This presentation is made by Dr Ashok Jaisingani for study purpose if any one like this than please give your comments.

1. Dr. Ashok Jaisingani

2. Rheumatoid Arthritis
 The commonest type of inflammatory arthritis is rheumatoid
arthritis affects approx. 3% of women & 1% men.
 The disease appear to arise from cell-mediated (T-cell)
autoimmune response, but there may be underlying infectious
etiology.
 After triggering of T-cell response there release of cytokines,
Interleukin – I & 6 (IL-I & IL-6)
Tumor Necrosis Factor (TNF)
 The disease mostly affect small joints of hands & feet,
however any joint of body or soft tissue can be involved.
 A layer of inflammatory tissues called „panus‟ spread over the
joint surface erode subchondrial bone, denuding articular
cartilage.
 Rheumatoid Factor (RF) is +ve in 80% of cases

3. Extra-articular Manifestation
 Extra-articular manifestation of rheumatoid
arthritis include:
 Skin – Subcutaneous Nodules
 Eyes – Scleritis, iritis
 Lungs – Interstitial lung disease, pleural
effusion.
 Heart – Myocarditis
 Kidneys – Nephritis
 Amyloid – Lungs, kidney, heart & bowl
 Compression & vascular neuritis.

4. Clinical Features
 Mostly the disease onset insidiously, with joint stiffness &
polyarthritis, some time disease may onset acutely in
about 30% of the pts & may present with malaise & low
grade fever.
 Hands & feet are commonly affected in early stage of the
disease.
 On examination there may be effusion & synovitis of
affected joints, which may cause
Swelling
Warmth
Erythema
Stiffness of affected joints with pain on movement.

5. Characteristic pattern Of Disease
 There may be deformity seen in hand & wrist
 Inflammation of tendon (Tenosynovitis), commonly affect
flexor & extensor muscles of hand & wrist.
 Rupture of extensor tendon, most commonly of little
finger.
 ESR & CRP are usually elevated
 Radial deviation of wrist
 Ulner deviation of metacarpophalangeal joints
 Z – deformity of thumb
 Boutonniere deformity of thumb
 Swan neck deformity
 Carpel tunnel syndrome

6. Rheumatology Criteria For
Diagnosis Of RA
 This involve pt having four of seven criteria
 1- Morning stiffness lasting atleast 1 – hour
 2- Active arthritis of three or more joints
 3- Active arthritis of atleast one hand joint (wrist, MCPJ,
PIPJ)
 4- Symmetrical arthritis
 5- Subcutaneous rheumatoid nodules on extensor
surface, juxta -articular or bony prominences
 6- Rheumatoid factor positive
 7- Radiographic changes of particular erosion, or
osteopenia in affected joints not osteoarthritis.

7. Treatment
 Long standing, stable, mild cases of rheumatoid arthritis can be
treated with analgesic and NSAIDs.
 The disease – modifying anti-rheumatic drugs (DMARDs) can be
useful in preventing long term recruitment of autoimmune cascade.
 DMARDs are following
1- Methotrexate
2- Gold
3- Sulphasalazine/ Salazopyrine
4- Lefunomide
5- Penicillamine
6- Ciclosporine
 The most recent development of anti – TNF drugs such as
“Etanercept & Infliximab” may revolutionize treatment
 Corticosteroid therapy continue to be useful systemically & locally
and by injection into joints or around tendon.

8. Surgery For Rheumatoid Arthritis
 Splints can be useful to reduce the pain & improve
function (unstable wrist, swan neck deformity)
 Orthotics are useful for the foot & ankle joints
 Arthodesis (fusion) for cervical spine, finger (PIPJ), wrist,
ankle & hind foot.
 Joint replacement for major joints including hip, knee,
elbow & shoulder joints.
 There are few sites where excision arthoplasty is used
such as distil ulna & radial head.
 Tenosynovectomy for inflamed tendon sheath in case of
resistant to medical treatment to prevent tendon rupture.
 In case of resistant to anti-inflammatory treatment
perform synovectomy