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Rheumatoid arthritis

  • Rheumatoid arthritis is an autoimmune disorder that primarily affects joints.

  • It occurs when the immune system mistakenly attacks the body's tissues, causing inflammation in the joint lining.

Overview

  • Rheumatoid arthritis (RA) is a chronic autoimmune disorder that primarily affects the joints, causing inflammation, pain, and potential joint destruction.

  • It can also have systemic effects, impacting various organs and systems in the body.

Symptoms

  • The symptoms of rheumatoid arthritis can vary in severity and may include:

  • Joint pain and tenderness

  • Joint stiffness, especially in the morning or after periods of inactivity

  • Swelling in the joints

  • Redness and warmth around the affected joints

  • Fatigue

  • Fever

  • Weight loss

  • Rheumatoid nodules (firm lumps under the skin, often around pressure points)

  • Reduced range of motion

Etiology

  • The exact cause of rheumatoid arthritis is unknown, but several factors are believed to contribute to its development:

  • Genetic factors - Certain genetic markers, such as HLA-DR4, increase the risk of developing RA.

  • Environmental factors - Smoking, exposure to certain infections, and other environmental factors can trigger the onset of RA in genetically predisposed individuals.

  • Immune system abnormalities - RA is an autoimmune disorder where the immune system mistakenly attacks the synovium (lining of the membranes surrounding the joints).

Pathogenesis of Rheumatoid Arthritis (RA)

  • Rheumatoid arthritis is an autoimmune disorder primarily affecting joints.

  • Genetic Predisposition: Genetic factors, such as HLA-DR4, increase susceptibility.

  • Immune System Dysfunction: Autoantibodies (e.g., rheumatoid factor, anti-CCP) target joint synovium, leading to chronic inflammation.

  • Synovitis: Inflammation of the synovial membrane results in pannus formation, which invades and destroys cartilage and bone.

  • Cytokines: Pro-inflammatory cytokines (TNF-α, IL-1, IL-6) drive the inflammatory response and joint destruction.

Treatment

  • There is no cure for rheumatoid arthritis, but treatments can help manage symptoms and slow disease progression.

  • Treatment options include:

1. Medications:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) - Reduce pain and inflammation.

  • Corticosteroids - Provide quick relief from inflammation and pain.

  • Disease-modifying antirheumatic drugs (DMARDs) - Slow disease progression and save joints and other tissues from permanent damage (e.g., methotrexate, leflunomide).

  • Biologic agents - Target specific parts of the immune system that fuel inflammation (e.g., TNF inhibitors, IL-6 inhibitors).

2. Physical therapy

  • Helps maintain joint flexibility and muscle strength.

3. Occupational therapy

  • Assists in adapting daily activities to reduce strain on the joints.

4. Surgery

  • In severe cases, surgical options like joint replacement or synovectomy may be considered.

5. Lifestyle modifications

  • Regular exercise, a balanced diet, stress management, and smoking cessation can help manage symptoms and improve quality of life.

Prevention

  • While there is no known way to prevent rheumatoid arthritis, early diagnosis and treatment can help manage the disease effectively and reduce the risk of joint damage.

  • Maintaining a healthy lifestyle, avoiding smoking, and regular medical check-ups are important in managing risk factors associated with RA.


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