Rheumatoid Arthritis

Table of Contents

Introduction Explanation & History Signs & Symptoms Diagnostic Testing Diagnosis Treatments Prognosis Conclusion Bibliography

Introduction

My name is Rebecca Ledford and I am 27 years old. Growing up I have always been a lover of the arts, especially the art of dance. So much that when I was 3 years old, my mother

enrolled me into my first dance class. For the better part of 15 years, dance was my life. Classes and competitions every

weekend.

At age 17 I was faced with the hardest decision I thought I would ever have to make. After seeing the doctor for minor wrist and knee pain, which at the time, I thought was just normal wear and tear from being a dancer for so many years, I was told that if I didn’t stop dancing sometime soon, I would end

up on crutches or in a wheelchair, by the time I was 35.

I was diagnosed with Rheumatoid Arthritis.

Explanation & History

Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that may affect many tissues and organs, but mainly attacks the joints producing an inflammatory synovitis.

The first known cases date back as far as 4500 BC. Although, the first recognized description of the disease was in 1800 by the French physician Dr. Augustin Jacob Landre-Beauvais.

The name, Rheumatoid Arthritis, was coined in 1859 by British rheumatologist Dr. Alfred Baring Garrod.

The name is based on the term “rheumatic fever,” an illness which includes joint pain and is derived from the Greek word rheumatos meaning flowing and the suffix –oid meaning resembling, thus giving it the translation as joint inflammation that resembles rheumatic fever.

While RA mainly affects the joints, problems involving other organs of the body are known to occur.

May also produce inflammation in the lungs, pericardium, pleura, and sclera.

It can be difficult to determine whether the extra-articular symptoms are directly caused by RA or from side effects of the medications commonly used to treat it.

Cause is unknown but autoimmunity plays a big part in its chronicity and progression.

RA is a chronic disease who’s pain intensity and deterioration of joint structures progress over time often leading to deformations and disability.

Epidemiology - Statistics

About 1% of the worlds population is afflicted, women almost 3 times more often than men.

It is 4 times more common among smoker’s than non-smokers and some Native American groups have a higher prevalence rate.

Genetics and/or family history play a big role as well.

Onset is uncommon under the age of 15, however no age is immune.

It is most commonly diagnosed between the ages of 40 and 50 years and normally no later than 80 years of age.

JOINTS

Arthritis of the joints – Synovitis. An inflammation of the synovial membrane that lines

the joints and tendon sheaths. Joints become swollen, tender, and warm, and

stiffness limits their movement. RA nearly always affects multiple joints. Common of joints affected are the small joints of the

hands, feet, and cervical spine, as well as, larger joints such as the shoulders and knees.

Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function.

Joints are often affected in a fairly symmetrical fashion, although this is not specific, and the initial presentation may be asymmetrical.

The Skin

The Rheumatoid Nodule Often subcutaneous, it is the feature most

characteristic of RA. The initial pathological process in nodule formation

is unknown, however, it is very similar to synovitis because of the structural features that occur in both.

The nodule has a central area of fibrinoid necrosis.▪ Tissue death, in which there is accumulation of

amorphous, proteinaceous material in the tissue matrix with a staining pattern reminiscent of fibrin.

Surrounding the necrosis is a layer of palisading macrophages and fibroblasts, corresponding to the intimal layer in synovium and a cuff of connective tissue containing clusters of lymphocytes and plasma cells.

Typically about 3 millimeters to a few centimeters in diameter, the nodules are usually found over bony prominences. The Olecranon – behind the elbow. The Calcaneal Tuberosity – the heel

bone. The Metacarpophalangeal Joints – the

hands.

Also may occur in other areas of the body that sustain repeated mechanical stress.

The Lungs & Kidneys

Fibrosis of the of lungs The formation or development of excess

fibrous connective tissue.▪ A recognized response to RA. It is very rare, but a

well identified consequence of therapy.

Renal Amyloidosis A progressive, incurable, metabolic disease

characterized by abnormal deposits of protein in the kidneys.▪ Treatment with Penicillamine, a metabolite of

penicillin although it has no antibiotic properties, and gold salts are causes of membranous nephropathy.

The Heart & Blood Vessels

Myocardial Infarction Commonly known as a heart attack.▪ Occurs when the blood supply to part of the heart

is interrupted causing some heart cells to die. Disambiguation

Stroke.▪ The rapid loss of brain function(s) due to

disturbance in blood supply to the brain. Atherosclerosis

The abnormal narrowing of an artery.▪ The condition in which an artery wall thickens

due to a build up of fatty materials such as cholesterol.

Other conditions of the heart caused by RA: Pericarditis▪ Inflammation of the pericardium – the sac

that contains the heart and the roots of the great vessels.

