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    Rheumatoid Arthritis: Department of Internal Medicine Samuel Asselo Murano Year VI Wednesday, 5 April 2017

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    Gideon K. Mutai
    The document discusses a case study of a 26-year-old woman presenting with joint swelling and stiffness in her hands and wrists for 3 weeks. She also has fatigue and low-grade fever. This fits the description of rheumatoid arthritis, a chronic inflammatory disease that primarily affects the synovium and causes symmetric joint inflammation and bone erosion. Treatment goals are to relieve pain, reduce inflammation, protect joints, maintain function, and control systemic involvement. Common treatments discussed are NSAIDs, methotrexate, corticosteroids, hydroxychloroquine, and TNF inhibitors.

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    Rheumatoid Arthritis: Department of Internal Medicine Samuel Asselo Murano Year VI Wednesday, 5 April 2017

    Uploaded by

    Gideon K. Mutai
    28 views17 pages
    The document discusses a case study of a 26-year-old woman presenting with joint swelling and stiffness in her hands and wrists for 3 weeks. She also has fatigue and low-grade fever. This fits the description of rheumatoid arthritis, a chronic inflammatory disease that primarily affects the synovium and causes symmetric joint inflammation and bone erosion. Treatment goals are to relieve pain, reduce inflammation, protect joints, maintain function, and control systemic involvement. Common treatments discussed are NSAIDs, methotrexate, corticosteroids, hydroxychloroquine, and TNF inhibitors.

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    The document discusses a case study of a 26-year-old woman presenting with joint swelling and stiffness in her hands and wrists for 3 weeks. She also has fatigue and low-grade fever. This fits the description of rheumatoid arthritis, a chronic inflammatory disease that primarily affects the synovium and causes symmetric joint inflammation and bone erosion. Treatment goals are to relieve pain, reduce inflammation, protect joints, maintain function, and control systemic involvement. Common treatments discussed are NSAIDs, methotrexate, corticosteroids, hydroxychloroquine, and TNF inhibitors.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    28 views17 pages

    Rheumatoid Arthritis: Department of Internal Medicine Samuel Asselo Murano Year VI Wednesday, 5 April 2017

    Uploaded by

    Gideon K. Mutai
    The document discusses a case study of a 26-year-old woman presenting with joint swelling and stiffness in her hands and wrists for 3 weeks. She also has fatigue and low-grade fever. This fits the description of rheumatoid arthritis, a chronic inflammatory disease that primarily affects the synovium and causes symmetric joint inflammation and bone erosion. Treatment goals are to relieve pain, reduce inflammation, protect joints, maintain function, and control systemic involvement. Common treatments discussed are NSAIDs, methotrexate, corticosteroids, hydroxychloroquine, and TNF inhibitors.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 17

    Rheumatoid Arthritis

    Department of Internal Medicine


    Samuel Asselo MuranoYear VI

    Wednesday, 5th April 2017


    Case Study
    A 26 year-old woman presents with a 3 week history of joint swelling
    and stiffness.
    PIPs, MCPs and wrists are involved symmetrically which you confirm
    on exam. Stiffness in the morning is about 2 hrs.
    She also has fatigue and low-grade fever.
    She has no back pain or DIP involvement.
    Rheumatoid Arthritis
    Chronic inflammatory multisystem disease.
    Main focus is the SYNOVIUM.
    Hallmark: Inflammatory synovitis in a symmetric distribution.
    Bone erosions, deformities.
    Predominant cells: T lymphocytes.
    Pro-Inflammatory cytokines that mediate inflammation: TNF-a, IL-1,IL-
    6
    Rheumatoid Arthritis
    Radial deviation of the wrist with ulnar deviation of the digits. Z
    deformity
    Boutoniere deformity
    Swan neck deformity
    Goals of Treatment
    The goals of therapy of RA are
    Relief of pain
    Reduction of inflammation
    Protection of articular structures
    Maintenance of function
    Control of systemic involvement
    Extra articular manifestation
    Rheumatoid nodules
    Rheumatoid vasculitis,
    Pleuropulmonary manifestations: pleural disease, interstitial fibrosis,
    pleuropulmonary nodules, pneumonitis, and arteritis.
    Pericarditis
    Neurologic manifestations: neuropathies of median, ulnar, radial
    (interosseous branch), or anterior tibial nerves.
    Eye: episcleritis,
    Felty's syndrome consists of chronic RA, splenomegaly, neutropenia, and, on
    occasion, anemia and thrombocytopenia.
    Osteoporosis
    Caplans Syndrome
    Labaratory
    Anti Cyclic Citrulinated Peptide
    Anemia
    ESR
    Xrays
    Synovial fluid Analysis
    Treatment
    NSAIDs
    Cyclooxygenase 2 (COX-2) inhibiors.
    Corticosteroids
    MTX
    Hydroxychloroquine
    Tumor Necrosis Factor (TNF) inhibitors
    i. Infliximab
    ii. Adalimumab
    iii. Etanercept
    Methotrexate dosage
    Start with 5 mg weekly.
    Increase by 2.5 mg every 2 weeks till you are administering 15 mg
    weekly.
    Treatment progress
    1. NSAIDs + Corticosteroids
    2. Methotrexate (right away).
    3. Remove 1 after 3 weeks. Maintain on 2 and Administer NSAIDs only
    when needed i.e joint pain.
    4. If MTX failed or patient developed complications, put on
    hydroxychloroquin or TNF inhibitors.
    5. When using TNF inhibitorsbe on alert for Pulmonary TB.

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