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The Underlying Cause ofMicrovascular Disfunction
in Rheumatoid Arthritis
Denata prabhasiwi030 09 062
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Why I choose this topic ????
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CRP
RHEUMATOID
ARTHRITIS
NO
DISCUSSIOn
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What is
rheumatoidarthritis
?????
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\
INFLAMMATION
AUTOIMMUNE
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EPIDEMIOLOGY
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Multifactiorial factors1. Genetic factors HLA DR4 with
Rheumatoid Arthritis type I
diabetes HLA DR2 with lupus2.Environment Infections Overexposure
to pesticides and toxins Stress
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sign and symptoms
Joint pain, typicallysymmetric
Morning joint stiffness (1hour)
Joint swelling
Articuler/classic
symptoms
Rheumatoid nodule
Cardiopulmonary disease
Eye disease Sjogrens syndrome
Neurologic syndrome
ekstrarticuler
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Clinical manifestations
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Rheumatoid nodule
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DIAGNOSTIC CRITERIA OF RHEUMATOID
ARTHRITIS
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WHAT ISCRP ??
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CRP is a protein
that produced in
the liver as respon
from inflammatory
cytokines, but
based on recentstudies show that
CRP can also be
produced by
extrahepatic tissues
such as adipose
cells and vascularsmooth muscle
cells
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Functions
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WHAT IS
NO ??
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efinition
Nitric Oxide is derived endhotelialreleasing factor (EDRF) that
synthesized
and released by endothelial cells and serves
as a potent vasodilator.
the release of NO stimulated by bradykinin
synthesised from the amino acid L-arginine
by the endothelial isoform of nitric oxide
synthase
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NOeNOS
nNOS
iNOS
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an enzyme that has the properties dependent onCa, the enzyme is
found in many types of cellsand are responsible for most of the
NOproduction in healthy blood vessels and releasedcontinuously by
arterial and venous endothelialcells and platelets.
Enzyme Endhotelial syntaseNO eNOS)
is a special form of eNOS function of nerves.Neuronal NO
synthasenNOS)
can be induced by immunological stimuli bycytokines and
endotoxin.
Inducible NO synthaseiNOS),
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what isunderlying causeof microvascular
dysfunction inRA
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C reactive
protein(CRP)
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Rheumatoidarthritis
Release cytokinesinflammation IL6,TNFa, IL1)
IncreasingCRP
DecreasedNO
Triggersoxidation of
LDL
Inducecomplementactivation
Foam cell
Atheroscleroticplaque
Disturbendhotelialvasoreactivity
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Prevention
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Conclusion
Systemic inflammation CRP) is associated withmicrovascular
dysfunction in patients with RA. Rheumatoidarthritis and
atherosclerosis are strictly linked, this link is sostrong th t
therosclerosis m y be considered n extr -articular m nifest tion of
thedisease, leading to an increasedrisk of CVD.
To prevent the occurrence of atherosclerosis in patients
withrheumatoid arthritis, the pateints can do traditional form
likephysical exercise and for medikamentosa treatment can useanti
inflamatory like methotrexate low dosage and TNF alfainhibitor
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