01 arthritis

8/6/2019 01 Arthritis

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ARTHRITISARTHRITIS


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ARTHRITIS:ARTHRITIS:

Usually chronic in natureUsually chronic in nature

inflammation of jointsinflammation of joints

may cause various degrees of disabilitymay cause various degrees of disability

most common types: rheumatoid arthritis,most common types: rheumatoid arthritis,

osteoarthritis, gouty arthritisosteoarthritis, gouty arthritis


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RHEUMATOID ARTHRITISRHEUMATOID ARTHRITIS


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RHEUMATOID ARTHRITIS:RHEUMATOID ARTHRITIS: Connective tissue diseaseConnective tissue disease

chronic inflammatory changeschronic inflammatory changes

migratory swelling and stiffnessmigratory swelling and stiffness

variable degree of deformity, ankylosisvariable degree of deformity, ankylosis


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RHEUMATOID ARTHRITIS:RHEUMATOID ARTHRITIS: Etiology: unknown; probably familial, orEtiology: unknown; probably familial, or

immunologic in natureimmunologic in nature

Immune complexes involved: HLAImmune complexes involved: HLA--DW4, DR4DW4, DR4

Patho: inflammation of synovial membranesPatho: inflammation of synovial membranes

Inc. amt of synovial fluid (sf)Inc. amt of synovial fluid (sf) protein is inc,protein is inc,

glucose is decglucose is dec

granulation tissue formationgranulation tissue formation(pannus)(pannus) cartilage destructioncartilage destruction ankylosisankylosis


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RHEUMATOID ARTHRITIS:RHEUMATOID ARTHRITIS: Rheumatoid noduleRheumatoid nodule most characteristic lesionmost characteristic lesion

Clinical Manifestations: symmetric joint pain,Clinical Manifestations: symmetric joint pain,

morning stiffnessmorning stiffness PIPs, MCPsPIPs, MCPs wristwrist kneesknees

may be accompanied by: fever, malaisemay be accompanied by: fever, malaise

Periarticular swelling of smaller jointsPeriarticular swelling of smaller joints

Many improve spontaneouslyMany improve spontaneously


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RHEUMATOID ARTHRITIS:RHEUMATOID ARTHRITIS: RADIOGRAPHIC FINDINGS:RADIOGRAPHIC FINDINGS:

early: tissue swelling, distended joint capsuleearly: tissue swelling, distended joint capsule

late: cartilage space narrowing, punchedlate: cartilage space narrowing, punched--outoutareas, bone erosion, cystareas, bone erosion, cyst--like areas, bony spurslike areas, bony spurs

LAB FINDINGS:LAB FINDINGS:

ESR increasedESR increased

Rheumatoid factor increasedRheumatoid factor increased


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R.A.R.A. O.A.O.A.Systemic disease; sick ptsSystemic disease; sick pts Pts are not sickPts are not sick

Acute inflam signs/symptAcute inflam signs/sympt Not commonNot common

PIPs anc MCPs affectedPIPs anc MCPs affected Weight bearing joints affectedWeight bearing joints affected

Subcutaneous nodules presentSubcutaneous nodules present No nodulesNo nodules

Osteoporosis, ankylosisOsteoporosis, ankylosis

commoncommon

Not commonNot common

ESR increasedESR increased ESR normalESR normal


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RHEUMATOID ARTHRITIS VARIANTS:RHEUMATOID ARTHRITIS VARIANTS:

1.1. Juvenile Rheumatoid Arthritis (JRA)Juvenile Rheumatoid Arthritis (JRA) StillsStills

diseasedisease affects children; crippling arthritisaffects children; crippling arthritis

2.2. Feltys syndromeFeltys syndrome severe arthritis withsevere arthritis with

leukopenia, splenomegaly, subcut nodulesleukopenia, splenomegaly, subcut nodules

3.3. Reiters syndromeReiters syndrome triad of polyarthritis,triad of polyarthritis,

nongonorrheal urethritis, conjunctivitisnongonorrheal urethritis, conjunctivitis

4.4. Palindromic rheumatismPalindromic rheumatism repeated episodes ofrepeated episodes of

acute arthritis without joint damageacute arthritis without joint damage

5.5. Ankylosing spondylitisAnkylosing spondylitis arthritis beginning atarthritis beginning at

sacrosacro--iliac joint, lumbar spine extendingiliac joint, lumbar spine extending

proximallyproximally


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RHEUMATOID ARTHRITIS:RHEUMATOID ARTHRITIS: TREATMENT:TREATMENT:

