Rheumatoid Arthritis Overview

Rheumatoid Arthritis (RA)

• RA is a systemic autoimmune disease, affecting approximately 0.8% of adults worldwide.
• Females are diagnosed with RA three times more often than males.
• Onset typically occurs between the ages of 36 and 50 years.
• Characterized by chronic inflammation and hyperplasia of synovial membranes.
• Synovial exudate increases and synovial membranes swell and thicken.
• Erosion of joints occurs.
• Progessively debilitating and widespread.
• Pain and stiffness are often worse upon rising.
• Symptoms include redness, heat, swelling, and decreased mobility.

RA Pathophysiology

• Etiology (cause) is complex, involving genetic susceptibility, immune triggering events, and autoimmunity against synovial cells, with potential environmental factors (e.g., infection, smoking) playing a role.
• Failure of tolerance and unregulated lymphocyte activation contribute to the disease.
• T and B cell responses target self-antigens within joint tissues, including enzymes like citrullination
• Antibodies, including those directed against other antibodies, form immune complexes within the synovium.
• These immune complexes activate the complement system and intensify the inflammatory response.
• The resulting chronic inflammation leads to pannus formation, cartilage erosion, fibrosis, and joint fixation (ankylosis).
• Muscle atrophy and joint spasms can also be present.
• Initial synovial changes cause initially minimal damage.
• Tissue damage is progressive.

RA Clinical Manifestations

• Onset is often insidious (gradual).
• Can cause significant joint swelling that is symmetric and widespread.
• Malalignment and deviation are common features of long-standing RA.
• Often involve any number of joints, with pain and stiffness notable during the initial rising from bed period.
• Redness, heat, swelling, and loss of mobility are common.
• Combination of cartilage, bone erosion, and fibrosis are frequently observed.
• Systemic manifestations, such as low-grade fever, fatigue, anorexia, weight loss, and weakness, can occur during exacerbations (periods of increased disease activity).
• Granulomas (nodules) may develop on blood vessels.

RA Diagnostic Criteria

• There is no single definitive test for RA.
• Diagnosis relies on a combination of factors:
  • History and physical examination. - Morning joint stiffness longer than one hour, arthritis of three or more joint areas, arthritis in hand joints, symmetric arthritis and rheumatoid nodules.
  • Several diagnostic tests, including: elevated Erythrocyte Sedimentation Rate (ESR); elevated C-reactive protein (CRP); detection of Rheumatoid factor (IgG) ; antinuclear antibodies (ANA). Presence of inflammatory products/ immune complexes in synovial fluid and radiographic visualization of joint damage.
• Many tests are not specific (they can falsely indicate the presence or absence of the disease).

RA Treatment

• Treatment strategies balance pharmacological and non-pharmacological approaches.
• Pharmacologically, drugs that induce remission (reduce disease activity), anti-inflammatory drugs, and immunosuppressant medications are utilized.
• Non-pharmacological therapy includes rest-activity balance, physical therapy exercises to promote joint mobility for pain relief physiotherapy, splints to support and prevent deformity, heat/cold therapy.
• In severe cases, surgical interventions, such as synovial membrane removal or joint replacement, might be necessary.

Explore the key aspects of Rheumatoid Arthritis (RA), including its epidemiology, symptoms, and underlying pathophysiology. This quiz delves into the complexities of this systemic autoimmune disease, its impact on individuals, and the biological mechanisms involved. Test your understanding of RA and its effects on joint health.