Keterangan
In recent years, significant advances have been made in the treatment of rheumatoid arthritis (RA), a chronic autoimmune disease that primarily affects the joints. These advancements have revolutionized the management of RA, providing new hope and improved outcomes for patients. Biologic drugs have emerged as a game-changer in RA treatment. These medications specifically target molecules and pathways involved in the immune response, such as tumor necrosis factor (TNF), interleukin-6 (IL-6), and Janus kinase (JAK) enzymes. Biologics have shown remarkable efficacy in reducing inflammation, slowing disease progression, and improving overall joint function. The concept of personalized medicine has gained prominence in RA treatment. Genetic testing and biomarker analysis help identify specific characteristics and disease mechanisms in individual patients. This information enables physicians to tailor treatment strategies, selecting the most appropriate medications and dosages for each person, leading to better outcomes. In cases where joint damage is severe and non-responsive to medical therapy, surgical interventions have also seen advancements. Joint replacement surgeries, such as total hip or knee replacements, have become increasingly sophisticated and durable, relieving pain and restoring mobility for individuals with advanced RA.
Ringkasan
- Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease primarily affecting joints, tendons, and bones, potentially leading to tissue destruction. It can affect individuals of any age, with a higher prevalence in females (3:1 female-to-male ratio). Patients commonly experience morning joint stiffness lasting over an hour, which improves with physical activity, particularly affecting small joints in the hands and feet.
- Clinical manifestations of RA are categorized as articular (joint-related) and extra-articular (affecting other body parts). Articular symptoms include pain, swelling, and limited joint movement, especially in MCP and PIP joints of the hand and MTP joints of the feet. Extra-articular manifestations encompass constitutional symptoms, rheumatoid nodules, hematological abnormalities (like anemia), and potential involvement of various systems, including respiratory and cardiovascular.
- Felty's syndrome, a complication of RA, is characterized by splenomegaly, chronic nodular rheumatoid arthritis, and neutropenia, primarily affecting the skin and respiratory systems. Cervical spine involvement is a concern, especially at the atlanto-axial joint, as instability can compress the spinal cord. Common deformities seen in RA include boutonniere and swan neck deformities of the hand.
- Diagnosis involves considering clinical presentations and lab investigations. Elevated RF and anti-CCP levels are indicative, with anti-CCP being more specific and prognostic. Acute phase reactants like ESR and CRP are often elevated, along with thrombocytosis and leucocytosis. Radiographic changes include osteopenia, uniform symmetric joint space narrowing, and marginal subchondral erosions.
- Management of RA focuses on relieving pain, preventing damage/disability, and early, individualized treatment. Modalities include NSAIDs (like celecoxib or etoricoxib) for symptom control, corticosteroids for flares and bridging therapy, and disease-modifying anti-rheumatic drugs (DMARDs) to alter the disease course.
- Commonly used DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. Less common options include gold, cyclosporine A, and D-penicillamine. Regular monitoring of patients on DMARDs is essential to assess efficacy and toxicity, with routine tests like CBC, LFT, and RF levels. DMARDs should be initiated early in patients with active disease, often from day one.
Contoh Sertifikat
Tentang Pembicara
Dokter Vishant Sharma
Kedokteran Darurat di Rumah Sakit Max Super Specialty Gurugram
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