Rheumatoid Arthritis

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  • Created by: Paul
  • Created on: 07-12-12 14:42
Epidemiology - RA
Affects 1% worldwide, 20-65, mean AOO 47-52, females at 3 x risk, Caucasians at higher risk, Urban populations at higher risk
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Aetiology - RA - (1) - Viral
Not one single bacteria has been found that is known to cause RA, Postulated that antibodies that react with E coli may be at fault - higher levels found in synovial fluid, Epstein Barr, Possibly prolong RA once initiated
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Aetiology - RA - (2) - Genetic
Hormones, Not inherited but may predispose, Specific variants of HLA, Gender (reduced in woman taking oral contraceptive)
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Aetiology - RA - (3) - Exogenous
Smoking (increased risk + may be more severe), Pollution, Stress
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Aetiology - RA - (4) - Autoimmunity
Higher levels of RF in sufferers, this reacts with the protein gamma globulin
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Rx - Rheumatoid Arthritis - pharmacotherapy (1)
1st (aspirin used previously not so common) naproxen or piroxicam to ease stiffness, synovitis and improve mobility
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Rx - Rheumatoid Arthritis - pharmacotherapy (2)
Gold salts, penicillamine, antimalarials or immunosuppressants
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Pathophysiology - Rheumatoid Arthritis - (3)
These cells secrete a variety of pro inflammatory mediators such as TNF-a, IL-1 and other cytokines such as IL-6, resulting in the underlying joint destruction that is seen in patients with long standing RA
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Pathophysiology - Rheumatoid Arthritis - (2)
Infiltration by macrophage like cells occurs and the synovial membrane is thickened by these chronic inflammatory cells, This thickening is made up of a variety of cells including T and B cells as well as macrophages
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Pathophysiology - Rheumatoid Arthritis - (5)
The pathological changes are not confined to joints, The synovial lining of tendon sheaths may be similarly inflamed and thickened, both in hands and feet
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Pathophysiology - Rheumatoid Arthritis - (1)
Immune system is activated by an unknown antigen, antigen presenting cells take this antigen to the T-cells and stimulate them, The T-cells then proliferate and secrete a variety of pro inflammatory cytokines and migrate to the synovial tissue
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Rx - Rheumatoid Arthritis - Surgery
Synovectomy, Arthrodesis, Excision arthroplasty or TJR
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Rx - Rheumatoid Arthritis - pharmacotherapy (3)
Steriods low levels to be used to minimise side effects, accessible joints can be treated with intra-articular steroids
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Pathophysiology - Rheumatoid Arthritis - (4)
As RA progresses the articular cartilage is softened and eroded the subchondral bone may also become eroded also, The eroded surfaces become covered by a soft membrane of inflammatory tissue known as pannus
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Pathophysiology - Rheumatoid Arthritis - (6)
The contained tendons may become softened and may rupture, This may aggravate any existing deformity, Inflammatory nodules may form in the soft tissue
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Pathophysiology - Rheumatoid Arthritis - (7)
After years of activity the disease tends to become less active usually leaving permanant damage, instability and deformity
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Other cards in this set

Card 2

Front

Aetiology - RA - (1) - Viral

Back

Not one single bacteria has been found that is known to cause RA, Postulated that antibodies that react with E coli may be at fault - higher levels found in synovial fluid, Epstein Barr, Possibly prolong RA once initiated

Card 3

Front

Aetiology - RA - (2) - Genetic

Back

Preview of the front of card 3

Card 4

Front

Aetiology - RA - (3) - Exogenous

Back

Preview of the front of card 4

Card 5

Front

Aetiology - RA - (4) - Autoimmunity

Back

Preview of the front of card 5
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