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RHeumatoid arthritis .pdf



Original filename: RHeumatoid arthritis.pdf
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Rheumatoid arthritis
Dr.Khwaja Nazim Uddin
MBBS(Dhaka)FCPS(M)
FRCP(Glasgow)FACP(USA)

Rheumatoid arthritis
The

typical clinical
phenotype of RA is a
symmetrical,
deforming, small and
large joint
polyarthritis,
often associated
with systemic
disturbance and
extra-articular
disease.

The clinical course
is usually life-long,
with intermittent
exacerbations and
remissions and
highly variable
severity

RA-Epidemiology






Rheumatoid arthritis (RA) is the most common
inflammatory arthritis in women
In Caucasians it is around 1.0-1.5% with a
female:male ratio of 3:1.
Before the age of 45, the female:male ratio is
6:1.
Prevalence increases with age, with 5% of
women and 2% of men over 55 years being
affected.

Even though infectious agents such as viruses, bacteria, and fungi
have long been suspected, the cause of rheumatoid arthritis is
unknown

Grading of function in RA






1: Fit for all activities-----------------no
handicap
11:Moderate restriction-independent despite
some limitation of joint movement
111: Marked restriction-limited self
care.Some assistanc required
1V :Confined to chair or bedbound largely
incapacitated and dependent

4
4/21/2017

Etiology
Autoimmunity: A is an autoimmune disease
 Heredity: Disease is increased in first-degree relatives
 HLA :-DR1 is more important in Indians and Israelis and
DW15 in Japanese.DR4 positivity more common in those
with severe erosive disease.
 Sex:Female gender is a risk factor and this susceptibility
is increased post-partum and by breast feeding.
 Infection: No infectious agents have been consistently
isolated
Smoking: Cigarette smoking is a risk factor for RA and for
positivity for rheumatoid factor in non-RA subjects.


Pathogenesis

Pathology


RA is characterized by

persistent cellular activation
 autoimmunity and
 the presence of immune complexes at
sites of articular and extra-articular lesions


Pathology
This leads to
 Chronic inflammation,
 Granuloma formation

and


Joint destruction.


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