Rheumatoid Arthritis
“An Autoimmune Mystery”
Cynthia Anderson
Dedicated to the memory of
my late brother in law,
Sherman F. Grace 19451991.
He never let RA stop him from
having a full productive life.
What is Rheumatoid Arthritis?
A chronic disease characterized by the
inflammation of the lining of the joints,
which is called the synovium.
Affects 2.1 million Americans between the
ages of 20 and 50, but also affects young
children and adults over 50
More common in women than men.
Known as an autoimmune disease because
the body’s immune system attacks the joint
lining.
History of Rheumatoid Arthritis
1858 – Dr Alfred Baring Garrod, named the
condition Rheumatoid Arthritis.
1895 – X-Ray was discovered.
1912 – Dr. Frank Billings introduced the
concept of focal infection.
In the 1920’s, physicians suspected the
cause of RA was bacterial infection, they
used gold and malaria drugs.
In 1940, was the turning point
Scientists discovered that RA was
associated with a malfunction of the
immune system.
Rheumatoid Factor was discovered
simultaneously in Norway and Columbia
Presbyterian Medical Center in New York.
1949 – Dr. Phillip Hench treated arthritic
patients successfully with Cortisone.
What is the cause of this
disease?
The exact cause of RA is unknown.
Suspected causes are:
Bacterial Infection
Genetic Marker
Stress
Viral Infection
Symptoms of RA Patients
• 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.
• Symetrical, affects joints on both sides of
the body.
• Rheumatoid nodules.
• Deformity of your joints over time.
Juvenile Rheumatoid Arthritis
Causes joint inflammation and
stiffness for more than six weeks in a
child of 16 years of age or less.
There are three types, classified by
the number of joints involved and
symptoms.
Pauciarticular, the most common, four
joints or fewer are affected.
JRA
Polyarticular, where five or more joints are
affected.
Systemic, besides joint swelling, a fever
and light skin rash is present.
Symptoms are similar to adults, joint
swelling, pain, and stiffness in the morning
or after a nap. It commonly affects the
knees and joints in the hands and feet
How does the immune system
play a role in this disease
In RA, for some unknown reason, the immune
system considers its own joint tissues foreign.
White blood cells 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.
Within weeks the synovium becomes
thickened.
The mass of synovial tissue that
spreads over the top of cartlidge 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.
Diagnosis Of RA
Clinical History
Physical Exams
Specific Lab Tests
CBC
ESR
CRP
RA Factor
Anti CCP
Imaging Studies
X-Ray
MRI
Cat Scan
Bone Scan
Conventional Methods of
Treatment
Nonsteroidal Anti Inflammatory Drugs
(NSAIDs) – Aspirin, Ibuprofen, COX-2
inhibitor.
Corticosteroids – Cortisone
Disease Modifying Antirheumatic Drugs
(DMARDs) – Methotrexate, Injectable
Gold, Hydroxychloroquine.
Biologic Response Modifiers – Enbrel,
Remicade, Humira.
Alternative Methods of
Treatment
Diet
Exercise
Acupuncture
Herbal Medicines
Massage
Stress Reduction Techniques –
prayer, meditation, hypnosis, yoga,
tai-chi.
The Bottom Line!!
Conclusion
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.
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.
References
Arthritis Foundation. “Disease Center.” Arthritis Foundation. 2004. 24 Aug. 2005.
< http://www.arthritis.org/conditions/DiseaseCenter/RA/ra_overview.asp>.
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?eaf>.
Parham, Peter. The Immune System. New York: Garland Science Publishing, 2005.
Shlotzhauer, Tammi L. M.D. and James McGuire M.D. Living with Rheumatoid Arthritis.
Baltimore: John Hopkins University Press, 2003.