A Review
Samir Albreshni Acknowledgements: Dr R Gorodkin
Objectives
Definitions of arthritis and rheumatoid arthritis Review the epidemiology of RA Disease course and complications Basic investigations
What is arthritis?
An inflammatory condition that affects the joints
Inflammation:
Excessive heat Swelling Pain Redness Loss of function
Epidemiology Of RA
Worldwide disease, affects all ethnic groups Females > males 3:1
Age onset - peak 35-45 years Can effect children and the elderly Occurs in about 1% of adult population (UK/US)
Risk Factors
Age and gender Genetic Hormonal and reproductive Infections Socioeconomic Lifestyle
Genetic
Genetic factors may predispose some individuals to
RA (concordance in twin studies; familial clustering)
Normal knee
Damaged Knee
Summary of XR changes
RA
Excess soft tissue Juxta-articular
osteopaenia Loss of jt. space Bony erosions Subluxation
OA
Loss of jt. space Subchondral sclerosis Subchondral cysts Marginal osteophytes
Laboratory Tests
FBC
Anaemia Thrombocytosis Acute phase response ESR / CRP / Alk P Raised immunoglobulins Rheumatoid factor Anti-CCP antibody
Rheumatoid Factor
Not unique to rheumatoid arthritis Present in about 80% of patients with RA Does not cause rheumatoid arthritis Associated with more severe disease NOT A BLOOD TEST FOR ARTHRITIS!!!!
NO!!!
Extra-articular Manifestations
Anaemia Sicca syndrome Pericarditis Pleuritis/ Pulmonary Fibrosis Subcutaneous Nodules Ocular Inflammation Neuropathies Vaculitis Splenomegaly (5% - only 1% is Feltys synd.) Amyloidosis
Nodule
Normal Lungs
Results:
Pain
Disability Loss of work
Mortality
Mortality
RA can reduce life expectancy by 10 to 15 years
Mortality may approach 50% over 5 years in cases of
severe disability
SMR
1 0.8
UK UK
Sweden USA/ Canada Finland
Mortality - Cardiac
3
SMR
1 0.8
UK UK
Sweden USA/ Canada Finland
Malignancy
SIR
5
Finland, 1978 Sweden, 1993 Denmark, 1996 Scotland, 2000
3 2
0.5
All cancers
NHL
Lung cancer
Colorectal cancer
Psychosocial Impact
Depression affects up to 40% of patients and may
impact compliance and reporting of symptoms
Economic Impact
In the US, the total cost of RA is estimated at more
than $32 billion (20 billion).
Treatments
Analgesics Steroids DMARDS (disease modifying anti-inflammatory
drugs) Physiotherapy OT Podiatry Surgery
Goals of RA Treatment
No constitutional symptoms (fever, malaise)
Returning to a normal work schedule Minimizing the impact on activities of daily living Changing the course of disease progression (slowing
or stopping the disease)
Gold
Penicillamine
Methotrexate
1950
1960
1970
1987
1998
1999
DMARDS
Antimalarials eye involvement Methotrexate monthly blood tests Sulphasalazine 3 monthly blood tests
Steroids osteoporosis, early DM, early
cataracts, weight gain, skin thinning
Summary
A chronic disease of unknown cause affecting the joints
and other tissues
Results in pain, disability, early mortality A clinical diagnosis i.e. a constellation of findings by
physician and lab, not just a blood test
Thank you
Any Questions