Download Rheumatoid Arthritis

Rheumatoid Arthritis
Ceris Evans
What I’m going to talk about
• What is rheumatoid arthritis?
• Who gets it?
• How come?
• So what?
• Presentation
• Investigations and diagnosis
What is rheumatoid arthritis?
• Chronic, symmetrical polyarthritis
• Usually affects small, mainly peripheral joints
• Associated with extra-articular features
Who gets it?
• World wide distribution
• Presents from early childhood to old age
– Most commonly presents between ages 30-50
• Female:male = 3:1
• Can be familial
• Associated with certain HLA types
– HLA-DR4 is present in 50-75% of patients with rheumatoid
arthritis and correlates with a poor prognosis.
How come people get rheumatoid
arthiritis?
• We’re not entirely sure
• Immune system is triggered
• Immune response within synovial tissue
• Synovitis leads to increase vascular permeability and proliferation
– Joint effusions
• Inflamed synovium – “pannus”
– Contains loads of immune cells (T cells, B cells, macrophages)
– These then secrete TNF, IL-1 etc
• Thinning of cartilage, focal bone destruction
So what?
• Wide range of complications for people with the
disease.
• Approximately 1/3 people with RA stop working
due to their disease within 2 years of the onset.
• Estimated cost, including indirect costs and work
related disability, is £3.8-£4.7 billion.
Presentation
• How does it present?
• Clinical features
• Articular
• Extra articular
• How does it present?
• Can also be
– Palindromic
– Transient
– Remitting
– Rapidly progressive
Articular features
Extra-articular
• Eyes
• Lungs
• Heart
• Nervous system
• Kidneys
• Spleen
• Blood
Investigations and diagnosis
•
Criteria for diagnosis (American College of Rheumatology 1987)
– Morning stiffness >1 hour
– Arthritis of three or more joints
– Arthritis of hands and wrists
6 weeks or more
– Symmetrical arthritis
– Subcuatenous nodules
– Positive serum RF
– Typical radiological changes (erosions +/- periarticular osteopaenia
Need four or more for a diagnosis
• Blood tests
• Serology
• X rays
• Aspiration
Summary
• Polyarticular, symmetrical, chronic arthritis
• Anyone can get in but women more than men
• Immune response within the synovium leads to inflammatory pannus,
causing erosion, joint space deformity and effusion.
• Costs a lot for lots of reasons.
• Presents with pain, swelling and early morning stiffness
• Articular, extra articular and systemic manifestations
• Diagnosis is based on history, clinical findings and investigations.
What I’ve talked about
• What is rheumatoid arthritis?
• Who gets it?
• How come?
• So what?
• Presentation
• Investigations and diagnosis
• Questions?
• NICE clinical guidance 79
• Pathogenesis of rheumatoid arthritis
– McInnes and Schett NEJM 2011365:2205-19
• Good old Kumar and Clark