Rheumatoid Arthritis
Presenters: Fatema Aishee
Nisat Faria Nisu
Rakibur Rahman
Mubashwera Karim Ananya
What is Rheumatoid Arthritis (RA)?
Autoimmune inflammation of synovium
-Thin layers of tissue
-Line joints and tendon sheaths
-Secretes hyaluronic acid to lubricate joint space
• Systemic disease with extraarticular complications
• Affects around 1% of the global population, more common in women
• Usual age of onset 30 to 50
• Common form of inflammatory arthritis
• Occurring throughout the world and all ethnic groups
• Prevalence of RA is approximately 0.8%-1.0% in Europe and South Asia
with female to male ratio 3:1
Pathophysiology
Drug target sites
Clinical Features of
Rheumatoid Arthritis
Typical presentation
•Pain
•Joint Swelling
•Stiffness
Articular manifestation of
rheumatoid arthritis:
Fig: Ulnar deviation of fingers
• Fixed flexion of DIP
• Hyper-extension of PIP
Fig:‘Swan neck‘ Deformity of the fingers
Fig:Boutonniere Deformity
Fig: Z deformity
Fig:Popliteal cyst
Extra-articular manifestation
of Rheumatoid Arthritis
A) Systemic B) Musculoskeletal
• Fever • Muscle-wasting
• Weight loss • Tenosynovitis
• Fatigue • Bursitis
• Susceptibilty to infection • Osteoporosis
C) Haematological
• Anaemia
• Thrombocytosis
• Eosinophilia
D) Lymphatic
• Felty syndrome
• Splenomegaly
E) Nodules
• Sinuses
• Fistulae
Fig:Nodules
F) Ocular
• Keratoconjunctivitis sicca
• Episcleritis
• Scleritis
• Scleromalacia
Fig:Sleromalacia
G)Vasculitis
• Digital arteritis
• Ulcers
• Pyoderma
gangrenosum
• Mononeuritis Multiplex
Fig:Digital gangrene
Fig:Pyoderma Gangrenosum
Foot drop Wrist Drop
H) Cardiac J)Pulmonary
• Coronary arteritis • Nodules
• Pericarditis • Caplan syndrome
• Myocarditis • Pneumothorax
• Conduction defects • Diffuse Parenchymal Lung
• Endocarditis Disease
k) Neurological
• Compression Neuropathy
• Cervical cord compression
• Peripheral Neuropathy
L) Amyloidosis
Emergencies of Rheumatoid arthritis
•Coronary arteritis
•Atlantoaxial subluxation
•Foot drop, Wrist drop
•Scleromalacia Perforans
Diagnosis & Investigations of
Rheumatoid Arthritis
Confirmation of the diagnosis
● ESR
● CRP
● RF
● ACPA
Exclusion of Differential
● Investigations will be guided by clinical
features
● X-ray both sacroiliac joints oblique view
● HLA-B27
● ANA
For Drug safety
● CBC
● ALT
● Serum Creatinine
● Urine R/E
● Chest X-ray
To monitor disease damage
● X-ray
Findings
● Periarticular osteopania
● Bony erosion
● Narrowing of joint space
● Decrease bone density
For systemic involvement
● Conduction defects
For systemic involvement
● Acute ST Elevated MI
ECG of Pericarditis
HRCT of chest
UIP Pattern NSIP Pattern
Atlantoaxial Subluxation
Management
Non-Pharmacological
Therapy
Pharmacological
Therapy
• NSAIDs
• Immunosuppressant including
steroids
• DMARDs
DMARDs: (a)Biologic
(b)cDMARDs
(c)tsDMARDs
Biologic dMARDs
• TNF-alpha
inhibitors:infliximab
• CD20 blockers:Rituximab
• IL-6 inhibitor:Tocilizumab
cDMARDs:
• Methotrexate
• Leflunomide
• Sulfasalazine
• Hydroxychloroquine
tsDMARDs:
• Tofacitinib
• Baricitinib
• Upadacitinib
• Filgotinib
Treatment
Target:
To achieve
remission
or low disease
activity
Surge
ry
Synovectomy ,
metatarsal osteotomies
etc.
Rheumatoid
Arthritis in
pregnancy
• Paracetamol:The oral analgesic of
choice
• DMARDs to be
used:Sulfasalazine,Azathioprine and
Hydroxychloroquine
• DMARDs to be
avoided:methotrexate,leflunomide,cy
clophosphamide and mycophenolate
• Biologic DMARDs can also be used
Treatment of complication:
• Cardiovascular disease:Statin,biologic and
non-biologic DMARDs
• Osteoporosis:Calcium and vitamin-D
supplement
• Lung disease:Anti-fibrotic drugs for fibrosis
• Eye complication:Artificial tears for dryness
