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Rheumatoid arthritis RA is a long-term autoimmune disorder that primarily affects joints. While the cause of rheumatoid arthritis is not clear, it is arthritis dissertation to involve a combination of genetic and environmental factors. The goals of treatment are to reduce pain, decrease inflammation, and improve a person's overall functioning. RA affects about Augustin Jacob Landré-Beauvais — of Paris. Arthritis of joints involves inflammation of the synovial membrane.
Joints become swollen, tender and warm, and stiffness limits their movement. With time, multiple joints are affected polyarthritis. Most commonly involved are the small joints of arthritis dissertation handsfeet and cervical spinebut larger joints like the shoulder and knee can also be involved.
RA typically manifests with signs of inflammation, with the affected joints being swollen, warm, painful and stiff, particularly early in the morning on waking or following prolonged inactivity. Increased stiffness early in the morning is often a prominent feature of the disease and typically lasts for more than an hour. Gentle movements may relieve symptoms in early stages of the disease. These signs help distinguish rheumatoid from non-inflammatory problems of the joints, such as osteoarthritis.
In arthritis of non-inflammatory causes, signs of inflammation and early morning stiffness are less prominent. As the pathology progresses the inflammatory activity leads to tendon tethering and erosion and destruction of the joint surface, which impairs range of movement and leads to deformity.
The fingers may suffer from almost any deformity depending on which joints are most involved. Specific deformitieswhich also occur in arthritis dissertationarthritis dissertation, include ulnar deviationboutonniere deformity also "buttonhole deformity", flexion of proximal interphalangeal joint and extension of distal interphalangeal joint of the handswan neck deformity hyperextension at proximal interphalangeal joint and flexion at distal interphalangeal joint and "Z-thumb.
In the worst case, arthritis dissertation, joints are known as arthritis mutilans due to the mutilating nature of the deformities. The initial pathologic process in nodule formation is unknown but may be essentially the same as the synovitis, since similar structural features occur in both.
The nodule has a central area of fibrinoid necrosis that may be fissured and which corresponds to the fibrin -rich necrotic material found in and around an affected synovial space, arthritis dissertation.
Surrounding the necrosis is a layer of palisading macrophages and fibroblastscorresponding to the intimal layer in synovium and a cuff of connective tissue containing clusters of lymphocytes and plasma cellscorresponding to the subintimal zone in synovitis. The typical rheumatoid nodule may be a few millimetres to a few centimetres in diameter and is usually found over bony prominences, such as the elbowthe heelarthritis dissertation, the knucklesor other areas that sustain arthritis dissertation mechanical stress.
Nodules are associated with a positive RF rheumatoid factor titerACPA, and severe erosive arthritis. Rarely, these can occur in internal organs or at diverse sites on the body. Several forms of vasculitis occur in RA, arthritis dissertation are mostly seen with long-standing and untreated disease. The most common presentation is due to involvement of small- and medium-sized vessels.
Rheumatoid vasculitis can thus commonly present with skin ulceration and vasculitic nerve infarction known as mononeuritis multiplex. Other, rather rare, skin associated symptoms include pyoderma arthritis dissertationarthritis dissertation, Sweet's syndromedrug reactions, erythema nodosumlobe panniculitisatrophy of finger skin, palmar erythemaarthritis dissertation, and skin fragility often worsened by corticosteroid use.
Diffuse alopecia areata Diffuse AA occurs more commonly in people with rheumatoid arthritis. Lung fibrosis is a recognized complication of rheumatoid arthritis. It is also a rare but well-recognized consequence of therapy for example with arthritis dissertation and leflunomide.
Caplan's syndrome describes lung nodules in arthritis dissertation with RA and additional exposure to coal dust, arthritis dissertation. Exudative pleural effusions are also associated with RA. People with RA are more prone to atherosclerosisand risk of myocardial infarction heart attack and stroke is markedly increased. To reduce cardiovascular risk, arthritis dissertation, it is crucial to maintain optimal control of the inflammation caused by RA which may be involved in causing the cardiovascular riskand to use exercise and medications appropriately to reduce other cardiovascular risk factors such as blood lipids and blood pressure.
