Rheumatoid Arthritis Overview

Rheumatoid Arthritis Overview

• Rheumatoid arthritis (RA) is a common, chronic autoimmune disease causing inflammation and destruction of joints.
• It typically affects synovial joints, commonly the hands, wrists, and feet.
• RA is a systemic condition, meaning it can affect other parts of the body, and it cannot be cured.

Objectives for Rheumatoid Arthritis

• Define rheumatoid arthritis using key words.
• Describe the pathogenesis and immune pathways of RA.
• Identify potential drug targets to treat RA.
• Describe the overall drug treatment for RA.
• Define Disease-modifying antirheumatic drugs (DMARDs) and their mechanisms of action.

What is Rheumatoid Arthritis

• A chronic autoimmune disease.
• Inflammatory and destructive arthopathy
• Primarily affects synovial joints.
• A systemic condition.
• Incurable.

Normal Joint Structure and Function

• Articular/hyaline cartilage acts as a shock absorber and allows for smooth, frictionless movement.
• Synovial membrane is not innervated, but secretes synovial fluid to nourish and cushion cartilage.

Pathophysiology of RA

• Sections on articular and non-articular aspects of RA are covered in the supplied information.

Articular Symptoms of Rheumatoid Arthritis

• Characterized by painful, warm, and swollen joints
• Three or more joints are involved.
• Morning stiffness lasting over 30 minutes

Joints Commonly Affected in RA

• Metacarpophalangeal (MCP), proximal interphalangeal (PIP), and metatarsophalangeal (MTP) joints.
• Knees, ankles, and wrists.
• Shoulders and elbows.
• Acromioclavicular and sternoclavicular joints.

Other Joints Involved in RA

• Cervical Spine (with potential for spinal cord impingement)
• Thoracolumbar, sacroiliac, and distal interphalangeal (DIP) joints of the hands are not frequently affected in RA.

Stages of Rheumatoid Arthritis

• Early stage, with possible symptoms like an early stage of joint pain, swelling, and stiffness
• Late stage showing severe deformity of joints such as boutonniere deformity, and swan-neck deformity

Non-articular Features of RA

• Presence of rheumatoid nodules (bumps under the skin, specifically on the arms).
• Inflammation affecting organs such as eyes, lungs, and heart.
• Possible blood disorders like anemia.
• Symptoms such as fatigue, fever, and tiredness.

Impact of Rheumatoid Arthritis

• Typical onset age range from 40-50 to 70 years of age, can manifest early in some.
• Approximately 1% of the UK population is affected.
• 12,000 patients under the age of 16 with RA in the UK.
• Significant healthcare costs include £560 million annually in NHS costs and £3.8 − £4.75 billion annually in broader economic costs.
• Prognosis is typically poor, with 33% of patients developing severe disability, and a notable reduction in life expectancy by 3-18 years on average.

Pathophysiology of Rheumatoid Arthritis (Detailed)

• Description of normal knee joint structure.
• Description of early and established rheumatoid arthritis.

Untreated RA Causes Joint Damage

• Pictures demonstrating significant joint damage over time due to progressive inflammation
• This shows the necessity of early diagnosis and treatment.

Signaling Pathways in RA

• Explains the pathways and cytokines like IL-1, TNF-α, and IL-6 involved in the inflammatory response in RA.

Auto-Antibodies and RA

• B cell activation in RA stimulates the production of anti-IgG antibodies including rheumatoid factor (RF) and anti-citrullinated protein antibodies (anti-CCP).
• A negative RF test doesn't exclude RA, while anti-CCP presence strongly suggests RA and has high sensitivity.

Causes of RA

• Genetic predisposition plays a significant role, with family history increasing risk.
• Environmental factors, such as smoking, hormones, infections, geographic location, and diet are potential triggers in susceptible individuals.

Diagnosis of Rheumatoid Arthritis

• Physical examination to asses joint function in general.
• Blood tests (full blood count, CRP, ESR) are used.
• Serologic tests for rheumatoid factor (RF) and anti-CCP antibodies confirm the presence of RA.
• Radiographic imaging (X-ray or MRI) to evaluate joint damage.

Drug Therapy for RA

• Description of various drug types.
• Diagram illustrating drug targets and mechanisms, including immunosuppressants, glucocorticoids, and anti-TNF agents.
• Notes on disease-modifying antirheumatic drugs (DMARDs) which aim to modify the disease course.

This quiz provides a comprehensive overview of rheumatoid arthritis (RA), including its definition, pathogenesis, and treatment options. Participants will learn about the systemic nature of the condition and the role of Disease-modifying antirheumatic drugs (DMARDs) in managing RA. Test your knowledge on this chronic autoimmune disease and its impact on joint health.