BioEd Online Prof. Dr. Sarma. R.V.S.N M.D.(Med), M.Sc.(Canada), RCGP, FCGP, FIMSA Consultant Physician and Cardio-Metabolic Specialist National Professor of Medicine Visiting Faculty – Frontier Life Line Visiting Professor of Medicine – SBMC Website: www.drsarma.in You Tube: drsarmaji channel
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Prof. Dr. Sarma. R.V.S.N M.D.(Med), M.Sc.(Canada), RCGP, FCGP, FIMSA Consultant Physician and
Website: www.drsarma.in. You Tube: drsarmaji channel. Rheumatoid Arthritis. Prof. Dr. Sarma. R.V.S.N M.D.(Med), M.Sc.(Canada), RCGP, FCGP, FIMSA Consultant Physician and Cardio-Metabolic Specialist National Professor of Medicine Visiting Faculty – Frontier Life Line - PowerPoint PPT Presentation
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Four or more of the following criteria must be present:
Morning stiffness > 1 hour
Arthritis of > 3 joint areas of the possible 28 joints
Arthritis of hand joints (MCPs, PIPs, wrists)
Symmetric swelling (arthritis) – same joints on both sides
Serum rheumatoid factor – RA Factor (antibody to IgG)
Rheumatoid nodules
Radiographic changes
First four criteria must be present for 6 weeks or more
Rheumatoid Arthritis: Typical Involvement
Wrist joints and MCP joints - very commonly involved
Index and middle Metacarpophalangeal joints
Proximal interphalangeal joints (PIP)
Metacarpophalangeal joints (MCP)
Metatarsophalangeal joints (MTP)
Elbows, Shoulders
Knees, Ankles, Hips. Lumbosacral area is not involved
Spine: only Atlanto-axial joint (C1– C2), subluxation
Terminal interphalangeal (TIPS) joints are not involved
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The Joints Involved in RA
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DAS28 (Disease Activity Scoring) for RA - EULAR
Calculated using a formula that includes Counts for tender and swollen joints – (28 joints) General health by the patient (on a scale of 0 to
100) A measurement of ESR or CRP Score > 5.1 – High disease activity, Score 5.1 to 3.2 – Moderate disease activity Score < 3.2 – Low disease activity Score < 2.6 – Being in Remission Response to Rx. – of ≥ 1.2 – Good and < 0.6 –
Poor
European League Against Rheumatism (EULAR)
Rheumatoid Arthritis – ACR Functional Classes
Classification
Specifications of activity levels
Class IComplete ability to perform daily activitiesself-care, vocational and avocational
Class IIAbility to perform usual self-care and vocational activities; limited avocational activities
Class III
Ability to perform usual self-care activities; limited vocational or avocational activities
Class IVLimited ability to perform usual self-care or vocational or avocational activities
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Extra Articular Manifestations of RA
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Swan-Neck and Boutonniere Deformities in RA
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http://images.rheumatology.org – Album of American College of Rheumatology
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Radiological Changes in Rheumatoid Arthritis
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Erosion of the Odontoid processErosion of the Odontoid process
It is the single most useful marker ESR is raised > 30 mm – other
confounders Ceruloplasmin Haptoglobin (Hp)
Leukocytosis, Nutrophilia
Normocytic normochromic anemia
Thrombocytosis
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Synovial Fluid in RA
No need in general for joint aspiration
Required to exclude other causes of arthritis
Inflammatory arthritis picture Turbid fluid with reduced viscosity Increased protein content Decreased glucose content WBC count from 2,000 to 50,000/l PMNLs predominate Total compliment, C3 and C4 are
markedly
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Rheumatoid Factor (RA Factor)
Developed by Eric Waller in 1937 – Rose Waller Test
Can be used to bridge gap between initiation of DMARD therapy and onset of action
Intra-articular steroid (IAS) injections can be used for individual joint flares
CONS
Does not conclusively affect disease progression
Tapering and discontinuation of use often unsuccessful
Low doses result in skin thinning, ecchymoses, and Cushingoid appearance
Significant cause of steroid-induced osteopenia
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Methotrexate (MTX) MTX is given 10 to 30 mg orally, IM, or SC per week It is DHF reductase inhibitor – Supplemental folic acid The clinical improvement takes one to two months Nausea, diarrhea; mouth ulcers; rash, alopecia; Abnormal