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Rheumatoid Arthritis (Pathophysiology (All these chemicals contribute to…
Rheumatoid Arthritis
Pathophysiology
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There is local production of rheumatoid factor (an auto-antibody) and immune complexes with complement activation
Fibroblasts produce IL6, vascular cell adhesion molecule (VCAM) and delay accelerating factor
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Activated T cells produce IFN, IL2+4. Macrophages produce IL1+8 and TNF-alpa. Mast cells produce histamine and TNF-alpha
The synovium proliferates and grows over the cartilage, producing a pannus
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The pannus destroys articular cartilage and subchondral bone, producing bony erosions
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There is loss of cartilage, causing joint space narrowing
Treatment
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Early use of DMARDs e.g. methotrexate, sulfasalazine, hydroxychloroquine, gold - significantly controls disease
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Surgery is only done for patients with maximum tolerated therapy but still experience pain and restricted joint movement
Symptoms
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Systemic symptoms e.g fever, weight loss
Signs
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Swollen MCP, PIP, wrist/MTP joints
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Investigations
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X-Ray: soft tissue swelling, loss of joint space, juxta-articular osteopenia
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Epidemiology
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Prevalence is 1%, and it is higher in smokers
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Definition
RA is a chronic systemic autoimmune inflammatory disease, with symmetrical, deforming, peripheral polyarthritis