RA & SJOGREN

RA & SJOGRENDR.A .Tahamoli RudsariRHEUMATOID ARTHRIRISIntroduction 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.Epidemiology The prevalence of RA is 0.5 1% of the adult population.

Women are affected approximately three times more often than men.

25 50 yGenetic 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-DRB1PTPN22

Environmental factors Smoking

EBVPathology 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

Clinical features Articular manifestation

Exteraarticular manifestation Articular features Chronic inflammatory symmetric polyarthritis

extraarticular features

Lab dataRF

Anti CCP

CBC, ESR, CRP, BUN, Cr, AST, AIT,

Synovial fluid analysisImaging Early in the disease, radiographic evaluations of the affected joints are usually not helpful in establishing a diagnosis.

Plain radiography

DIAGNOSIS

CLINICAL COURSE TREATMENTNSAIDs

Glucocorticoids

DMARDsHCQMTXSSZLEF

Biological DMARDs

Anti TNF agentsRituximab

Anakinra AbataceptTocilizumab SJOGREN DISEASEDefinition Sjgren'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 Sjgren's syndrome

Secondary Sjgren's syndrome

Epidemiology The prevalence of primary Sjgren's syndrome is approximately 0.51.0%, while 30% of patients with autoimmune rheumatic diseases suffer from secondary Sjgren's syndrome.Secondary Sjgren's syndromeRA

SLE

SSC

MCTD

PBCVasculitis CAHMiddle-aged women are primarily affected.

Female/Male : 9/1Clinical features Exocrine gland features

Extraglandular disease features

810 years may elapse from the initial symptoms to full-blown development of the disease.

Oral The principal oral symptom of Sjgren'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 Sjgren's syndrome but is uncommon in those with the secondary syndrome.`Ocular 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 Sjgren's syndrome , while they are very rare in patients with Sjgren's syndrome associated with rheumatoid arthritis.

Anti Ro/SS-A

Anti La/SS-B