21/10/2025
Rheumatoid Arthritis (RA)🧐🩺👇
Rheumatoid arthritis is a chronic, systemic autoimmune disease that primarily affects the joints, causing inflammation of the synovial membrane leading to pain, swelling, stiffness, and deformity.
🛑Pathophysiology
• The immune system attacks the synovium (lining of joints).
• This causes chronic inflammation, leading to:
• Synovial thickening (pannus formation)
• Cartilage destruction
• Bone erosion and joint deformity
• It can also affect other organs (heart, lungs, skin, eyes, blood vessels).
🛑Signs and Symptoms
Joint-related:
• Symmetrical joint pain and swelling (usually small joints: hands, wrists, feet)
• Morning stiffness lasting >30 minutes
• Warm, tender joints
• Limited range of motion
• Deformities (swan neck, boutonnière, ulnar deviation)
Systemic symptoms:
• Fatigue, fever, malaise
• Weight loss
• Rheumatoid nodules (firm lumps under skin near joints)
🛑Diagnosis
1. Laboratory Tests
• ↑ Rheumatoid factor (RF)
• ↑ Anti-CCP antibodies (highly specific)
• ↑ ESR and CRP (indicate inflammation)
• Mild anemia (anemia of chronic disease)
2. Imaging
• X-ray: joint space narrowing, bone erosion
• Ultrasound or MRI: early joint inflammation
🛑Treatment
Goals: reduce inflammation, relieve pain, prevent joint damage
1. Medications
• NSAIDs: relieve pain and stiffness (e.g., ibuprofen, naproxen)
• Corticosteroids: short-term control of inflammation (e.g., prednisone)
• DMARDs (Disease-Modifying Antirheumatic Drugs): slow disease progression
• Methotrexate (first-line)
• Sulfasalazine
• Leflunomide
• Hydroxychloroquine
• Biologic Agents: target immune system components
• Etanercept, Infliximab, Adalimumab (anti-TNF agents)
• Tocilizumab, Rituximab (other biologics)
2. Non-Pharmacological
• Physical therapy and gentle exercise
• Heat/cold application
• Joint protection (splints, assistive devices)
• Balanced diet (anti-inflammatory foods, omega-3)
• Smoking cessation
3. Surgical Management
• Joint replacement (arthroplasty) in severe cases
• Synovectomy (removal of inflamed synovium)