1 IN THE NAME OF GOD. 2 Rheumatoid Arthritis A chronic multisystem disease Characteristic feature: Persistent inflammatory synovitis Peripheral joints.
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1 IN THE NAME OF GOD
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Rheumatoid Arthritis A chronic multisystem disease
Characteristic feature: Persistent inflammatory synovitis
Peripheral joints Symmetric Cartilage damage and bone erosions
Destruction 3
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Epidemiology Most common form of chronic inflammatory arthritis
Prevalence :~1% (range 0.32.1%) women: 3 times more often than men
Throughout world; all races 5
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Epidemiology Onset: 4 and 5 decades of life Incidence between
25 and 50 y 6
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Genetics First-degree relative 2-10 times Concordant in
monozygotic twins 1520% 7
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Genetics Major genetic risk factors class II HLA HLA-DR4
(DR1*0401) and related alleles 8
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Environmental factors Climate and urbanization Incidence and
severity of RA Smoking : Relative Risk: 1.5-3.5 Severe RA with
antibodies to CCP 9
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11 ANTIGEN Genetic Background MACROPHAGE
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12 DR MACROPHAGE IL -1 CD80/86
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13 ANTIGEN DR MACROPHAGET-CELL CD4+ IL -1 CD80/86 CD 28
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14 Genetic Background IL- 1 ANTIGEN MACROPHAGE T CELL IL 2 B
Cell ANTIBODY
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15 AUTOIMMUNE REACTION Genetic Background IL- 1 ANTIGEN
MACROPHAGE T CELL IL 2 B Cell IMMUNE COMPLEX ANTIBODY
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16 AUTOIMMUNE REACTION Genetic Background IL- 1 ANTIGEN
MACROPHAGE T CELL IL 2 B Cell ANTIBODY IMMUNECOMPLEX COMPLEMENT
TARGET INFLAMMATION
Onset In 2/3 of patients begins with: - Fatigue, anorexia,
generalized weakness This prodrome may persist for weeks or months
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Onset Specific symptoms appear gradually - Especially: hands,
wrists, knees, feet - Symmetric 1/3 of patients Initially one or a
few joints 20
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Articular Most common manifestation: - Pain An almost
invariable feature: - Morning stiffness of >1-h Constitutional
symptoms: - Weakness, easy fatigability, anorexia, and weight loss
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Articular Initially, impairment in physical function is caused
by: - Pain and inflammation Later: - Fibrous or bony ankylosis
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Articular Symmetric Certain specific joints: - Wrist joints -
MCP, PIP - Synovitis of the elbow Flexion contractures - Knee -
Forefoot, ankles, and subtalar - Hip & shoulder DIP: rare Not
affect lumbar and thoracic spine 25
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Articular Synovial joints of C1-C2: - On occasion -
Atlantoaxial subluxation - Pain in the occiput - Rarely:
compression of the cord 26
Articular Characteristic joint changes: Hand: - Thumb
Hyperextension of the first IP Flexion of the first MCP 30
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Articular Characteristic joint changes: Foot: - Hallux valgus -
Eversion at hindfoot - Plantar subluxation of the metatarsal heads
- Widening of the forefoot - Lateral deviation and dorsal
subluxation of the toes 31
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Extraarticular Manifestation RA is a systemic disease 40% of
patients As a rule: occur in high titers of RF or antiCCP 33
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Rheumatoid nodule In 2030% On areas subjected to mechanical
pressure Elsewhere 34
Vasculitis Severe RA and high titers of RF Can affect nearly
any organ Polyneuropathy and mononeuritis multiplex Cutaneous
ulceration and dermal necrosis Digital gangrene Visceral infarction
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Vasculitis Uncommon Renal vasculitis is rare 37
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Pleuropulmonary Pleuritis: - Most common pulmonary
manifestation - Autopsy Common - Symptomatic Infrequent 38