Rheumatoid Arthritis NEET  

Rheumatoid Arthritis (RA) is a long-term autoimmune disorder that mainly targets the joints, resulting in inflammation, pain, and stiffness. Unlike osteoarthritis, which develops due to joint wear and tear, RA arises when the immune system mistakenly attacks the synovium—the protective lining around the joints. This immune response leads to swelling, joint damage, and, over time, potential deformities.

1.0Etiology

• The exact etiology is unknown, but there are factors like genetics, environmental (smoking) & infectious components. 
• These factors may cause modification and production of autoantigens (citrulline) by the citrullination process, leading to an autoimmune reaction.

2.0Pathogenesis

• The pathology of RA: 
• Synovitis (Joints, Tendon sheaths, Bursae) 
• Vasculitis: widespread cutaneous vasculitis with necrosis of the skin (seen in people with very active, strongly seropositive disease) 
• Subcutaneous Nodules

• The interaction between antigen-presenting Cells and HLA-DR4 will activate T and B cells. 
• This will lead to the production of Autoantibodies (RF & Anti-CCP) and the activation of macrophages, which will lead to the production of inflammatory cytokines (TNF-α, IL-1,6,17). 
• This will lead to the activation of Chondrocytes and Synoviocytes to produce collagenases and other proteases, which will cause bone and cartilage destruction.

3.0Joint Inflammation

• Warm, swollen, and tender joints usually in a symmetrical pattern 
• Early morning stiffness (lasting more than 1hr) that improves with activity 
• Swelling in the small joints of the hands and feet. 
• There's spindling of the fingers caused by swelling of PIPJs and MCP but NOT DIPJs or 1st CMC 
• RA does not only affect the hands; once you suspect RA, you should examine all the joints such as the temporomandibular joint, sternoclavicular joint, etc.. 
• Baker cysts (synovial cysts in the popliteal fossa) may be present Joint Involvement On Presentation Of RA: 
• 75% of cases presented with Polyarticular: 
• 60% of them have only small joints of hand & feet involvement 30% have only large joints involvement, 
• 10% have BOTH small & large joint involvement. 
• 25% of cases presented with monoarticular: 
• 50% have Knee involvement only.
• 50% have shoulder, wrist, hip, ankle, or elbow involvement. If a patient presents with sudden monoarthritis, ALWAYS consider septic arthritis or infection like TB (in case of chronic); these must be excluded before the symptoms are attributed to a disease flare-up. [p;

4.0Symptoms of RA

• Joint pain and swelling
• Morning stiffness lasting more than 30 minutes
• Fatigue and weakness
• Warm, tender joints
• Weight loss
• Fever (in some cases)

5.0RA diagnosed

• Physical examination (checking joint swelling and tenderness)
• Blood tests (e.g., rheumatoid factor (RF), anti-CCP antibodies, C-reactive protein (CRP), and ESR)
• Imaging tests (X-rays, ultrasound, or MRI to detect joint damage)

6.0Treatment  for RA

Medications:

• Disease-modifying antirheumatic drugs (DMARDs)
• Biologic response modifiers (biologics)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids

Lifestyle Changes

• Regular exercise and physical therapy
• Balanced diet (anti-inflammatory foods)
• Stress management

Surgery: (in severe cases)

• Joint replacement or corrective surgery