DR.A.Tahamoli Rudsari
Rheumatoid arthritis (RA) is a chronic multisystem disease of unknown cause. Although there are a variety of systemic manifestations, the characteristic feature of established RA is chronic inflammatory symmetric polyarthritis.
The prevalence of RA is 0.5 – 1% of the adult population. Women are affected approximately three times more often than men. 25 – 50 y
RA is found at approximately times the expected rate in first-degree relatives of RA patients. 10 – 25 % The class II major histocompatibility complex allele are known to be major genetic risk factors for RA. HLA-DRB1 PTPN22
Smoking EBV
RA affects the synovial tissue and underlying cartilage and bone. The pathologic hallmarks of RA are synovial inflammation and proliferation, focal bone erosions, and thinning of articular cartilage.
Pathogenesis
Articular manifestation Exteraarticular manifestation
Chronic inflammatory symmetric polyarthritis
extraarticular features
RF Anti CCP CBC, ESR, CRP, BUN, Cr, AST, AIT, … Synovial fluid analysis
Early in the disease, radiographic evaluations of the affected joints are usually not helpful in establishing a diagnosis. Plain radiography
NSAIDs Glucocorticoids DMARDs HCQ MTX SSZ LEF
Biological DMARDs Anti – TNF agents Rituximab Anakinra Abatacept Tocilizumab
Sjögren's syndrome is a chronic, slowly progressive autoimmune disease characterized by lymphocytic infiltration of the exocrine glands resulting in xerostomia and dry eyes.
Approximately one-third of patients present with systemic manifestations. Primary Sjögren's syndrome Secondary Sjögren's syndrome
The prevalence of primary Sjögren's syndrome is approximately 0.5–1.0%, while 30% of patients with autoimmune rheumatic diseases suffer from secondary Sjögren's syndrome.
RA SLE SSC MCTD PBC Vasculitis CAH
Middle-aged women are primarily affected. Female/Male : 9/1
Exocrine gland features Extraglandular disease features 8–10 years may elapse from the initial symptoms to full-blown development of the disease.
The principal oral symptom of Sjögren's syndrome is dryness (xerostomia). Physical examination shows a dry, erythematous, sticky oral mucosa. Enlargement of the parotid or other major salivary glands occurs in two-thirds of patients with primary Sjögren's syndrome but is uncommon in those with the secondary syndrome.`
Patients usually complain of a sandy or gritty feeling under the eyelids. Other symptoms include burning, accumulation of thick strands at the inner canthi, decreased tearing, redness, itching, eye fatigue, and increased photosensitivity. keratoconjunctivitis sicca
Extraglandular (systemic) manifestations are seen in one-third of patients with Sjögren's syndrome, while they are very rare in patients with Sjögren's syndrome associated with rheumatoid arthritis.
Anti Ro/SS-A Anti La/SS-B