Doctors who treat people with RA should be sensitive to cardiovascular arthritis dissertation when prescribing anti-inflammatory medications, arthritis dissertation may want to consider prescribing routine use of low doses of aspirin arthritis dissertation the gastrointestinal effects are tolerable. Anemia is by far the most common abnormality of arthritis dissertation blood cells which can be caused by a variety of mechanisms.
The chronic inflammation caused by RA leads to raised hepcidin levels, leading to anemia of arthritis dissertation disease where iron is poorly absorbed and also sequestered into macrophages. The red cells are of normal size and color normocytic and normochromic.
A low white blood cell count usually only occurs in people with Felty's syndrome with an enlarged liver and spleen. The mechanism of neutropenia is complex. An increased platelet count occurs when inflammation is uncontrolled, arthritis dissertation.
Renal amyloidosis can occur as a consequence of untreated chronic inflammation. The eye can be directly affected in the form of episcleritis [32] or scleritiswhich when severe can very rarely progress to perforating scleromalacia.
Rather more common arthritis dissertation the indirect effect of keratoconjunctivitis siccawhich is a dryness of eyes and mouth caused by lymphocyte infiltration of lacrimal and salivary glands.
When severe, arthritis dissertation, dryness of the cornea can lead to keratitis and loss of vision as well as being painful. Preventive treatment of severe dryness with measures such as nasolacrimal duct blockage is important. Liver problems in people with rheumatoid arthritis may be due to the underlying disease process or as a result of the medications used to treat the disease. Peripheral neuropathy and mononeuritis multiplex may occur.
The most common problem is carpal tunnel syndrome caused by compression of the median nerve by swelling around the wrist. Arthritis dissertation disease of the spine can lead to myelopathy.
Clumsiness is initially experienced, but without due care, this can progress to quadriplegia or even death, arthritis dissertation.
Constitutional symptoms including fatiguelow grade fevermalaisemorning stiffnessloss of appetite and loss of weight are common systemic manifestations seen in people with active RA.
Local osteoporosis occurs in RA around inflamed joints. It is postulated to be partially caused by inflammatory cytokines. More general osteoporosis is probably contributed to by immobility, systemic cytokine effects, local cytokine release in bone marrow and corticosteroid therapy.
The incidence of lymphoma is increased, although it is uncommon and associated with the chronic inflammation, not the treatment of RA. Periodontitis and tooth loss are common in people with rheumatoid arthritis. RA is a systemic whole body autoimmune disease, arthritis dissertation.
Some genetic and environmental factors affect the risk for RA. HLA-DR4 is the major genetic factor implicated — the relative importance varies across ethnic groups, arthritis dissertation. Genome-wide association studies examining single-nucleotide polymorphisms have arthritis dissertation around one hundred alleles associated with RA risk. Other risk loci include genes affecting co-stimulatory arthritis dissertation pathways, for example CD28 and CD40cytokine signaling, arthritis dissertation, lymphocyte receptor activation threshold e.
There are established epigenetic and environmental risk factors for RA. Silica exposure has been linked to RA. No infectious agent has been consistently linked with RA and there is no evidence of disease clustering to indicate its infectious cause, [41] but periodontal disease has been consistently associated with RA, arthritis dissertation. The many negative findings suggest that either the trigger varies, or that it might, in fact, be a chance event inherent with the immune response.
RA primarily starts as a state of persistent cellular activation leading to autoimmunity and immune complexes in joints and other organs where it manifests, arthritis dissertation. Factors allowing an abnormal immune response, once initiated, become arthritis dissertation and chronic.
These factors are genetic disorders which change regulation of the adaptive immune response. Other environmental arthritis dissertation hormonal factors may explain higher risks for women, including onset after childbirth and hormonal medications, arthritis dissertation. A possibility for increased susceptibility is that negative feedback mechanisms arthritis dissertation which normally maintain tolerance — are overtaken by positive feedback mechanisms for certain antigens, such as IgG Arthritis dissertation bound by rheumatoid factor and arthritis dissertation fibrinogen bound by antibodies to citrullinated peptides ACPA arthritis dissertation Anti—citrullinated protein antibody.
Once the generalized abnormal immune response arthritis dissertation become established — which may take several years before any symptoms occur — plasma cells derived from B lymphocytes produce rheumatoid factors and ACPA of the IgG and IgM classes in large quantities, arthritis dissertation.
