Clinical Therapeutics: Eva Fe R. Columna M D - 3 B
Clinical Therapeutics: Eva Fe R. Columna M D - 3 B
Clinical Therapeutics: Eva Fe R. Columna M D - 3 B
EVA FE R. COLUMNA
MD-3B
Case 17
RHEUMATOID
ARTHRITIS
RHEUMATOID ARTHRITIS (RA)
Release of cytokines
Persistent synovitis
Pannus formation
Z deformity
Extraarticular Manifestations:
Cutaneous – rheumatoid nodules and vasculitis
Pulmonary - pleural disease, interstitial fibrosis,
pleuropulmonary nodules, pneumonitis, and arteritis
Ocular – episcleritis and scleritis
Hematologic - anemia, Felty’s syndrome
Cardiac – pericarditis, myocarditis
Neurologic – myelopathies secondary to cervical spine
disease, entrapment
Diagnosis
Criteria a–d must be present for at least 6 weeks.
Criteria b–e must be observed by a physician
Laboratory Findings
No tests are specific for RA
(+) Rheumatoid Factor
(+) anti-CCP
Elevated ESR
Synovial Fluid Analysis
Measure Normal Inflammatory
Volume (ml) <3.5 >3.5
Clarity Transparent Translucent to opaque
Color Clear Yellow
WBC / mcL <200 2000-75000
PMN leukocytes <25% >50%
Culture Negative Negative
Differential Diagnosis
Nonsteroidal Anti-
Patient Education
Inflammatory Drugs (NSAIDs)
Disease-Modifying Anti- Exercise
Rheumatic Drugs (DMARDs) Physical therapy
Biologic Response
Modifiers (Biologic DMARDs) Surgery
Corticosteroids
Immunosuppressive Therapy
Prognosis/Mortality