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3. CONTENTS :
1. History
2. Introduction
3. Epidemiology
4. Causes
5. Signs and Symptoms
6. Diagnosis
7. Treatment
8. Conclusion
9. Path Forward
10. References
3

4. History of R.A
 1858 – Dr. Alfred Baring
Garrod, named the condition
Rheumatoid Arthritis.
 In the 1920’s, physicians suspected
the cause of RA was bacterial
infection, they used gold and malaria
drugs.
 1940- Scientists discovered that RA
was associated with a malfunction of
the immune system.
 1949 – Dr. Phillip Hench treated
arthritic patients successfully with
4

5. What is Rheumatoid Arthitis
(R.A)?
 Rheumatoid arthritis is an
autoimmune disease in which the
normal immune response is
directed against an individual's
own tissue, including the joints,
tendons, and bones, resulting in
inflammation and destruction of
these tissues.
5

6. Epidemiology.. Who gets
R.A??
 ANYONE CAN GET R.A
◦ From babies to the very old
 Common Age to Start: 20’s to 50’s
 Sex: Females more common than
males 3:1
 1% of Indian population is affected
with R.A
6

7. Causes :
 The exact cause of RA is unknown.
 Suspected causes are:
1. Bacterial Infection
2. Genetic Marker
3. Stress
4. Viral Infection
 Other suspects include female
hormones.
 Smoking.
7

8. How does it start?
 RA usually starts off slowly (insidious)
over weeks to months and progresses
(70%)
 It can come on overnight (acute) but this
is rare (10%)
 It can come on over a few weeks
(subacute – 20%)
 In the initial stages of each joint
involvement, there is warmth, pain, and
swelling, with corresponding decrease of
range of motion of the affected joint.
 Progression of the disease results in
reducible and later fixed deformities. 8

9. Joints affected
http://www.umm.edu/graphics/images/en/17128.jpg 9

10. Normal joint
http://img.webmd.com/dtmcms/live/webmd/consumer_assets/site_images/articles/health_and_medical_reference/joints_bones_and_muscles/ar
thritis_basics_normal_joint.JPG
10

11. What happens in the
JOINTS?
 In RA, for some unknown reason, the
immune system considers its own joint
tissues as foreign.
 WBC that normally protect the
body, migrate to the joint cavity.
 Synovium becomes inflammed and
engorged with fluid, causing synovitis.
 Lymphocytes, Macrophages, continue to
enter the joint cavity and
multiply, differentiate, and release
inflammatory
mediators, cytokines, leukotrienes, and
prostaglandins. 11

12. Continued…
 Within weeks the synovium becomes
thickened.
 The mass of synovial tissue that spreads
over the top of cartilage in a rheumatoid
joint is called a Pannus, made of white
blood cells: macrophages, B&T
Cells, neutrophils, plasma cells, NK
cells, and T Helper cells.
 These cells produce the Rheumatoid
Factor, prostaglandins, cytokines and
other mediators.
 Over time, the chemicals from the cells
damage
cartilage, ligaments, tendons, and bone. 12

13. Tumor Necrosis Factor (TNF)
 TNF is a potent inflammatory cytokine
 TNF is produced mainly by
macrophages and monocytes
 TNF is a major contributor to the
inflammatory and destructive changes
that occur in RA
 Blockade of TNF results in a reduction
in a number of other pro-inflammatory
cytokines (IL-1, IL-6, & IL-8)
13

14. TNF Receptor
How Does
TNF Exert Its
Any Cell
Effect?
Trans-Membrane
Bound TNF
Macrophage
Soluble TNF
14

15. 15

16. How Are the Effects of
TNF Receptor
TNF Naturally
Balanced?
Any Cell
Trans-Membrane
Bound TNF
Macrophage Soluble Receptor
Soluble TNF
16

17. Established R.A
http://t0.gstatic.com/images?q=tbn:ANd9GcTuR85lK2XKocig-
Sut0u1LP3BrEF9aXmUYf9sAt4acgxa36SKIOuQmWA 17

