rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system
– which normally protects its health by attacking foreign substances like bacteria and
viruses – mistakenly attacks the joints. This creates inflammation that causes the tissue
that lines the inside of joints (the synovium) to thicken, resulting in swelling and pain in
and around the joints. The synovium makes a fluid that lubricates joints and helps them
move smoothly
Clinical manifestation
An autoimmune disorder
• Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In
some people, the condition can damage a wide variety of body systems, including the skin, eyes,
lungs, heart and blood vessels.

rheumatoid arthritis
• occurs when your immune system mistakenly attacks your own body's tissues.Unlike the wear-and-
tear damage of osteoarthritis, rheumatoid arthritis affects the lining of your joints, causing a painful
swelling that can eventually result in bone erosion and joint deformity.The inflammation associated
with rheumatoid arthritis is what can damage other parts of the body as well. While new types of
medications have improved treatment options dramatically, severe rheumatoid arthritis can still
cause physical disabilities.
• SymptomsSigns of rheumatoid arthritis may include:Tender, warm, swollen joints
Joint stiffness that is usually worse in the mornings and after inactivity
Fatigue, fever and loss of appetite
 system involved rheumatoid arthritis

• Along with the joints, RA can affect many of the body's organs, including the heart, eyes, and
brain, as well as the skeleton.
• The joints RA can affect any joint in the body, and it commonly develops in the fingers,
hands, and feet
• The skeleton the joints contain cartilage, which prevents the bones from rubbing together.
Over time, inflammation from RA can cause the cartilage to break down.
• The skin in as many as 20 percent of people with RA, Rheumatoid nodules develop under
the skin, over bony areas. While they are often painless and are generally not a cause for
concern, they can cause discomfort if a person places pressure on them, such as when
kneeling
• The mouth people with RA are more likely than others to experience dry mouth, or
xerostomia.
• The eyes RA can also cause inflammation in the eyes, as well as dry eye syndrome, which
can lead to ongoing irritation and eventually damage the cornea.
• The lungs in around 80 percent of people, RA affects the lungs. The effects are usually not
severe enough to cause symptoms. However, inflammation in the lungs can lead to
pulmonary fibrosis, which can cause scarring and breathing difficulties.
• The heart inflammation from RA can damage the heart and blood vessels. In some cases,
the consequences are life-threatening.
• The nerves RA causes inflammation and swelling, which can compress the nerves in the
area.
Anatomy of Rheumatoid Arthritis
• For rheumatoid arthritis (RA), the most important part of your anatomy to understand is the joints.
RA usually starts in the neck (cervical spine), so we'll start there, too. the joints in spine that can be
affected by RA.
• Cervical Spine JointsAt the top of your spine, where your spine and skull come together, you have
the atlas vertebra.
• On the axis, there is a special bony projection called the odontoid process or the dens that's the
pivot point for the C1 vertebra, or the atlas. The odontoid process is a tooth-like structure that rises
from the body of the axis, and the joint space between the axis and the atlas is termed atlantoaxial.
That is a joint that can be affected by RA.

• The whole joint—cartilage and all—is covered by a thin membrane called the synovium. The
synovium produces synovial fluid, which is what truly helps your joints move well. The synovial fluid
lubricates the cartilage and bone.
• Thoracic and Lumbar SpinesIt's rare for rheumatoid arthritis to affect the thoracic (upper or mid-
back) or lumbar (low back) spines) It is possible.
Pathophysiology of rheumatoid arthritis

• Rheumatoid arthritis (RA) is a systemic inflammatory disease mainly

characterized by synovitis and joint destruction.
• Etiology of RA is unknown. Although the impact of genetic factors is
obvious, the genetic basis is not sufficient to explain the triggering of the
immune insult.
• The dominant feature is inflammation, primary in synovium. The synovial
membrane in RA becomes hyperplastic. There is an increased number of
both type synoviocytes and is infiltrated with immune and inflammatory
cells: particularly macrophages, B- and T-lymphocytes, plasma cells and
dendritic cells. Increased levels of cytokines are present. Cytokines play a
central role in the perpetuation of synovial inflammation.
Treatment
• There is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is
more likely when treatment begins early with medications known as disease-modifying anti
rheumatic drugs (DMARDs).
• Medications
• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation
• Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow
joint damage.
• Disease-modifying antirheumatic drugs (DMARDs). These drugs can slow the progression of
rheumatoid arthritis and save the joints and other tissues from permanent damage
• Therapy Your doctor may send you to a physical or occupational therapist who can teach you
exercises to help keep your joints flexible.
• Surgery If medications fail to prevent or slow joint damage, you and your doctor may consider
surgery to repair damaged joints.