PRACTICUM MATERIAL 11: A CASE OF RHEMATOID ARTHRITIS Description of Theory Rheumatoid arthritis or Rheumatoid arthritis (RA) is a systemic autoimmune disease. RA is a multisystem disorder whose etiology is not yet known with certainty and is characterized by synovitis destruction. This disease is a systemic inflammation that is most commonly characterized by symmetrical joint involvement.The etiology of RA is not yet known with certainty. However, its occurrence is correlated with complex interactions between genetic and environmental factors. a)Genetic, in the form of a relationship with the HLA-DRB1 gene and this factor has a sensitivity and disease expression rate of 60%. b)Sex Hormones, changes in hormonal profile in the form of stimulation of Placental Corticotraonin Releasing Hormone which secretes dehydropiandrosterone (DHEA), which is an important substrate in placental estrogen synthesis. And estrogen and progesterone stimulate the humoral immune response (TH2) and inhibit the cellular immune response (TH1). In RA the TH1 response is more dominant so that estrogen and progesterone have opposite effects on the development of this disease. c)Infection Factors, several infectious agents are thought to be able to infect host cells and change the reactivity or response of T cells so that RA disease occurs. d)Heat Shock Protein (HSP), is a protein produced in response to stress. This protein contains a sequence of homologous amino acids. It is suspected that there is a molecular similarity phenomenon where antibodies and T cells recognize HSP epitopes on infectious agents and host cells. This can cause a cross-reaction of lymphocytes with host cells, thereby triggering an immunological reaction. e)Environmental factors, one example is smoking Rheumatoid Arthritis Risk Factors Risk factors for increasing the occurrence of RA include female gender, a family history of RA, older age, exposure to salicylates and smoking. Risks may also occur due to consuming more than three cups of coffee a day, especially decaffeinated coffee Obesity is also a risk factor Pathophysiology of Rheumatoid Arthritis RA is a systemic autoimmune disease that attacks the joints. Autoimmune reactions occur in synovial tissue. Joint damage begins to occur from the proliferation of macrophages and synovial fibroblasts. Lymphocytes infiltrate the perivascular area and proliferation of endothelial cells occurs, then neovascularization occurs. Blood vessels in the involved joint become occluded by small clots or inflammatory cells. The formation of pannus is due to irregular growth in inflamed synovial tissue. Pannus then invades and damages joint cartilage and bone. The immunological response involves the role of cytokines, interleukins, proteinases and growth factors. This response results in joint destruction and systemic complications. Rheumatoid Arthritis Therapy RA therapy must be started as early as possible to reduce the rate of disease worsening. Patients must be referred within 3 months of the appearance of symptoms to confirm the diagnosis and initiation of DMARD therapy (Disease Modifying Anti-Rheumatic Drugs). RA therapy aims to: a. To reduce the pain experienced by patients b. Maintaining its functional status c. Reduces inflammation d. Controlling systemic involvement e. Protection of joints and extra-articular structures f. Control disease progression g. Avoid complications related to therapy Implementation of Practicum a. Case Mrs. RA, 57 years old, came to the doctor complaining of leg pain in the left and right knees, there was no swelling, when she got up from sitting she felt so painful that it took several minutes before she could walk after getting up from sitting, when walking there is no pain. The pain he felt started 2 years ago when he fell from a motorbike.As a result of the diagnosis, the doctor prescribed the following medication: R/Flamar gel S 2 dd 1 R/ Tramadol 50 mg Paracetamol 500 mg Methylprednisolone 8 mg Glucosamine 500 mg S 3 dd 1 cap No. XXX R/ Lansoprazole 30 mg S 2 dd 1 tab