Health and Illness 1 RA notes.docx - Rheumatoid Arthritis Rheumatology Connective tissue disease(CTD major focus Noninflammatory localized

Health and Illness 1 RA notes.docx - Rheumatoid Arthritis...

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Rheumatoid Arthritis Rheumatology Connective tissue disease (CTD) major focus Noninflammatory: localized arthritis (osteoarthritis) not systemic, not an autoimmune disease Inflammatory: rheumatoid arthritis, SLE, autoimmune disease Rheumatoid Arthritis Chronic, systemic autoimmune disease Inflammation of connective tissue in diarthrodial (synovial) joints (fingers, wrists, elbows) Periods of remission and exacerbation Extraarticular manifestations Affects all ethnic groups Incidence increases with age and peaks between ages 30 and 50 Estimated 1.5 million Americans Three times as many as women as men RA Pathology Inflammation (synovitis) leads to pannus formation, obliteration of the articular space and finally ankylosis Etiology and Pathophysiology Autoimmune etiology: combination of genetics and environmental triggers
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Antigen triggers formation of abnormal immunoglobulin G (IgG) Autoantibodies develop against the abnormal IgG: Rheumatoid factor (RF) Cause is unknown. Probably results from combination of genetics and environmental triggers Rheumatoid factors combines with IgG immune complexes, deposit on synovial membranes or cartilage in joints, activates complement, inflammatory response Neutrophils, proteolytic enzymes, damage cartilage and thicken synovial lining Stages Stage I (early): Synovitis. X-ray: soft tissue swelling, possible osteoporosis, no joint destruction Stage II (moderate): Increased joint inflammation, gradual destruction in joint cartilage, narrowing joint space from loss of cartilage. Stage III (severe): formation of synovial pannus. X-ray: extensive cartilage loss, erosion at joint margins, possible deformity Stage IV (end-stage): inflammatory process subsides, loss of joint function, formation of subcutaneous nodules. Clinical Manifestations Joints Onset typically insidious Fatigue, anorexia, weight loss, generalized stiffness May report history of precipitating event (infection, stress, exertion, childbirth, surgery, emotional upset) Specific joint involvement (pain, stiffness, limited motion, and signs of inflammation)
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Symptoms occur symmetrically Often affects small joints
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