PATHOSCHEMA® Immersive Experience (PIE) | Rheumatoid Arthritis (RA) ⛶ Expand Experience Periarticular Bone Healthy Synovium (1-2 Layers) Clear Synovial Fluid Articular Homeostasis Synoviocytes synthesize hyaluronic acid providing frictionless biomechanics. 1. Synovitis 2. Pannus Formation 3. Ankylosis & Erosion Microvascular Hyperemia & Leukocyte Infiltration Hyperplastic Synovial Border Invasive Pannus Destroys Articular Cartilage Marginal Bone Erosion & Fibrous Ankylosis Marginal Erosion (RANKL Mediated) Joint Space Obliteration Symmetric Polyarthritis Simultaneous target of small bilateral joints (MCP, PIP, wrists) Subcutaneous Rheumatoid Nodules Extra-articular manifestation over olecranon / extensor surfaces Ulnar Deviation / Swan-Neck Chronic tendon slippage & volar subluxation 1. Serology (RF / ACPA) 2. Acute Phase (ESR / CRP) 3. Plain Radiography 4. High-Resolution US ACPA / Anti-CCP Specificity Anti-Citrullinated Protein Antibodies show >95% specificity Erythrocyte Sedimentation Rate (ESR) Fibrinogen aggregation accelerates red cell sedimentation Joint Space Narrowing & Marginal Erosions Power Doppler Synovial Hypertrophy I. Bridge Therapy II. csDMARDs III. bDMARDs IV. Symptomatic Short-Term Glucocorticoid Bridging Rapidly suppresses transcription of inflammatory cytokines while DMARDs take effect. First-Line: Methotrexate Monotherapy Inhibits dihydrofolate reductase, blocking purine synthesis and clonal lymphocyte expansion. Anti-TNF Biologics (e.g., Adalimumab) Directly intercepts TNF-alpha ligand, arresting downstream synovial angiogenesis and osteoclast activation. NSAIDs & Analgesia Reversibly inhibits COX-1/COX-2 to manage systemic prostaglandin-mediated pain and stiffness. Clinical Evidence Mastery Question 1 of 10 Score: 0 Loading... 1. Physiology 2. Pathophysiology 3. Symptoms 4. Investigations 5. Management 6. Mastery