-- Bed restBed rest

--ExercisesExercises

-- DietDiet

--NSAIDsNSAIDs

-- Heat modalitiesHeat modalities

-- SynovectomySynovectomy


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R.A. of the Wrist and Hand:R.A. of the Wrist and Hand:

Progressively disablingProgressively disabling

ThumbThumb adduction; fingers deviate to ulnar sideadduction; fingers deviate to ulnar side

MCP arthritis: ulnar driftMCP arthritis: ulnar drift

Intrinsic contracture: swanIntrinsic contracture: swan--neck deformityneck deformity

boutonniere deformity: PIPs flexed, Distal jointboutonniere deformity: PIPs flexed, Distal joint

hyperextendedhyperextended

Trigger finger: synovitis of flexor tendon sheathsTrigger finger: synovitis of flexor tendon sheaths

Carpal tunnel syndrome: median nerveCarpal tunnel syndrome: median nerve

compressioncompression


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ANKYLOSING SPONDYLITIS:ANKYLOSING SPONDYLITIS:

StrumpellStrumpell--Marie arthritisMarie arthritis

Seronegative (negative for rheumatoid factors)Seronegative (negative for rheumatoid factors)

Ossification of the ligaments of the spine; andOssification of the ligaments of the spine; and

involvement of hips and shouldersinvolvement of hips and shoulders Sacroiliac joints affected earlySacroiliac joints affected early

fusion on intervertebral ligamentsfusion on intervertebral ligaments

Clinically: stiffness without pain, then pain overClinically: stiffness without pain, then pain overhips, buttocks, lumbosacral regionhips, buttocks, lumbosacral region

XRAY: Bamboo spineXRAY: Bamboo spine


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OSTEOARTHRITISOSTEOARTHRITIS


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OSTEOARTHRITIS:OSTEOARTHRITIS: Degenerative Joint DiseaseDegenerative Joint Disease

Chronic arthritis in middle agedChronic arthritis in middle aged elderlyelderly

affects weight bearing jointsaffects weight bearing joints

degenerative changes in cartilage; bonydegenerative changes in cartilage; bony

overgrowthovergrowth

minimal inflammationminimal inflammation

Etiology: mechanical, genetic factors play a roleEtiology: mechanical, genetic factors play a role

Pathology: Articular cartilage changes rather thanPathology: Articular cartilage changes rather than

synovial membrane (RA)synovial membrane (RA)


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Osteophyte (spicules/ spurs) formationOsteophyte (spicules/ spurs) formation

Clinically: Stiffness with pain; usuallyClinically: Stiffness with pain; usually

monarticular than polyarticular; stiffness lessensmonarticular than polyarticular; stiffness lessens

with moderate joint usewith moderate joint use followed by discomfortfollowed by discomfortwith prolonged use relieved by restwith prolonged use relieved by rest

aggravated by cold, wet weatheraggravated by cold, wet weather

Heberdens nodesHeberdens nodes enlargement of DIPsenlargement of DIPs

Bouchards nodesBouchards nodes enlargement of PIPsenlargement of PIPs

Latter stages: limitation of joint motionLatter stages: limitation of joint motion disabilitydisability


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O.A. SPINE OSTEOPHYTEO.A. SPINE OSTEOPHYTE


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slowly progressive, intermittent courseslowly progressive, intermittent course

Radiologic findings: cartilage thinning/ narrowingRadiologic findings: cartilage thinning/ narrowing

of cartilage space; spurs; cystof cartilage space; spurs; cyst--like spaceslike spaces

No diagnostic lab findingsNo diagnostic lab findings

Treatment: assurance, rest, exercises, weightTreatment: assurance, rest, exercises, weight

reduction, NSAIDs for pain, heat modalitiesreduction, NSAIDs for pain, heat modalities


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OSTEOARTHRITIS OF THE SPINE:OSTEOARTHRITIS OF THE SPINE:

Common, M>FCommon, M>F

Affects lumbar and cervical levelsAffects lumbar and cervical levels

Disc degeneration, spur/leaf formationDisc degeneration, spur/leaf formation

Low back pain, stiffness, radiating pain,Low back pain, stiffness, radiating pain,

OSTEOARTHRITIS OF THE HIP:OSTEOARTHRITIS OF THE HIP:

