1. Etiology
1.1. Unknown
1.2. more women than men get RA, and it usually develops in middle age.
1.3. Having a family member with RA increases the odds of developing RA.
1.4. Environmental and genetic fector
1.5. Smoking
1.6. Obesity
2. Symptoms
2.1. Joint pain, tenderness, swelling or stiffness that lasts for six weeks or longer.
2.2. Morning stiffness that lasts for 30 minutes or longer.
2.3. More than one joints is affected
2.4. Small joints (wrists, certain joints in the hands and feet) are typically affected first.
2.5. Same joints on the both side of the body is affected
2.6. Fatigue
2.6.1. Fever
2.7. Flaire
3. Treatment strategies
3.1. Early, aggressive treatment – to reduce or stop inflammation as quickly as possible.
3.2. Targeting remission or another goal (treat-to-target) - work toward little or no signs or symptoms of active inflammation
3.3. Tight control – keep inflammation at the lowest level possible
3.4. Drugs for use
3.4.1. DMARDs and biologics
3.4.1.1. hydroxychloroquine (Plaquenil) leflunomide (Arava) methotrexate (Trexall) sulfasalazine (Azulfidine) minocycline (Minocin)
3.4.2. Janus associated kinase inhibitors
3.4.2.1. tofacitinib baricitinib
3.4.3. NSAIDs
3.4.3.1. celecoxib (Celebrex) ibuprofen (prescription-strength) nabumetone (Relafen) naproxen sodium (Anaprox) naproxen (Naprosyn) piroxicam (Feldene)
3.4.3.2. diclofenac diflunisal indomethacin (Indocin) ketoprofen etodolac (Lodine) fenoprofen
3.4.4. Opioids
3.4.4.1. codeine acetaminophen/codeine fentanyl hydrocodone (Vicodin) hydromorphone morphine meperidine (Demerol) oxycodone (Oxycontin) tramadol (Ultram)
3.4.5. Corticosteroids
3.4.5.1. betamethasone prednisone dexamethasone cortisone hydrocortisone methylprednisolone prednisolone
3.4.6. Immunosuppressant
3.4.6.1. cyclophosphamide (Cytoxan) cyclosporine azathioprine hydroxychloroquine (Plaquenil)
3.4.7. Anti TNF alpha
3.4.7.1. Adalimumab (Humira) Certolizumab pegol Etanercept Infliximab Golimumab
3.5. Surgery Total joint replacement Synovectomy Tendon repair Joint fusion
4. Lifestyle modification
4.1. Regular exercise Apply heat or cold Relaxing Stress free life Fish oil Plant oil And therapy like tai chi
5. Definition
5.1. Rheumatoid arthritis (RA) causes joint inflammation and pain. It happens when the immune system doesn’t work properly and attacks lining of the joints (called the synovium)
5.2. The disease commonly affects the hands, knees or ankles, and usually the same joint on both sides of the body. But sometimes causes problems in other organs also
6. Cause
6.1. autoimmune disease like RA, the immune system mistakes the body’s cells for foreign invaders and releases inflammatory chemicals that attack body cells
6.2. in the case of RA, the synovium. That’s the tissue lining around a joint that produces a fluid to help the joint move smoothly.
6.2.1. The inflamed synovium gets thicker and makes the joint area feel painful and tender, look red and swollen and moving the joint may be difficult
6.3. Environmental and genetic fectors
7. Diagnosis
7.1. Physical examination.
7.1.1. look for joint tenderness, swelling
7.1.2. warmth and painful or limited movement
7.1.3. bumps under the skin or a low-grade fever.
7.2. Medical history
7.2.1. ask about joint symptoms (pain, tenderness, stiffness, difficulty moving)
7.2.2. how severe they are, what actions make them better or worse
7.2.3. whether family members have RA or another autoimmune disease.
7.3. Blood test
7.3.1. Esr
7.3.2. C reactivate protein
7.3.3. Rheumatoid fector
7.3.4. citrullinated peptide
7.4. Imaging test
7.4.1. Xray,MRI, ultrasound- we can found erosions