Pathophysiology Of Rheumatoid Arthritis

Pathophysiology Of Rheumatoid Arthritis

Question 1. Write a short note on osteomyelitis.
Answer:

Classification of Osteomyelitis

Acute Osteomyelitis:

• Acute suppurative osteomyelitis
• Acute subperiosteal osteomyelitis
• Acute periostitis.

Pathophysiology of rheumatoid arthritis

Chronic Osteomyelitis:

• Non-Specific Type:
  • Chronic intramedullary osteomyelitis
  • Chronic focal sclerosing osteomyelitis
  • Chronic diffuse sclerosing osteomyelitis
  • Chronic osteomyelitis with proliferative periostitis
  • Chronic subperiosteal osteomyelitis
  • Chronic periostitis.
• Specific Type:
  • Tuberculous osteomyelitis
  • Syphilitic osteomyelitis
  • Actinomycotic osteomyelitis.

Radiation-induced osteomyelitis

Idiopathic osteomyelitis.

Acute suppurative osteomyelitis is a serious sequelae of periapical infection, there is the diffuse spread of infection throughout medullary spaces with subsequent necrosis of a variable amount of bone.

Rheumatoid arthritis mechanism

Osteomyelitis Etiology

• Direct spread of infection from dental pulp into the mandible.
• Spread of infection in the mandible from presenting suppurative odontogenic infections.
• Spread of infection following removable of the tooth without proper asepsis and antibiotic coverage.
• Compound fracture of the mandible with exposure of bone outside the mucosa.
• Post-radiation secondary infection.
• Infection to the preexisting bony lesions, For Example. Paget’s disease of bone and fibrous dysplasia.

Osteomyelitis Clinical Features

• It occurs after 50 years of age and males are more commonly affected.
• The mandibular lesions are diffused in nature.
• Acute suppurative osteomyelitis of the mandible in young adults causes severe pain, and diffuse and enlarged swelling of the mandible.
• There is loosening and soreness of the regional teeth with difficulty in food intake.
• Multiple intraoral and extraoral pus-discharging sinuses often develop and discharge of pus is seen from the gingival service of the affected teeth.
• Paresthesia of the lip is common.
• The patient is slightly febrile and general symptoms include fever, malaise, anorexia, and vomiting.

Pannus formation in RA

Osteomyelitis Histopathology

• In acute suppurative osteomyelitis, the bone marrow undergoes liquefaction and purulent exudates occupy the marrow space.
• A large number of acute inflammatory cell infiltrations are present which shows PMNs with the occasional presence of lymphocytes and plasma cells.
• Some areas of affected bone undergo necrosis with the generation of osteoblast and osteocyte cells and therefore results in the development of sequestrum (a piece of dead bone)
• When the acute phase of infection subsides the new shell of bone called “involucrum” is formed over inflammatory focus.

Question 2. Write a note on the pathophysiology of rheumatoid arthritis.
Answer:

Following is the pathophysiology of rheumatoid arthritis.