In late adult yearsIn late adult years

Painful, disabling affectationPainful, disabling affectation

severe restriction of motionsevere restriction of motion


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OSTEOARTHRITIS OF THE KNEE:OSTEOARTHRITIS OF THE KNEE:

Most frequently affected by O.A.Most frequently affected by O.A.

progressive pain accompanied by effusion,progressive pain accompanied by effusion,

stiffness, limitation of joint motionstiffness, limitation of joint motion


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O.A. SPINEO.A. SPINE


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O.A. HIPO.A. HIP


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GOUTY ARTHRITISGOUTY ARTHRITIS


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GOUTY ARTHRITIS:GOUTY ARTHRITIS:

Characterized by hyperuricemiaCharacterized by hyperuricemia

90% are males90% are males

recurring attacks of monarticular painrecurring attacks of monarticular pain

Precipitated by excessive intake of meatsPrecipitated by excessive intake of meats

Joints involved: 1Joints involved: 1stst metatarsophalangeal jointmetatarsophalangeal joint

(PODAGRA)(PODAGRA)

hand, wrist, knee, elbowhand, wrist, knee, elbow

> Joint is red, swollen, warm, tender, extremely> Joint is red, swollen, warm, tender, extremely

painful on motionpainful on motion


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GOUTY ARTHRITIS:GOUTY ARTHRITIS:

Pathology: sodium urate deposits (tophi); chalky,Pathology: sodium urate deposits (tophi); chalky,creamy materialcreamy material

Radiographic findings: in later stages, smallRadiographic findings: in later stages, small

punchedpunched--out areasout areas Lab findings: inc. blood uric acidLab findings: inc. blood uric acid

-- needle shaped negatively birefringentneedle shaped negatively birefringent

microcrystalsmicrocrystalsTreatment: colchicine, allopurinolTreatment: colchicine, allopurinol


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PSEUDOGOUT: ChondrocalcinosisPSEUDOGOUT: Chondrocalcinosis

Deposition of calcium pyrophosphate crystalsDeposition of calcium pyrophosphate crystalswithin articular cartilagewithin articular cartilage

Frequently in elderly patientsFrequently in elderly patients

Noted in hyperparathyroidismNoted in hyperparathyroidism

Affected joints: knee>hipAffected joints: knee>hip

XRAY: calcified articular cartilageXRAY: calcified articular cartilage


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OTHER ARTHRITIS:OTHER ARTHRITIS:

1.1. Diffuse Idiopathic skeletal hyperostosis (DISH)Diffuse Idiopathic skeletal hyperostosis (DISH)

-- ankylosing hyperostosis, Forestiers diseaseankylosing hyperostosis, Forestiers disease

-- involves the spine; ossification of the anteroinvolves the spine; ossification of the antero--

lateral borders of the vertebral bodieslateral borders of the vertebral bodies

-- disk spaces are spared (unlike in ankylosingdisk spaces are spared (unlike in ankylosing

spondylitis)spondylitis)

2. Hemophilic Arthritis2. Hemophilic Arthritis

-- bleeding into joints due to hemophiliableeding into joints due to hemophilia

-- causes changescauses changes


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OTHER ARTHRITIS:OTHER ARTHRITIS:

3. Ankylosis: stiffening/restriction of the normal3. Ankylosis: stiffening/restriction of the normalrange of motion of a jointrange of motion of a joint

-- may be fibrous/partial or falsemay be fibrous/partial or false

-- may be bony/complete or truemay be bony/complete or true


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SPECIAL THERAPEUTIC PROCEDURES:SPECIAL THERAPEUTIC PROCEDURES:

1.1. ARTHRODESIS: bony ankylosis by surgery; toARTHRODESIS: bony ankylosis by surgery; to

ensure optimal position for the jointensure optimal position for the joint

2.2. ARTHROPLASTY: surgical procedure to restoreARTHROPLASTY: surgical procedure to restore

motion to a stiffened jointmotion to a stiffened joint

a. Resectional: removal of a segment of bone;a. Resectional: removal of a segment of bone;

pain is relieved but stability is diminishedpain is relieved but stability is diminished

b. Interpositional: insertion of a substanceb. Interpositional: insertion of a substance

(fascia, skin, plastic e.g.) between 2 reconstructed(fascia, skin, plastic e.g.) between 2 reconstructedjoint surfacesjoint surfaces

c. Repalcement: replaced by prosthesisc. Repalcement: replaced by prosthesis


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THANK YOU!!THANK YOU!!

01 arthritis

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