18. Real images of affected
joints..
18
http://t3.gstatic.com/images?q=tbn:ANd9GcRDNkPcY3zheYEWvL5Fk5xsg8iGiojZmXaO74GOO_4uNotthMhMeA

19. Signs & Symptoms :
• Fatigue.
• Stiffness, especially in early morning and
after sitting a long period of time.
• Low Grade Fever, Weakness.
• Muscle pain and pain with prolonged
sitting.
• Rheumatoid nodules.
• Deformity of joints over time.
 Joints are usually
◦ Swollen
◦ Warm
◦NOT RED
http://lh3.ggpht.com/RBG1yD3ab-uyQdaCaEmH1B8r5MCchN5Y3e9WAJFn6LrzD2tdfTV1bYhKgBjjEvyYWdbN=s133 19

20. Diagnosis :
 Anti-CCP antibody test.
 Complete blood count.
 Synovial fluid test.
 Imaging Studies
1. X-Ray
2. M.R.I Scan
3. C.A.T Scan
4. Bone Scan
20

21. Treatment :
Physical Healthy
Surger
Medications therapy Diet y
Removal
Disease of the Total joint
Modifying Anti- joint replacemen
inflammatory lining t
Anti (Synovec
Rheumatic medications :
Eg. Asprin, tomy)
Drugs
(DMARDs): Nonsteroidal
Eg. Anti-
Methotrexate Inflammatory
Drugs
(NSAIDs)-such
Biological as ibuprofen .
Therapies
(Biologics)
: Eg.
Infliximab
21

22. Biological Therapies (Biologics)
Monoclonal Antibody :
Strategies for Infliximab
Reducing
Effects of
TNF!!.
Trans-Membrane
Bound TNF
Macrophage
Soluble TNF
22

23. Chimeric (murine & human)
monoclonal antibody directed
against TNF-α
http://lh6.ggpht.com/_K-9oRygAfTpS3Y7yX8j6lYqZAnkhCXmLu1q9-
iQQeHO2XUSz0qdwAmK_UGM9_J1EtEX=s122 23

24. Conclusion
 R.A is a chronic disease of unknown
cause affecting the joints and other
tissues resulting in deformity of joints
over time.
 RA patients today can live a healthy
and productive life. Today’s medicines
used can relieve pain and swelling
and in some cases put the disease in
remission, preventing bone damage or
deformity.
24

25. Path forward :-
 New drugs are emerging with
increased efficacy but long term risks
unknown.
 It is only a matter of time when
researchers will find the reason why
the body’s immune system attacks the
synovial lining of the joints which
causes this disorder known as
Rheumatoid Arthritis.
25

26. References
 Arthritis Foundation. “Disease Center.” Arthritis Foundation. 2004. 24
Aug. 2005.
<http://www.arthritis.org/conditions/DiseaseCenter/RA/ra_overview.a
sp>.
 Arthritis Foundation. Good Living with Rheumatoid Arthritis. Atlanta:
Arthritis Foundation, 2004.
 Lahita, Robert G. M.D. Rheumatoid Arthritis – Everything You Need
to Know. New York: Avery, 2001
 Mayo Clinic. “Rheumatoid Arthritis.” Mayo Clinic.com. Mayo
Foundation for Medical Education and Research. 8 April. 2005. 10
Oct. 2005 http://www.mayoclinic.com/invoke.cfm?id=DS00020>.
 National Institute of Arthritis and Musculoskeletal and Skin Diseases.
“Questions and Answers About Juvenile Rheumatoid Arthritis.”
National Institute of Health. 2001 July. 10 Oct. 2005.
<http://www.niams.nih.gov/hi/topics/juvenile_arthritis/juvarthr.htm>.
 Oxford Journals. “Alfred Baring Garrod.” Heberden Historical Series.
British Society for Rheumatology. 2001. 28 Oct. 2005.
<http://rheumatology.oxfordjournals.org/cgi/content/full/40/10/1189?e
af>.
 Parham, Peter. The Immune System. New York: Garland Science 26

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