Rheumatoid Arthritis

Rheumatoid arthritis (RA), is a chronic autoimmune disorder that primarily affects the joints, causing inflammation, pain, and potential long-term damage. It is essential for healthcare students to grasp the fundamentals of this condition to better understand its pathophysiology, clinical manifestations, diagnosis, and management.

I. Pathophysiology:

A. Autoimmune Origin:

1. RA is characterized by the immune system mistakenly attacking the synovium (lining of the membranes that surround the joints).
2. Chronic inflammation leads to the destruction of cartilage, bone, and other joint structures.

B. Genetic Factors:

Genetic predisposition is a significant risk factor, with specific genetic markers associated with an increased likelihood of developing RA.

II. Clinical Manifestations:

A. Joint Involvement:

1. Symmetrical polyarthritis affecting small and large joints.
2. Morning stiffness lasting more than 30 minutes is a common early sign.

B. Extra-Articular Manifestations:

RA can impact various organs, leading to complications such as rheumatoid nodules, lung involvement, and cardiovascular disease.

III. Diagnosis:

A. Clinical Evaluation:

1. Thorough patient history and physical examination.
2. Assessment of joint involvement, morning stiffness, and other symptoms.

B. Laboratory Tests:

1. Elevated levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
2. Inflammatory markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be elevated.

C. Imaging Studies:

X-rays, ultrasound, and magnetic resonance imaging (MRI) help visualize joint damage.

IV. Management:

A. Medications:

1. Disease-modifying anti-rheumatic drugs (DMARDs) to slow down disease progression.
2. Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids for symptom relief.

B. Physical and Occupational Therapy:

1. Exercises and joint protection strategies.
2. Assistive devices to enhance daily functioning.

C. Patient Education:

1. Emphasize the importance of adherence to medications.
2. Encourage a healthy lifestyle with regular exercise and a balanced diet.