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Pathology of Rheumatoid arthritis

Pathology: Initially the synovium becomes oedematous, filled with fibrin exudates and cellular infiltrates.→synovial fluid ↑→Inflammation persists→ synovium gets hypertrophied → surrounds the periphery of the articular cartilage to form a pannus. → articular cartilage loses its smooth shiny appearance.→pannus extends over the cartilage→periphery and burrows into the subchondral bone

With further progress of the disease  ➥ the cartilage becomes worn off  ➥ the bone surfaces become raw                     ↓
The joints gets distorted, at first because of severe muscle spasm associated with pain, however later due to fibrosis of the capsule and other soft tissue structures.
In few cases, adhesions create between apposing layers of pannus, leading to fibrous ankylosis,and later hard /bony ankylosis. In an advanced disease,  capsule gets distended by the hypertrophied synovium and synovial fluid, and the ligaments supporting the joint are stretched, resulting in subluxation of the joint. Osteoporosis develops in the bones adjacent to the diseased joint. Peri-articular tissues, notably tendons and muscles become oedematous and infiltrated with cells, and may rupture spontaneously
The curse of the disease varies from patient to patient. In some, it is no more than a mild arthritis which totally recovers; in others it may be a severe, chronic debilitating disease, ultimately ending up in deformities. A typical case has a background of spontaneous remissions and exacerbations.few factors known  are physical exertion, psychological stress, infections and occasionally, trauma.

➥ The subsequent activation of cytokines, B cells, and other inflammatory mediators causes a marked synovitis, with polymorphonuclear leukocytes proliferating in the superficial lining of the synovium and joint fluid, while T cells, B cells, fibroblasts, and plasma cells congregate around small blood vessels in the deeper layer of the synovium. ➦The synovium hypertrophies, develops villous formation, and also can produce a pannus, an invasive granulation tissue that invades and erodes adjacent subchondral bone and cartilage.Catabolic enzymes produced by the inflamed synovium initiate proteoglycan and collagen destruction. Additional stress to the articular cartilage is caused by associated joint effusion, which stretches the capsule and causes ligamentous instability. ➦ No laboratory study is diagnostic of Rheumatoid arthritis, but approximately 80% of patients with Rheumatoid arthritis  have abnormal levels of rheumatoid factors (IgM or IgG antibodies that bind to the Fc portion of IgG to form immune complexes). ➦High levels of rheumatoid factor are associated with severe disease and greater extra-articular involvement. Occasionally, a patient may present with acute monoarticular arthritis, but this finding is more consistent with an underlying septic arthritis. Rheumatoid arthritis is a systemic disease, and most patients have extra-articular manifestations. Subcutaneous rheumatoid nodules composed of lymphocytes clustered in focal aggregates and surrounded by collections of plasma cells typically form over pressure points 

Dr .Lalit Choudhary
Hii everyone, I'm Dr Lalit Choudhary PT. Born and brought up in delhi. Practicing as a professional PHYSIOTHERAPIST. As a therapist I love to interact with others and and get myself updated regarding all the social issues which are leading my countrymen to distress themselves. Yes, I agree that Iam a workaholic but my work gives me immense pleasure but there are sometimes when I feel stressed up so to relax myself I travel to new places, meet new people and try to adopt their culture. Most of the time I like to travel hills as it helps me to relax and enjoy our nature beauty. For being a good therapist and to deal with all the difficulties I always prefer to be good listener and have good patience that is what my strength is. I also work as a social worker and the Founder of thesocialphysiofitnessclub and PHYSIO FIT INDIA. In last I just want to say that " I believe that physical therapy is not just a therapy but actually a remedy which not only make you physically fit but also adds happiness, joy and more days to your life." So don't just sit and thought now it's time to stand and work on yourself.

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