It typically results in warm, swollen, and painful joints. While the cause of rheumatoid arthritis is not clear, it is ivan damjanov pathophysiology pdf to involve a combination of genetic and environmental factors. The underlying mechanism involves the body’s immune system attacking the joints. The goals of treatment are to reduce pain, decrease inflammation, and improve a person’s overall functioning.
This may be helped by balancing rest and exercise, the use of splints and braces, or the use of assistive devices. 5 million people as of 2015. 5 and 50 per 100,000 people newly developing the condition each year. Arthritis of joints involves inflammation of the synovial membrane. Joints become swollen, tender and warm, and stiffness limits their movement. Synovitis can lead to tethering of tissue with loss of movement and erosion of the joint surface causing deformity and loss of function.
RA typically manifests with signs of inflammation, with the affected joints being swollen, warm, painful and stiff, particularly early in the morning on waking or following prolonged inactivity. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. Gentle movements may relieve symptoms in early stages of the disease. As the pathology progresses the inflammatory activity leads to tendon tethering and erosion and destruction of the joint surface, which impairs range of movement and leads to deformity. The fingers may suffer from almost any deformity depending on which joints are most involved. The hammer toe deformity may be seen. In the worst case, joints are known as arthritis mutilans due to the mutilating nature of the deformities.
Several forms of vasculitis occur in RA, but are mostly seen with long-standing and untreated disease. The most common presentation is due to involvement of small- and medium-sized vessels. Rheumatoid vasculitis can thus commonly present with skin ulceration and vasculitic nerve infarction known as mononeuritis multiplex. Lung fibrosis is a recognized complication of rheumatoid arthritis. Anemia is by far the most common abnormality of the blood cells which can be caused by a variety of mechanisms. Eyes The eye can be directly affected in the form of episcleritis or scleritis, which when severe can very rarely progress to perforating scleromalacia. Some genetic and environmental factors affect the risk for RA.
There are established epigenetic and environmental risk factors for RA. Silica exposure has been linked to RA. No infectious agent has been consistently linked with RA and there is no evidence of disease clustering to indicate its infectious cause, but periodontal disease has been consistently associated with RA. The many negative findings suggest that either the trigger varies, or that it might, in fact, be a chance event inherent with the immune response.
RA primarily starts as a state of persistent cellular activation leading to autoimmunity and immune complexes in joints and other organs where it manifests. The initial site of disease is the synovial membrane, where swelling and congestion lead to infiltration by immune cells. Factors allowing an abnormal immune response, once initiated, become permanent and chronic. These factors are genetic disorders which change regulation of the adaptive immune response. Other environmental and hormonal factors may explain higher risks for women, including onset after childbirth and hormonal medications. B lymphocytes produce rheumatoid factors and ACPA of the IgG and IgM classes in large quantities.
These activate macrophages through Fc receptor and complement binding, which is part of the intense inflammation in RA. This contributes to local inflammation in a joint, specifically the synovium with edema, vasodilation and entry of activated T-cells, mainly CD4 in microscopically nodular aggregates and CD8 in microscopically diffuse infiltrates. The disease progresses by forming granulation tissue at the edges of the synovial lining, pannus with extensive angiogenesis and enzymes causing tissue damage. Cytokines and chemokines attract and accumulate immune cells, i.