rheumatoid arthritis ra n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
RHEUMATOID ARTHRITIS (RA) PowerPoint Presentation
Download Presentation
RHEUMATOID ARTHRITIS (RA)

Loading in 2 Seconds...

play fullscreen
1 / 54

RHEUMATOID ARTHRITIS (RA) - PowerPoint PPT Presentation


  • 111 Views
  • Uploaded on

RHEUMATOID ARTHRITIS (RA). RHEUMATOID ARTHRITIS ( RA ) Gergely Péter dr. Definition: Chro ni c destru ctive diseases characterized by joint inflammation with pain and swelling. In a considerable proportion of patients, the arthritis is progressive, resulting in joint destruction and

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'RHEUMATOID ARTHRITIS (RA)' - livia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
rheumatoid arthritis ra
RHEUMATOID ARTHRITIS (RA)

RHEUMATOID ARTHRITIS (RA)

Gergely Péter dr

Definition: Chronic destructivediseases characterized by joint inflammation with pain and swelling. In a considerable proportion of patients, the arthritis is progressive, resulting in joint destruction and

ultimately incapacitation and increased mortality.

Relatively common, prevalence: 0.3-1.5 %, themale:femaleratiocca. 1:3.

Typical case: womanaged 30-40 years with polyarthritis and early joint deformities.

pathogenesis of ra
Pathogenesis of RA

Endogenous factors Exogenous factors

MHC genes, hormon milieu) cross-reacting antigenes,

bacteria, viruses

Synovial vasculitis

Adhesion molecule expression cellular infiltration

Macrophages, T cells, B cells, granulocytes

Cytokines (TNF-a, IL-1, IL-6), RF, free-radicals, enzymes

Synovial proliferation, angiogenesis, chondrocyte-, osteoclast-

activation

Pannus, cartilage destruction, bone resorption

Pathogenesis of RA

cytokine interactions
Cytokineinteractions

Cytokine

interactions

Cytokinek

interakciói

classification criteria of ra ara 1987
Classification criteria of RA (ARA, 1987)
  • Morning stiffness – for at least 1 hr and present for atleast 6 weeks
  • Swelling of 3 or more joints for at least 6 weeks
  • Swelling of wrist, metacarpophalangeal (MCP) orproximal interphalangeal (PIP) joints for at least 6weeks
  • Symmetric joint swelling
  • Typical radiologic changes in hands (erosions orunequivocal bony decalcification)
  • Rheumatoid nodules
  • Serum rheumatoid factor (RF) positivity
  • Diagnosis is made by the presence of 4 or more criteria
differential diagnosis of polyarthritis

Differential diagnosis of polyarthritis

  • RA should be differentiated from:
  • Other autoimmune diseases (SLE, primary Sjögren’s syndrome, MCTD, PM/DM,PSS, PAN, gian cell vasculitis, polymyalgia rheumatica, adult onset Still’sdisease)
  • Viral diseases (parvovirus B19 infection, rubella, hepatitis B &Cinfection)
  •  Bacterial infections (tbc, rheumatic fever, Jaccoud’s arthritis, septicendocarditis, mycoplasma arthritis)
  • Seronegative spondylarthritides(erosive psoriatic arthitis, reactivearthritis, enteropathic arthritis)
  • Paraneoplastic arthritis
  • Other diseases (e.g. hyperthrophic osteoarthropathy,erythema nodosum, agammaglobulinemia, acromegaly, diabetes mellitus)
  • Other rheumatic diseases (chronic gout, inflamed erosive osteoarthritis)
Differential diagnosis of polyarthritis
signs of early ra undifferentiated arthritis
Signs of early RA (=undifferentiated arthritis)

In the early stage (within the first 3-6 months) (ARA) classification criteria cannot be used.

The patient should be referred to a rheumatologist, if

•         the patient has 3 or more swollen joints

•         the metacarpophalangeal (MCP) and/or

metatarsophalangeal (MTP) joints are involved; the squeeze test is positive

•         morning stiffness is 30 min or more.

squeeze test
Squeeze test

Squeeze test

joint involvement in ra
Joint involvement in RA

The most specific sign of RA is arthritis.

It is progressive and deforming in the majority (2/3) of cases (= erosive polyarthritis)

ra early stage
RA early stage

RA early stage

early assymmetric ra
Early assymmetric RA

Early assymmetric RA

pip joint involvement in ra
PIP joint involvement in RA

PIP joint involvement in RA

ra swan neck deformity
RA: swan neck deformity

RA: swan neck deformity

ra ulnar deviation
RA: ulnar deviation

RA: ulnar deviation

ulnar deviation in ra with severe atrophy of interosseal muscles
Ulnar deviation in RA with severe atrophy of interossealmuscles

Ulnar deviation in RA with severe atrophy of interosseal

muscles

ra boutonni re deformity
RA: Boutonnière deformity

RA: Boutonnière deformity

ra arthritis mutilans
RA: arthritis mutilans

RA: arthritis mutilans

involvement of joints of feet in ra
Involvement of joints of feet in RA

Involvement of joints of feet in RA

severe destruction of ankles in ra
Severe destruction of ankles in RA

Severe destruction of ankles in RA

periarticular osteoporosis decalcification
Periarticular osteoporosis (decalcification)

Periarticular osteoporosis (decalcification)

erosions and sclerosis in late stage
Erosions and sclerosis (in late stage)

Erosions and sclerosis (in late stage)

erosion in ra
Erosion in RA

Erosion in RA

early erosions mri
Early erosions (MRI)