These activate macrophages through Fc receptor and complement binding, which is part of the intense inflammation in RA. This contributes to local inflammation in a joint, specifically the synovium with edemavasodilation and entry of activated T-cells, mainly CD4 in microscopically nodular aggregates and CD8 in microscopically diffuse infiltrates.
The disease progresses by forming granulation tissue at the edges of the synovial lining, pannus with extensive angiogenesis and enzymes causing tissue damage, arthritis dissertation. Cytokines and chemokines attract and accumulate immune cells, i.
activated T- and B cells, monocytes arthritis dissertation macrophages from activated fibroblast-like synoviocytes, in the joint space. By signalling through RANKL and RANKthey eventually trigger osteoclast production, which degrades bone tissue. The aggressive phenotype of fibroblast-like synoviocytes in rheumatoid arthritis and the effect these cells have on the microenvironment of the joint can be summarized into hallmarks that distinguish them from healthy fibroblast-like synoviocytes.
These hallmark features of fibroblast-like synoviocytes in rheumatoid arthritis are divided into 7 cell-intrinsic hallmarks and 4 cell-extrinsic hallmarks. The cell-extrinsic hallmarks of FLS in RA are: promotes osteoclastogenesis and bone erosion, arthritis dissertation, contributes to cartilage degradation, induces synovial angiogenesis, and recruits and stimulates immune cells, arthritis dissertation. X-rays of the hands and feet are generally performed when many joints affected.
In RA, there may be no changes in the early stages of the disease or the x-ray may show osteopenia near the joint, arthritis dissertation, soft tissue swelling, and a smaller than normal arthritis dissertation space.
As the disease advances, there may be bony erosions and subluxation. Other medical imaging techniques such as magnetic resonance imaging MRI and ultrasound are also used in RA. Color Doppler and power Doppler ultrasound are useful in assessing the degree of synovial inflammation as they can show vascular signals of active synovitis, arthritis dissertation. This is important, since in the early stages of RA, the synovium is primarily affected, and synovitis seems to be the best predictive marker of future joint damage.
When RA is clinically suspected, arthritis dissertation, a physician may arthritis dissertation for rheumatoid factor RF and anti-citrullinated protein antibodies ACPAs measured as anti-CCP antibodies. Therefore, the test is not specific for RA, arthritis dissertation. Hence, new serological tests check for anti-citrullinated protein antibodies ACPAs. The by far most common clinical test for ACPAs is the anti- cyclic citrullinated peptide anti CCP ELISA. Other blood tests are usually done to differentiate from other causes of arthritis, like the erythrocyte sedimentation rate ESRC-reactive proteinfull blood countkidney functionliver enzymes and other immunological tests e.
Elevated ferritin levels can reveal hemochromatosisa mimic of RA, or be a sign of Still's diseasea seronegative, usually juvenile, arthritis dissertation, variant of rheumatoid arthritis.
The new criterion is not a diagnostic criterion but a classification criterion to identify disease with a high likelihood of developing a chronic form, arthritis dissertation. These new classification criteria overruled the "old" ACR criteria of and are adapted for early RA diagnosis.
The "new" arthritis dissertation criteria, arthritis dissertation, jointly published by the American College of Rheumatology ACR and the European League Against Rheumatism Arthritis dissertation establish a point value between 0 and Four areas are covered in the diagnosis: [65]. The arthritis dissertation criteria accommodate to the growing understanding of RA and the improvements in diagnosing RA and disease treatment.
Fasting for Rheumatoid Arthritis
, time: 6:19Arthritis - Wikipedia
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body, including skin, eyes, lungs Devil's claw (Harpagophytum procumbens) is an herb. It has been used by mouth for back pain and arthritis, but there is little evidence to support these uses. Devil's claw is native to south Dissertations from PDF. Transgender Young Adults, Sibling Relationships, and Mental Health, Jordon Bosse, Nursing. PDF. Social Factors that Exacerbate Features of Borderline Personality Disorder in Young Adult Women Between 25 and 35 years of age Living in the Commonwealth of Puerto Rico, Erika M. Carrasquillo, Nursing. PDF
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