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Rheumatoid arthritis

Rheumatoid arthritis. Dr. Wahby Ghalib CABO, FJMC, MRCS. aetiology. Genetic Immunologic : HLA-DR4 Viral infection. pathology. Synovitis Destruction : erosion of articular cartilage erosion of subchondral bone tendon rupture

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Rheumatoid arthritis

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  1. Rheumatoid arthritis Dr. Wahby Ghalib CABO, FJMC, MRCS

  2. aetiology • Genetic • Immunologic : HLA-DR4 • Viral infection

  3. pathology • Synovitis • Destruction : erosion of articular cartilage erosion of subchondral bone tendon rupture • Deformity

  4. C / f • Prevalence : 2% • Female : male 3 : 1 • 4th or 5th decade • MPJs & PIPJs • Wrists, feet, knees & shoulders

  5. Criteria of diagnosis : 4 / 7 • Arthritis of the hand • Bilateral arthritis • 3 or more joints • Morning stiffness > hr • Rheumatoid nodules • Rheumatoid factor • XR features of RA

  6. Extraarticular features • Rheumatoid nodule : 24 % • Myopathy • Neuropathy • Lymphadenopathy • Nerve entrapment syndromes • Visceral involvement

  7. Visceral involvement • Carditis, pericarditis • Pleuritis, pulmonary fibrosis • Hepatitis • Nephrotic syndrome • Vasculitis • Scleritis

  8. syndromes • Sjogren syndrome : xerostomia, xerophthalmia • Felty syndrome : splenomegaly, neutropenia

  9. complications • Tendon rupture • Deformity • Atlantoaxial joint instability • Infection • O.A. • Amyloidosis

  10. deformities • Wrist : radial deviation • Fingers : ulnar deviation Boutonnier swan neck • Knee : valgum • Foot : hallux valgus • Toes : claw

  11. XR • Soft tissue swelling • Periarticular osteoporosis • Loss of joint cavity • Bone erosion • O.A.

  12. Investigations • Normocytic hypochromic • ↑ ESR • CRP : +ve • RF : +ve in 80 % : Anti - IgG IgM • ANA : +ve in 30 %

  13. : bad : prognosis • Female • RF • Rheumatoid nodule • Vasculitis • Periarticular erosion

  14. treatment

  15. No cure of RA • Rx aims to alleviate symptoms & delay progression

  16. NSAIDS • Disease modifying agents • Steroids • Splintage • Physiotherapy • Surgery

  17. surgery • Synovectomy • Tendon rupture : repair or transfer • Arthrodesis • Arthroplasty • Osteotmy

  18. thanx

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