Rheumatoid arthritis is an auto immune disease that causes chronic inflammation of joints. It can also cause inflammation of the tissue around the joints as well as other organs in the body.
- Age group: more common in fourth and fifth decade.
- Sex: Female: Male- 3:1
- Prevalence: occurs throughout the world.
- Genetic Factor: HLA DR4 (gene)
- Joints effected: synovitis of small joints of hands, feet and wrist.
AETIOLOGY AND PATHOGENESIS
R.A. is an autoimmune disease.
Exact etiology still unknown but the theory of disease is most accepted one.
- First theory: states that T cells, through interaction with an antigen, is the primary cell responsible for initiating the disease is well as for driving chronic inflammatory process.
- Second Theory: states that while T cells may be important in initiating the disease, chronic inflammation is self – perpetuated by macrophages and fibroblasts in T cell independent manner.
. There is inflammation of synovial membranes. Infiltration with leucocytes and plasma cells actively synthesize antibodies
. Synovial tissue enlargement (known as pannus)
. Encroachment and destruction of articular cartilage
. Affection of nearby structures: ligament destruction, muscle atrophy and subcutaneous nodules
- Onset – gradual but occasionally abrupt.
- Fatigue, low grade fever, joint weakness, stiffness, swollen joints by several weeks.
- Condition – invariably bilateral
- Skin covering joints has ruddy, cyanotic hue.
- Stiffness usually worsens early on arising, easing after an hour and is thought to be related to synovitis.
- Articular: bone adjacent to joint is eroded by the intrusion of exuding synovial membrane.
- Extra articular: occur most often in sero positive patients with more severe joint pain. Nodules occur in twenty to thirty percent of cases. Rarely nodule may arise in lungs, heart or sclera of eye.
- Muscle adjacent to inflamed joints atrophy and there may be focal infiltration with lymphocytes.
- Subcutaneous nodules consist of a central area of fibrinoid material surrounded by a palisade of proliferating mononuclear cells.
- Specific hand abnormalities include ‘swan neck’ deformity, the boutonniere or ‘button hole deformity’, and a Z deformity of the thumb
- In the forefoot dorsal subluxation of the metatarsophalangeal (MTP) joints in ‘cock-up’ toe deformity. This causes pain on weight bearing on the exposed MTP heads and development of secondary deformity, reflecting damage to the ankle and subtalar joint. This is often associated with loss of the longitudinal arch (flat foot) due to rupture of the tibialis posterior tendon.
- Although the joint are almost always the principal focus of the rheumatoid arthritis, other organ system may also be involved. Extra articular manifestations of rheumatoid arthritis occur most often in sero-positive patient with more severe joint disease
Rheumatoid nodules are the most characteristic extra articular lesion of the disease.
- Nodules occur in 20-30% cases
- Location:- extensor surface of the arm and elbow but are also prone to develop at pressure point on the feet and knee
- Rarely nodules may arise in visceral organ such as the lungs, heart or the sclera of the eye.
- Blood test: CBC, ESR, RF test, CRP.
- Synovial fluid analysis.
Should prescribe according to symptom similarities-
- Rhus tox
- Benzoic acid etc.
1. Dr. R.K. BISWAS
B.Sc., B.H.M.S., M. Sc.(microbio.), M.D.(Homoeo.)
2. Dr. Ruchi Biswas, M. D. (Homoeo.)