Definition. Rheumatoid arthritis is a systemic inflammatory disease of
unknown etiology, with a majority interest in joint development and usually
chronic and progressive. It is characterized by a chronic inflammation of the
synovium, tendon sheaths, bursa and joint recesses, where the framework creates
a persistent synovitis, with destruction of cartilage, erosion strange, damaged
the joint capsule and tendon-ligamentous structures with deformations and
ankylosis of involved joints. The character system is the extra-articular
manifestations and that these lesions of granulomatous and vasculitic type. The
involvement of connective tissue includes the AR within the systemic connective.
Epidemiology. Predilection for women, with women affected than men 3:1 and
incidence between 0.5% and 2%. Onset between the 4th and the sixth decade.
Etiology. Importance of immune mechanisms in the genesis of the disease, even if
they are pulled into play traumatic factors, psychological, endocrine-metabolic,
nutritional, infectious. A possible role of repeated trauma to a joint is
recognized, sometimes at the base of etiopathogenetic time of the lesion on the
psychological and hormonal factors habitus, it is said that a tragic event could
trigger the '. HR, and that pregnancies are grounds for remission of the disease,
and the same applies to the use of oral contraceptives, resulting in a lower
incidence of the same, being obstructive jaundice there is also a remission,
perhaps because of the role played by cortisol and its non- degradation,
infectious hypothesis exists which recognizes a role for microplasma infection
or bacteria, or Epstein-Barr virus, but there is nothing conclusive yet, the
importance of hereditary and constitutional factors emerge from a study on
antigens histocompatibility class II, where those affected by AR types have
HLA-DR1 and HLA DR4 and HLA Dqw3, correlated with severe extra-articular
manifestation.
. Pathogenesis. In any event, within secure and recognized a role in tissue
damage by immune complexes (IC) and cell-mediated immunity to the action, with
vasculitis and proliferation of synovial cells + lymphocytic infiltration for
release of cytokines and proliferative aspects. It shows a large portion of IgG
and IgM in articular synovial cells and cells lining the joints or ragociti RA,
the local reaction between antigens and antibodies with complement activation
leads to the recall of circulating polymorphonuclear cells and release of
hydrolytic enzymes , superoxide and radicals who then are responsible for the
perpetuation of inflammation and activation of macrophages and fibroblasts and
deposition of collagen fibers. Another interesting aspect is the presence of T
helper cells that release linfochinementre the synovium exhibit a display on
their surface antigenic class II molecules, perhaps to present to
immunocompetent cells (Lymphocytic?) A hypothetical antigen and trigger the
process of inflammation and self-destruction of the entire joint structures (cartilage,
tendon, ligament and bone). Macrophages may release, in turn, produce soluble
factors and plasminogen activator that converts it into plasmin saturation
dell'alfa2-macroglobulin. The subcutaneous nodules on the extensor surface of
arms, olecranon, sacred histologically are data from a central area of fibrinoid
necrosis, a zone of fibroblasts arranged radially fence and finally determines
one or panarterite panflebite with extensive necrosis of the vascular wall, with
frameworks akin to polyarteritis nodosa.
Pulmonary lesions. May include chronic pleural effusion, a formation of multiple
nodules and granulomatous lesions and interstitial fibrosis.
. Rheumatoid factor (RF).
The FR are autoantibodies that react with the Fc of IgG and belong to three
classes of Ig: IgM, IgG, IgA, and they are highlighted through a response that
rheumatic test since they can agglutinate latex particles and can react with
denatured DNA , DNA-nucleoprotein. The FR can find and persist in synovial.
Symptoms.
The disease has an acute onset with their signs and symptoms of systemic disease,
with fever, enlarged lymph nodes, splenomegaly. It features a symmetrical
peripheral polyarthritis which initially affects the small joints of the hands,
feet, wrists and knees but can affect the elbows, shoulders, joints coxofemorali,
ankles, Article COPLA present pain, impotence, muscle stiffness, synovial
hypertrophy, thickening of the capsule and increase of synovial fluid, the wrist
is almost always impressed with carpal tunnel syndrome for trapping the median
nerve below the transverse carpal leigh. The metacarpophalangeal joints, over
time, the fingers are deformed and take a look "on blast" with ulnar deviation
of the phalanges, at the Achilles tendon, you may have a bunion and the level of
the flexor tendons, the tarsal tunnel syndrome. Nodules
A characteristic of rheumatic up. Finally, it indicates the involvement of the
lungs, known as Caplan syndrome, or rheumatoid pneumoconiosis, pulmonary nodules
with.
Laboratory.
Is finding increasing fraction of gamma globulin, C-reactive protein, and
ceruloplasmin; normochromic-normocytic anemia, positive rheumatoid factor> of
1:80, anti DNA and anti-FROG (antigen or rheumatoid arthritis), anti-EBNA ( or
Epstein Barr nuclear antigen);
Instrumental investigations. Rx of hands, with swelling of soft tissue,
periarticular osteoporosis, periosteal reactions, surface erosion, cartilage
defects, destruction of goods;
ARA criteria (American Rheumatism Association). 1) morning stiffness, 2)
arthritis of 3 or more areas, 3) arthritis of the hand joints, 4) symmetrical
arthritis, 5) Presence of FR blood; radiological abnormalities;
Therapy. E 'highly specialized; uses NSAIDs, nonsteroidal anti-inflammatory
drugs for their analgesic, antipyretic, analgesic, cortisone in doses
appropriate, gold salts, D-penicillamine, antimalarials.
Italiano Claudio
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