Endocarditis▪ Inflammation of the inner layer of the heart.

Left Ventricular Failure▪ Commonly known as heart failure.

Valvulitis▪ Inflammation of one or more of the heart

valves.

The Eyes

Ocular Episcleritis▪ Inflammation of the sclera or white of the eye.

Scleromalacia▪ An abnormal softening of the sclera.

Keratoconjunctivitis Sicca▪ Dryness of the eyes.▪ Caused by the lack of tear production.▪ When severe, dryness of the cornea can lead to

keratitis. Inflammation of the cornea.

▪ Loss of vision.

The Blood

Hematological Anemia▪ The most common abnormality of the blood

cells.▪ Red blood cells are of normal size and color

but are lacking in number. Neutropenia▪ An abnormally low white blood cell count.▪ Normally only occurs when the patient has an

enlarged liver or spleen.

Thrombocytosis▪ An increased platelet count.▪ Occurs when inflammation is uncontrolled.

Neurological

Carpel Tunnel Syndrome Due to compression of the medial nerve

by swelling around the wrist.

Atlanto-Axial Subluxation Erosion of the odontoid process and/or

transverse ligaments in the cervical spine’s connection to the skull.▪ Vertebrae begin slipping over one another

and compress the spinal cord.▪ Clumsiness is initially experienced, but without due

care this can progress to quadriplegia. Quadriplegia :: paralysis of all four extremities.

Diagnostic Testing

X Rays X rays of hands and feet are generally

performed in people with RA. Magnetic Resonance Imaging (MRI) Ultrasounds

Blood Tests Rheumatoid Factor (RF)▪ RF is a specific antibody in the blood.▪ A negative RF does not rule out RA. The

arthritis is then called seronegative, most common during the first year of illness and converting to seropositive status over time.

Anti-citrullinated Protein Antibodies (ACPAs)▪ Like RF, this testing is only positive in a

proportion of all RA cases. ▪ Unlike RF, this test is rarely found positive if

RA is NOT present, giving it a specificity of about 95%.

Other blood tests performed when RA is suspected:▪ Lupus Erythematosus▪ A connective tissue disease

▪ Erythrocyte Sedimentation Rate (ESR)▪ The rate at which red blood cells precipitate in a 1 hour period.

▪ C-Reactive Protein▪ A protein found in the blood in response to inflammation.

▪ Full Blood Count▪ Gives information about all blood cells.

▪ Renal Function▪ Kidney Function

▪ Liver Enzymes▪ Gives information on the state of a patient’s liver

Diagnosis

At least FOUR criteria MUST be met for classification of RA. Morning stiffness of more than 1 hour most

mornings for at least 6 weeks. Arthritis and soft-tissue swelling of more than 3

of 14 joints, present for at least 6 weeks. Arthritis of the hand joints, present for at least 6

weeks. Symmetric arthritis, present for at least 6 weeks. Subcutaneous nodules in specific places. Rheumatoid Factor at a level above the 95th

percentile. Radiological changes suggestive of joint erosion.

Treatment

Goal of Treatment To alleviate the current symptoms and to prevent

future destruction of the joints resulting in handicap.▪ Cortisone Therapy▪ Cortisone, a steroid hormone, can be valuable to a long term

treatment plan.

▪ Anti-inflammatory Agents▪ Non-Steroidal Anti-Inflammatory Drugs

Aspirin Ibuprofen Naproxen

▪ Acetaminophen Tylenol

▪ Opiates Any of the narcotic alkaloids found in the opium poppy.

▪ Diproqualone A Sedative

▪ Lidocaine Topical A local anesthetic

Other Therapies Include: Weight Loss Occupational Therapy Podiatry▪ The study of the foot, ankle, and leg.

Physiotherapy Immunoadsorption Therapy▪ A drug that has effect on the immune system.

Radon Therapy▪ A radioactive water bath.

Acupuncture▪ A technique of inserting fine needles into specific

points of the body to relieve pain.

Prognosis

Disability Daily living activities are impaired. After 5 years of disease, approximately 33% of

sufferers can no longer work. After 10 years of disease, approximately 50% of

sufferers have substantial functional disability.

Some people have mild or short-term symptoms, but in most cases, the disease is progressive for life.

The life shortening effect of RA varies. Most sources cite a lifespan reduction of 5 to 10 years.

Conclusion

Rheumatoid Arthritis is more severe than I ever really began to think that

it was. I watched my grandmother suffer through it for so many years,

but never really understood the extent of the disease.

I’ve been a sufferer of Rheumatoid Arthritis for almost 11 years now. I’m certainly glad that I’ve been given the chance to better understand the inner

workings of my body through this project.

Bibliography

www.wikipedia.com www.emedicinehealth.com www.nlm.nih.gov