic criteria. Patients with synovitis of at
least one joint and no other explanation for the finding are candidates for assessment. The
criteria use a scoring system with a combined score of 6 or more out of 10 indicating that the
patient has definite RA.
• Laboratory abnormalities include normocytic, normochromic anemia; thrombocytosis or
thrombocytopenia; leukopenia; elevated erythrocyte sedimentation rate and C-reactive
protein; positive rheumatoid factor (60%–70% of patients); positive anticitrullinated protein
antibody (ACPA) (50%–85% of patients); and positive anti nuclear antibodies (25% of patients).
• Aspirated synovial fluid may reveal turbidity, leukocytosis, reduced viscosity, and normal or
low glucose relative to serum concentrations.
• Early radiologic findings include soft tissue swelling and osteoporosis near the joint
(periarticular osteoporosis). Erosions later in the disease course are usually seen first in the
metacarpophalangeal and proximal interphalangeal joints of the hands and
metatarsophalangeal joints of the feet.
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PROGNOSIS
What is the prognosis (outlook) for people who
have rheumatoid arthritis (RA)?
• Although there isn’t currently a cure for rheumatoid
arthritis, there are many effective methods for
decreasing your pain and inflammation and slowing
down the disease process. Early diagnosis and effective
treatment are very important.
• If you don’t see a provider for RA treatment, the disease
can cause permanent damage to your cartilage and,
eventually, your joints. RA can also harm organs like
your lungs and heart.
