Rheumatoid arthritis &
Gout
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(RA) is an autoimmune disease that causes chronic
inflammation of the joints & can also cause
inflammation of the tissue around the joints .
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Inflammatory arthritis
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Peak incidence in 3rd to 4th decades( ‫ )عقود‬of life
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3-5 times higher preponderance(‫ ( يكثر‬in females than
males
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Exact mechanism is not known
1) Autoantibody-Rheumatoid factor(R.F.) : R.f. is Anti-IgG
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2)other autoantibodies:
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Antinuclear factor(ANF)
Antibodies to Collagen type-2 class
Antibodies to cytoskeleton
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3) Activation of cell-mediated immunity which is observed
by numerous inflammatory cells
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4)Trigger events :Local/systemic infection
It includes some infectius agents such as
Epstein-Barr Virus(EBV)
cytomegalovirus(CMV)
rubella
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Longitudinal
Course of RA
CCP, cyclic citrullinated peptide; CTLA4,
cytotoxic T-lymphocyte antigen 4; GP39,
cartilage glycoprotein 39; PADI4, peptidyl
arginine deiminase, type IV; PTPN22,
protein tyrosine phosphatase, nonreceptor type 22.
Reproduced with permission from McInnes
IB, et al. Nat Rev Immunol. 2007;7(6):429442.
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Tender , warm , swollen joints
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Joints inflammation often affect wrist & finger joints
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Also affect other joints including neck ,shoulder ,elbow
,hips ,knees ,ankles ,feet
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Fatigue ,occasional fever ,sense of not feeling well
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Pain & stiffness after morning wake up or after a long rest
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By imaging:
 X-ray
 MRI
 Ultra sound
By Blood tests:
a)Inflammatory markers:
 ESR(erythrocytes sedimentation rate)
 C reactive protein(CRP)
 ANA(anti-nuclear antibody)
b)Rheumatoid factor:
c)Anti-ccp antibodies : it in 99% gives +ve result
d)Anti-MCV assay(anti-Mutated citrullinated Vimentin)
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There is no cure for RA,there is some treatments which
can modify the disease process.
GOAL for Treatments :
1. Relieve pain
2. Reduce inflammation
3. slow down or stop joint damage
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1)medication
2)surgery
3)lifestyle
1)medication:
 Classification:
1.
2.
3.
4.
5.
6.
Anti-inflammatory-analgesic drugs
Anti-inflammatory drugs without direct analgesic action
Disease Modifying Antirheumatic Drugs(DMRDs)
immunosuppressants
TNF-alpha blockers
Interleukin-1 blockers
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ANTIINFLAMMATORY-ANALGESIC DRUGS
Eg.aspirin,indomethacin,ibuprofen,naproxen,
piroxicam,nabumetone,diclofenac,celecoxib
M.O.A:
It inhibit pg,& chemicals that are responsible for pain and
swelling
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Ibuprofen-: Individuals should not use ibuprofen for more
than 10 days for the treatment of pain or more than 3 days for
the treatment of a fever unless directed by a physician
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Celecoxib:
The lowest effective dose should be used for each patient
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GLUCOCORTICOIDS-:They are used when disease
 Is not responding NSAIDs.
 Have serious side effect incase of high doses
 Eg.prednisolone:-
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Eg.
Methotrexate
Hydroxychloroquine
Sulfasalazine
Gold salts
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METHOTREXATE:
 It is antimetabolite drug
M.O.A: It inhibit dihydro folate
 Reductase enzyme.
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It is antimalerial drug.
Eg.
Gold thioglucose(SOLGANAL)
Gold thiomalate (MYOCHRYSINE)
Auranofin (RIDAURA)
Sulfasalazine is used to treat rheumatoid arthritis in combination with
anti- inflammatory medications. Sulfasalazine is generally well
tolerated.
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Hip replacement
Knee replacement
SYNOVECTOMY
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It is metabolic disorder characterized by hyperuricaemia
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Normal plasma=1-5 mg/dl
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Stages of gout:1.
2.
3.
4.
asymptomatic hyperuricaemia
acute gouty arthritis
intercritical period
chronic tophaceous stage
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Types :1)metabolic-10% cases
Over production of uric acid
2)renal- 90% cases
Reduced renal excretion of uric acid
Causes:1)genetic(absence of hypoxanthine)
2)medication:3)lifestyle
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Drugs that causes hyperuricaemia :
 Alcohol
 Thiazide
 Cytotoxic drugs
 Amiloride
 Isoretinoin
 Ethambutol
 Cyclophosphamide
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Acute attack:
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Over hours frequently nocturnal
Excruciating pain
Swelling, redness and tenderness
Podagra
May effect knees, wrist, elbow, and rarely SI and hips
Chronic:
 Destructive tophacous
 Much greater chance if untreated
 nodules
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DIAGNOSIS:1. X-ray
2. Synovial fluid test:3. Blood test: Normal level:1-5mg/dl
 Above 7 in males
 Above 6 in females indicate hyperuricaemia.
 W.B.C.,ESR is increased in gout without infection.
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Uric acid is end product of purine metabolism
Monosodium urate has low water solubility
When conc. Of MSU is above 7mg/dl,their solubility is
decreased due to saturation and it form crystal.
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Goal of treatment: Relieve pain
 Reduce inflammation
 Terminate acute attack
 Prevent recurrent attack
 Prevent complications associated with chronic
deposition of urate crysals in tissues.
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Classification of drugs no cure alone)
 1)NSAIDs
 2)colchicine
 3)corticosteroids
 4)uricosuric drugs
 5)xanthine oxidase inhibitor
NSAIDs: Indomethacin
 Naproxen
 Piroxicam
 diclofenac
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COLCHICINE: It is an alkaloid from
colchicum autumnale.
 It is antimitotic drug.
MOA it inhibit release of
Glycoprotein & subsequent
Events.

It inhibit granulocyte
Migration into inflamed
joints.
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CORTICOSTEROIDS: Eg.prednisolone
 They are rarely used.they are used in case of patient which is
contraindicate to NSAIDs.
 they produce rapid response like colchicine.but it is
contraindicated to patients with renal failure.
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PROBENECID: It is uricosuric drug.
 MOA It is act by inhibiting reabsorption of uric acid.so,excretion
of uric acid is increased.
XANTHIN OXIDASE INHIBITOR: Eg.allopurinol.
 It is hypoxanthine analogue.
 MOA: It is act by inhibiting Xanthine oxidase which is required for
synthesis of uric acid.
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
OA is a group of diseases and mechanical abnormalities
entailing degradation of joints, including articular
cartilage and the subchondral bone next to it

OA is derived from the Greek word ‘ostoe’, meaning ‘of
the bone’, ‘arthro’, meaning ‘joint’, and ‘itis’, meaning
inflammation
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Osteoarthritis is the most common type of arthritis.
The prevalence increases with age
80% of people over 60 years will have some radiological
evidence of it, although only 60% of those will show
symptoms.
Primary Osteoarthritis Most Common
Thought to be result of Aging
Decreased ability to withstand stress
Ligaments supporting joints weaken
Causes
Trauma
Obesity
Abnormal joints
Surgery
Gout
Hormone disorders
Diabetes
To Relieve pain
Increase motion
Improve strength