Early erosions (MRI)

scinti graphy of the hands
Scinti-graphy ofthe hands

Scinti-

graphy of

the hands

baker s cyst
Baker’s cyst

Baker’s cyst

bursitis in the shoulder
Bursitis in the shoulder

Bursitis in the shoulder

bursitis and rheumatoid nodule
Bursitis and rheumatoid nodule

Bursitis and rheumatoid nodule

rheumatoid nodules
Rheumatoid nodules

Rheumatoid nodules

atlantoaxial subluxation
Atlantoaxialsubluxation

Atlantoaxial

subluxation

ra end stage
RA – end stage

RA – end stage

extraarticular manifestations of ra
Extraarticular manifestations of RA
  • rheumatoid nodules – subcutaneous

- in internal organs (lung, aortic valve)

  • pleuritis/pericarditis
  • fibrotizing alveolitis
  • Felty’s syndrome
  • vasculitis
  • amyloidosis
systemic manifestations of ra pulmonary fibrosis
Systemic manifestations of RA: pulmonary fibrosis

Systemic

manifestations of

RA:

pulmonary fibrosis

interstitial pneumonitis in ra
Interstitial pneumonitis in RA

Interstitial pneumonitis in RA

systemic manifestations of ra caplan s syndrome
Systemic manifestations of RA: Caplan’s syndrome

Systemic

manifestations of

RA:

Caplan’s syndrome

rheumatoid nodules in the lungs
Rheumatoid nodules in the lungs

Rheumatoid nodules in the lungs

episcleritis in ra
Episcleritis in RA

Episcleritis in RA

scleritis in ra
Scleritis in RA

Scleritis in RA

scleromalacia perforans
Scleromalacia perforans

Scleromalacia perforans

vasculitis in ra
Vasculitis in RA

Vasculitis in RA

vasculitis in ra1
Vasculitis in RA

Vasculitis in RA

large granular lymphocytes in felty s syndrome
Large granular lymphocytes in Felty’s syndrome

Large granular lymphocytes in Felty’s syndrome

disease modifying antirheumatic drugs dmard
Disease modifying antirheumatic drugs (DMARD)

Disease modifying antirheumatic drugs (DMARD):

Drug Adverse effects Dose

gold (i.m.)dermatitis, stomatitis, 25-50 mg /2-4

proteinuria, enterocolitis, weeks

thrombocytopenia

gold (p.o.) less frequently used, brecause of lower tolerability

chloroquine (hydroxy- retinopathia, pigment- 250 mg/day

chloroquine) anomalies

Regular ophthalmology check is required

d-penicillamine proteinuria, myasthenia, 125-750 mg/day

stomatitis

Owing to low tolerability it is not used any more

azathioprine hepatitis, bone marrow depression 50-150 mg/day

Scarcely given in RA

methotrexatehepatotoxicity, pulmonary fibrosis, 7,5-25 (MTX) bone marrow depression mg/week

most frequently used therapy

sulfasalazin e
sulfasalazine

sulfasalazine nausea, vomiting 1,5-2 g/day

diarrhea, bone marrow depression

cyclosporine A nephrotoxicity, tremor 1,5-4 mg/kg/day

creatinineand blood pressure should be checked regularly

leflunomidehepatotoxicity, GI 10-20 mg/day

complaints

TNF-blockers: local reaction, autoimmune disease (SLE, SM)

(etanercept, infection (tbc)

infliximab, and

abatacept)

etanercept: 25 mg 2x weekly s.c.

infliximab: 3 mg/kg every 8 week i.v.

Other:

anakinra (IL-1 blocker)

rituximab (anti-CD20 antibody)

abatacept (T cell activation blocker antibody)

diseases related to ra
Diseases related to RA:
  • Diseases related to RA:
  • Juvenile forms (= juvenile RA, juvenile idiopathicarthritis (JIA)
  • Subgroups:
  • systemic (Still’s disease)
  • pauciarticular (<4 joints)
  • polyarticular (similar to adult RA)
  • 2) Seronegative (RF negative) forms (seronegative
  • spondarthropathies = SNSA)
  • Ankylosing spondylarthritis (Mo Bechterew)
  • Psoriatic arthritis
  • Reiter’s disease - postinfectious arthritis
  • Enteropathic arthritis
classification criteria of jia ara 1982
Classification criteria of JIA (ARA, 1982)

1. Persistent arthritis of at least 6 weeks duration in one or more joints

2. Exclusion of other causes of arthritis (in particular):

a. other systemic autoimmune diseses (SLE, rheumatic fevers, vasculitis, PSS, SS, MCTD, Behçet’s syndrome, PM/DM, SPA, Reiter’s syndroma, psoriatic arthritis)

b. Infectious arthritis

c. Inflammatory bowel diseases

d. Neoplasms (e.g. leukaemia)

e. Nonrhematic conditions

f. Hematologicdiseases

g. Psychogenic arthralgia

h. Other (sarcoidosis, hyperthrophicosteoarthropathy, villonodular synovitis, chronic aktive hepatitis, familial Mediterraneanfever)

micrognathia in jia
Micrognathia in JIA

Micrognathia in JIA

inflamed joints with diffuse edema in snsa sausage like fingers
Inflamed joints with diffuse edema in SNSA (‘sausage-like’ fingers)

Inflamed joints with diffuse edema in SNSA (‘sausage-like’ fingers)

involvement of dip joint in snsa
Involvement of DIP joint in SNSA

Involvement of DIP joint in SNSA

asymmetric mtp arthritis in snsa
Asymmetric (MTP) arthritis in SNSA

Asymmetric (MTP) arthritis in SNSA

skin and nails in psoriasis
Skin and nails in psoriasis

Skin and nails in

psoriasis