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Rheumatoid arthritis rheumatoid arthritis is a chronic systemic inflammatory disorder with progressive erosion of the bone and cartilage causing significant joint destruction and deformity it affects women more often than men and has a typical onset at age 30 to 50 years patients typically present with pain swelling of the joint morning stiffness which improves
With activity lasting typically more than an hour and systemic features like fatigue fever in anemia it involves proximal interphalangeal and metacarpal phalangeal joints sparing the distal interphalangeal joints metatarsal phalangeal joints were also involved it can involve large joints like knees and elbows later in the course of the disease on examination
Affected joints are tender to touch are swollen with limited range of motion tenosynovitis of the palms can result in a trigger finger due to taut aponeurosis there can be a reduction in grip strength and can be a sensitive sign of early disease rheumatoid nodules which are firm and non-tender subcutaneous nodules usually close to pressure points are commonly
Seen on elbows off the spinal column rheumatoid arthritis affects the cervical spine most often and in case manipulated like during in the trakula intubation can lead to spinal cord compression and see plain increased levels of pro-inflammatory cytokines and lack of physical activity may contribute to local or generalized bone loss resulting in ostia or in some
Cases osteoporosis and bone fractures the risk increases if other risk factors like a low body babe female sex smoking history postmenopausal women or alcohol abuse or present the degree of bone loss generally correlates with disease activity inadequate physical activity and optimization of calcium and vitamin d intake what minimization of glucocorticoid doses
Should be implemented to prevent or reduce the bone loss bisphosphonate therapy may also be beneficial in severe cases diagnosis is made with lab examination like a positive anti sit chillin aidid c-peptide antibodies which is the diagnostic test there can also be an elevated igm levels of rheumatoid factor the inflammatory markers which is acid reactive protein
And the earth through site sedimentation rate correlate with disease activity and needs to be performed as well x-rays shows soft tissue swelling joint space narrowing bone erosion xin osteopenia treatment goals and rheumatoid arthritis are to induce and maintain earlier emission control the inflammation of the joint synovium and prevent progression of joint
Damage all patients diagnosed with rheumatoid arthritis should be started on this is modifying or antirheumatic drugs as soon as possible as joint damage begins early in its course enes aids and selective cox-2 inhibitors like study coxa provide only symptomatic relief but do not reduce the disease progression or alters the disease disease-modifying antirheumatic
Drugs include non biologic agents which target inflammatory pathways like methotrexate hydroxychloroquine laughlin amide is a tire print sulfasalazine and biologic agents which are produced by recombinant dna technology which target cytokines and cell surface proteins like infliximab at a lee moon lab tested asuma rituximab etanercept so on and so forth tumor
Necrosis factor-alpha inhibitors are associated with significant adverse effects including neutropenia and infections with reactivation of latent tuberculosis or other opportunistic new infections can be a possibility because of an underlying neutropenia in patients treated with human acrosses factor-alpha inhibitors there can also be exacerbations of heart
Failure demyelinating illnesses in an increased risk of malignancy with the use of tumor necrosis factor-alpha inhibitors disease-modifying antirheumatic drugs and their adverse effect profile methotrexate is a preferred initial disease modifying antirheumatic drug in patients with moderate to severe acting toward arthritis due to its efficacy and long-term
Safety profile methotrexate is a dm ard which works by inhibiting dihydrofolate reductase enzyme patients should be tested for hepatitis b and c and tuberculosis before starting therapy as immunosuppression with the mu rds can activate the underlying disease causing lethal complications like multi organ failure and death methotrexate should not be used in patients
Who are pregnant or who are planning to become pregnant in the near future and those with severe renal insufficiency or liver disease or excessive alcohol intake patients who did not respond after six months may require biologic dmr d is such as tumor necrosis factor-alpha inhibitors like etanercept or infliximab as a step up therapy herto logic toxicity with
Macrocytic red blood cells may occur with its usage and one of the more serious normalities is the development of pancytopenia with the use of methotrexate in an attempt to prevent these complications the american college of rheumatology recommends routine peripheral blood counts every three months other side-effects of methotrexate include nausea stomatitis
Rash hepatotoxicity interstitial lung disease alopecia and fever methotrexate acts by interfering with the cellular utilization of folic acid and folate depletion is considered to be the cause of most of these complaints some of these reactions can be alleviated or prevented by the addition of supplemental folic acid without changing the efficacy of methotrexate
Azathioprine is an immunosuppressive agent that has been used to treat rheumatoid arthritis remember it’s not really as efficacious as the other dme artis and is associated with significant hematologic and gastrointestinal toxicity felty syndrome the triad of inflammatory arthritis splenomegaly and neutropenia is characteristic of felty syndrome felty syndrome
Is most common in patients with long-standing rheumatoid arthritis and is seen more commonly in women in their fourth or fifth decades patients with faulty syndrome typically have severe appositive rheumatoid arthritis with an increased risk for extra-articular manifestations like skin ulcers or vasculitis etc the niche opinion or phallus syndrome increases the
Risk of recurring bacterial infections the pathophysiology is usually unknown but there is an association with hla dr4 and in patients with a family history of rheumatoid arthritis for faulty syndrome diagnosis is usually clinical but hemet law studies like peripheral blood smear or bone marrow biopsy are frequently performed to exclude other causes of neutropenia
Faulty syndrome usually improves with treatment of the underlying rheumatoid arthritis with disease-modifying antirheumatic drugs like method tracks a
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Rheumatoid arthritis Animation – Etiology, Signs and Symptoms, Pathology, Diagnosis, and Treatment By Dr.G Bhanu Prakash Animated Medical Videos
