part 2 spcon module 3

WHAT CONDITION IS THIS?

● Chronic multi-system disease

● Wide range of articular and extraarticular findings

● Unknown cause

● Inflammatory process

● Immune response

● Genetic

● Characteristic feature: persistent inflammatory synovitis (usually peripheral, symmetric involvement)

RHEUMATOID ARTHRITIS

In RA, what is the s ite of primary effect?

SYNOVIAL LINING OF JOINTS

In RA,

○ Gene product of Class II MHC (major histocompatibility complex)

○ One of the major genetic factors in etiology

○ Seen in 70% of patients

● HLA-DR4

In RA, this is the consequence of massive infiltration of immune cells (T lymphocytes) into the synovial fluid

Joint inflammation –

In RA, this is the predominant infiltrating cell

– T lymphocyte

What is the hallmark of RA?

SYNOVIAL INFLAMMATION

○ Cartilage destruction

○ Bone erosions

○ Changes in joint integrity

In RA, what associating deformity is this?

radial deviation at the wrist with ulnar deviation of digits often with palmar subluxation of proximal phalanges

Z deformity -

In RA, what associating deformity is this?

hyperextension of PIP jt with flexion of DIP

Swan-neck deformity –

In RA, what associating deformity is this?

flexion of PIP and extension of DIP jt

Boutonniere deformity

In RA, enumerate the extraarticular manifestations

rheumatoid nodules

rheumatoid vasculitis

pleuropulmonary manifestations

In RA, what extraarticular manifestation is being defined?

■ 20-30%

■ Found on periarticular structures, extensor surfaces, or other areas subjected to mechanical pressure

■ Common location: olecranon bursa, proximal ulna, achilles tendon, occiput

■ Found in patients with (+) RF

■ Central zone of necrotic material including collagen fibrils, cellular debris, noncollagenous filaments

■ Middle zone of palisading macrophage

■ Outer zone of granulation tissue

RHEUMATOID NODULES

In RA, what extraarticular manifestation is being defined?

■ Seen with high titer of RF, severe RA

■ Most aggressive form

■ Polyneuropathy, cutaneous ulceration and dermal necrosis

■ Digital gangrene

■ Visceral infarction

■ Myocardial infarction

RHEUMATOID VASCULITIS

In RA, what extraarticular manifestation is being defined?

■ Pleural disease

■ Interstitial fibrosis, pneumonitis

■ Pleural effusion (fluid with low levels of glucose)

○ Neurologic manifestations is rare

Pleuropulmonary manifestations

Recite the 2019 Classification Criteria for RA

In RA,

Leiden prediction rule:

• <4 points

100% of not developing RA

In RA,

Leiden prediction rule:

• ≤6 points

92% chance of not developing RA

In RA,

Leiden prediction rule:

• ≥8 points:

• 84% chance of RA development

In RA,

Leiden prediction rule:

• ≥11 points:

• 100% chance of RA development

In RA, this medication controls the symptoms and inflammatory processes. It is also rapid and effective in mitigating symptom

aspirin and nsaids

In RA, this medication suppresses signs and symptoms of inflammation. it also retards the development and progression of bone erosions

low dose oral glucocorticoids

In RA, this medication decreases elevated levels of acute phase reactants. it also modifies destructive phase of the disease

Disease modifying anti-rheumatic drugs (DMARDS)

In RA, this medication is transient relied when systemic medica approach fails

intraarticular glucocorticoids