A Chronic,

systemic inflammatory disease,

characterised by symmetrical joint
involvement which is typically

hallmark
feature: persistent symmetric
polyarthritis (synovitis)
erosive/destructive.

Function of JOINTS:
To allow articulation

between two or more bones

and
secondarily to permit
movement by contraction of
opposing muscles.

Unknown
Genetic
Autoimmune

Antigen
Environmental agent, infectious agent
Genetic
Susceptibility
HLA-DR4
HLA-DQ
HLA- DP

Activates CD4 helper

T cells and probably
B lymphocytes
Cytokines

T cells stimulates
synovial macrophage
and fibroblast

Activates
B lymphocytes

T cells stimulates
synovial macrophage
and fibroblast

Activates B lymphocytes

Formation of
rheumatoid
factor

RANKL
Cytokines
Fibroblast
Chondrocytes
Synovial cells

Activates
osteoclast

Enzymes release
(collagenase, streptomelysin,
elactase, PGE2 and matrix
metalloproteinases, others)

Proliferation
Pannus
formation
Joint
destruction

Formation of
autoimmune
complexes and
probable deposition
in the joint

Joint injury

INTERLEUKIN 1
IL-1 is a potent stimulator of synoviocytes,
chondrocytes and osteoblasts (Figure 1).
IL-1 is a proinflammatory cytokine that amplifies
and perpetuates the disease process in RA

arthritis
Associated with
low fever
Fatigue
Morning stiffness
Joint soft, warm to
touch

2. extra-articular features

ssociated syndromes (possible

plications)

(a) Sjgrens syndrome-salivary gland

inflammation and keratoconjunctivitis
(b) Feltys syndrome-profound neutropenia,
thrombocytopenia and splenomegaly
(C) Pulmonary involvement-(pleuritis, interstitial
pneumonitis, alveolitis and intrapulmonary
rheumatoid nodules)
(d) Cardiac involvement-pericarditis

Kriteria RA (ARA 1987)

Kriteria 1 4 selama 6 minggu :
1. Kaku pagi hari
2. Artritis pada 3 daerah persendian atau
lebih
3. Artritis pada persendian tangan
4. Artriris simetris
5. Nodul rheumatoid
6. Faktor reumatoid serum positif
7. Perubahan gambaran radiologis

ns

1. Morning stiffness lasting more

than
1 hour
2. Arthritis of 3 or more joint areas.
3. Arthritis of the hand joints
4. Symetric arthritis
5. Rheumatoid nodules over
extensor
surface or bony prominences.
6. Serum rheumatoid factor.
7. Radiologic changes.

Terapi

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