1. DR.A.Tahamoli Rudsari

3.  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.

4.  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

5.  RA is found at approximately 2 -10 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

6.  Smoking  EBV

7.  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.

8. Pathogenesis

9.  Articular manifestation  Exteraarticular manifestation

10. Chronic inflammatory symmetric polyarthritis

20. extraarticular features

26.  RF  Anti CCP  CBC, ESR, CRP, BUN, Cr, AST, AIT, …  Synovial fluid analysis

27.  Early in the disease, radiographic evaluations of the affected joints are usually not helpful in establishing a diagnosis.  Plain radiography

34.  NSAIDs  Glucocorticoids  DMARDs HCQ MTX SSZ LEF

35.  Biological DMARDs Anti – TNF agents Rituximab Anakinra Abatacept Tocilizumab

37.  Sjögren's syndrome is a chronic, slowly progressive autoimmune disease characterized by lymphocytic infiltration of the exocrine glands resulting in xerostomia and dry eyes.

38.  Approximately one-third of patients present with systemic manifestations.  Primary Sjögren's syndrome  Secondary Sjögren's syndrome

39.  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.

40.  RA  SLE  SSC  MCTD  PBC  Vasculitis  CAH

41.  Middle-aged women are primarily affected.  Female/Male : 9/1

42.  Exocrine gland features  Extraglandular disease features  8–10 years may elapse from the initial symptoms to full-blown development of the disease.

43.  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.`

44.  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

45.  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.

47.  Anti Ro/SS-A  Anti La/SS-B