THE ARTHITIDES: FOCUS ON RHEUMATOID AND OSTEOARTHRITIS MICHAEL PINCUS, DO RHEUMATOLOGY LAHEY HOSPITAL AND MEDICAL CENTER Disclosures No Disclosures  Approach to the Arthritic Patient History is key Monoarticular ->   Aspirate! Duration and onset  Acute acute (hours/days) or   chronic (insidious)  Inflammatory Crystal  Inflammatory or Non  Infection  Inflammatory “pseudoseptic”  presentation of a typically If Inflammatory  polyarticular disease Soft tissue  Non Inflammatory  (bursitis/myalgia) vs Trauma  Articular Hemarthrosis  Monoarticular vs Multiple  Polyarticular  Symmetric or Asymmetric  Approach to the Arthritic Patient Rash Family History   AOSD dermatographism, AS> SLE > RA   urticaria SLE ACLE, Malar, Tumid  Constitutional Sxs  Infections:  Fever  Lyme-> Erythema Chronicum  GCA, Vasculitis, SLE, AOSD, Migrans  Peroidic FeverSyndromes/FMF Reactive-> Keratoderma  Crystal, Acute Sarcoidosis Blenorrhagicum Weight Loss  Virus/AOSD Maculopapular  GCA, Paraneoplastic  Vasculitis Palpaple Purpura  Psoriatic Plaques  RA Rare  Bechet’s Pustular, Pathergy+  Sarcoid  EN, Lupus Pernio  Approach to the Arthritic Patient Organ Involvmenet  Renal  SLE, Vasculitis, Gout  Lung  Scleroderma, RA, Sjogrens, Dermatomyositis and Anti-Synthase syndromes  Heart  SLE, RA, GCA  Neuro  SLE, Sjogrens, Vasculitis, Sarcoid, Bechets, MAS/HLH  Ocular  HLA B27 related, RA, Bechets, Vasculitis  Mucosal  Bechets, Sjogren, IBD  Raynauds  Sjogrens, RA, SLE, Cryoglobulin, Antiphopholipid Syndromes  Objectives: Rheumatoid Arthritis Learn epidemiology and proposed pathogenesis  Review common and uncommon presentations of  Rheumatoid Arthritis Become familiar with some of the old and new  therapies Rheumatoid Arthritis: Pathogenesis to Treatment Epidemiology Affects all ethnicities  Female: Male 2.5:1  Peak incidence 4-5th decades  Estimated prevalence is 1%, rates are declining  Prevalence increases to 5% in females > 70  Differences in prevalence  0.1% rural Africans  5% in Pima and Chippewa Indians  Why??? Genetics  Hormonal factors  Environmental influences  Infectious exposures  Genetics Risk in first degree relative is 1.5x higher  Concordance rate is higher with monozygotic twins  (12%) as compared with dizygotic twins (3.5%) Double Take: Twins with RA Fight It Together