My hands are aching

My hands are aching

1. Cause

   • Rheumatoid arthritis
     • Chronic
     • Autoimmune
     • Inflammatory
     • How?
       • Autoreactive T- cells recognize synovium as foreign
     • RF factor
       • This exposes sites that allow binding of IgM (RF)
         • The complex accumulate in joints and other areas causing complications
       • Conformational changes occur in Fc region of IgG
       • IgG binds to cryptic epitope
         • This epitope can be a free DNA from damaged cells
       • "IgM antibody against self IgG"

2. Demography

   • Name: Farida
   • Age: 45 y.o
   • Occupation: typist

3. Presented in clinic with

   • Pain in joints
   • Stiffness especially in the morning
   • Swelling of those joints

4. Investigations

   • Blood tests
   • x-Ray
     • x-Ray
       • Findings
         • Periarticular osteopenia
           • Due to activation of osteoclasts
             • RANKL production by activated T-cells
         • Deformities
           • Foot
             • Claw toe
             • Bunion
           • Swan neck
           • Boutonnière deformity
           • Radial deviation
           • Ulnar deviation

5. Joints of the wrist

   • Radiocarpal
   • Flexor retinacula
   • Radio ulnar articulation
   • Ulnar articulates
   • Carpal tunnel
     • Posteriorly by carpals
     • Anteriorly by flexor retinaculum
     • Content
       • Tendons
         • Flexor digitorum profundus
         • Flexor pollicis longus
         • Flexor digitorum superficialis

6. Carpal tunnel syndrome

   • Median nerve

7. Rheumatoid arthritis

   • Symptoms
     • Pain in joints
     • Swelling of those joints
     • Stiffness especially in the morning
   • Systemic disease
     • Pulmonary nodules
     • Felty's syndrome
     • Eyes problem
     • Vasculitis
   • Treatment
     • NSAIDs
     • DMARDs
     • Glucocorticoids
   • Autoimmune disease
     • Genetic
     • Failure of Tolerance
       • Types of Tolerance
         • Peripheral
           • T-reg cells are involved
         • Central
           • Negative selection in the thymus is involved

8. Joint structure

   • Synovial membrane
     • Pannus formation
     • Brother suggested decrease in
   • Capsule
   • Two bones
   • Articular cartilage
   • Two bones

9. Joints of the hand

   • Distal interphalangeal Joints of the wrist
     • Between second and third phalanges
   • Proximal interphalangeal
     • Between first and second phalanges
   • Carpometacarpal
     • Between carpals and metacarpal
   • Metacarpophalangeal
     • Between metacarpals and first phalanges

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