Rheumatoid arthritis joints involved

Rheumatoid Arthritis Joints extra-articular tissue Rare CNS involvement Peripheral neuropathies common... 

FIGURE 54-1. Patterns of joint involvement in rheumatoid arthritis. (From DiPiro JT, Talbert RL, Yee GC, et al, (eds.) Pharmacotherapy. 6th ed. New York McGraw-Hill 2005, Figure 89-3, p. 1673, with permission.)... 

Kanbe K, Takemura T, Takeuchi K, Chen Q, Takagishi K, Inoue K. Synovectomy reduces stromal-cell-derived factor-1 (SDF-1) which is involved in the destruction of cartilage in osteoarthritis and rheumatoid arthritis. J Bone Joint Surg Br 2004 86(2) 296-300. 

Rheumatoid arthritis (RA) is a chronic and usually progressive inflammatory disorder of unknown etiology characterized by polyarticular symmetric joint involvement and systemic manifestations. 

Radiographic changes lypical of rheumatoid arthritis on posteroanterior hand and wrist x-rays, which must include erosions or unequivocal bony decalcification localized to or most marked adjacent to tire involved joints (osteoarthritis changes alone do not qualify). 

Leflunomide is an immunomodulatory dmg inhibiting dihydroorotate dehydrogenase, an enzyme involved in de novo pyrimidine synthesis. It has also anti-inflammatory effects. Leflunomide is able to slow progression of the disease and to cause re-mission/relief of symptoms of rheumatoid arthritis and psoriatic arthritis such as joint tenderness and decreased joint and general mobility in patients. The combined use of leflunomide with methotrexate may... 

Penicillamine (Cuprimine) can be used to treat acute, severe rheumatoid arthritis, producing reductions in joint pain, edema, and stiffness. The response to penicillamine is usually delayed (4-12 weeks), and remissions can last several months after withdrawal of treatment. Radiographic evidence of this drug s efficacy is limited thus, penicillamine is seldom used to treat rheumatoid arthritis. The mechanism of action of penicillamine is unknown, but some evidence suggests that it may involve the inhibition of angiogenesis, synovial fibroblast proliferation, or transcriptional activation. Because penicillamine can chelate copper and promote its excretion, it is used to treat Wilson s disease (hepatolenticular degeneration) and has also been used in mercury and lead intoxication. 

As antirheumatic Salicylates are the drug of choice in the treatment of rheumatoid arthritis. In larger dose they suppress the swelling, immobility and redness of the joints involved. They are also useful in the acute rheumatic fever. They produce relief in pain, swell-... 

Several agents are now available that inhibit the action of tumor necrosis factor-alpha (TNF-a). TNF-a is a small protein (cytokine) that is released from cells involved in the inflammatory response. TNF-a seems to be a key chemical mediator that promotes inflammation and joint erosion in rheumatoid arthritis.83 Drugs that inhibit this chemical will therefore help delay the progression of this disease by decreasing TNF-a s destructive effects.70... 

Rheumatoid arthritis is a disease that involves inflammation in joints and causes severe pain and immobility. The worldwide scenario indicates that the elderly population suffers the most from this disease. The drugs of choice for treatment of this condition are nonsteroidal antiinflammatory drugs (NSAIDs), which include acetylsalicylic acid, diclofenac sodium, piroxicam, nimesulide, celecoxib, and refecoxib. Therapeutic doses, adverse effects, and precautions are given in the foifowing pages. 

Rheumatoid arthritis (RA) is a progressive disease which mainly affects the joints of the body. It is an inflammatory condition which follows a relapsing, remitting course, which can be very variable. The hands and wrists are most commonly affected although other joints may be involved. It is usual that the disease is found in symmetrical joints, although this is not always the case. 

The sulfasalazine molecule comprises sulfa-piridine and 5-aminosalicylic acid linked by an azo-bond which is split by colonic bacteria, releasing the component parts. Sulfapiridine, as a sulphonamide, has an antifolate action which is believed to benefit rheumatoid arthritis, while it is the salicylate moiety that is thought to be effective in inflammatory bowel disease a fuller description appears on page 64. Sulfasalazine is used as a DMARD for rheumatoid arthritis, spondyloarthropathy with peripheral joint involvement, and psoriatic arthritis. 

Parkes and co-workers have also conducted H NMR studies on s5movial fluid from patients with rheumatoid arthritis. Tbe nature of the nontransferrin-bound iron in the synovial fluid of patients with inflammatory joint disease was investigated. Transferrin is an iron ion transport protein. In these patients the synovial fluid contains non-transferrin-bound iron which appears to be in low-molecular-mass, redox-active complexes of unknown type. This form of iron has the adverse effect of stimulating free-radical lipid peroxidations involving oxygen. 500 MHz spin-echo H NMR spectroscopy was used to show that the incubation of patient synovial fluid with the powerful Fe(III)... 

Rheumatoid arthritis is a systemic disease characterized by symmetrical inflammation of joints, yet may involve other organ systems. 

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