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p
is a chronic multisystem
disease of unknown cause characterized by a
symmetrical arthritis, with pain, swelling and
stiffness
p w is a degenerative joint disease, a
type of arthritis that is caused by the breakdown and
eventual loss of the cartilage, it represents failure of
the diarthrodial (movable, synovial lined) joint.
p is a disease that involves the build-up of uric
acid in the body. Excess uric acid causes needle-
shaped crystals to form in the synovial fluid.
Rheumatoid Arthritis:
p autoimmune disease that causes chronic
inflammation of the joints
p The symptoms can come and go, and each person
with RA is affected differently.
p Other people have times when the symptoms get
worse (flares, and times when they get better
(remissions.
p Others have a severe form of the disease that can
last for many years or a lifetime. This form of the
disease can cause serious joint damage.
p More often in women
p Often starts during the 4th & 5th decades of life.
athogenesis
Rheumatoid Arthritis
p ¦ ¦¦ F
persistent inflammatory synovitis, involving the
peripheral joint in a symmetrical distribution
p
potential to cause cartilage damage, bone
erosions and changes in joint integrity
ONSET OF RHEUMATOID ARTHRITIS:
1. Insidious - in approximately 2/3 of patients,
systemic manifestations, including, fatigue,
anorexia, musculoskeletal symptoms may precede
overt symptoms of arthritis by months.
p In some patients, external events (major infections,
surgical procedures, trauma, or childbirth precede
the clinical onset.
p insidious onset followed by progression to
polyarticular involvement is the most common
course.
2. Acute ʹ occurs in approximately 10% of
patients
p rapid development of polyarthritis
accompanied by constitutional symptoms
including fever, lymphadenopathy and
splenomegaly
Rheumatoid arthritis
SIGNS & SYMTOMS:
p Stiffness- morning stiffness is one of the
hallmark symptoms of rheumatoid arthritis
p Swelling ʹ synovial fluid enters into the joint,
hypertrophy of the synovium, thickening of
the joint capsule
p ain aggravated by movement ʹ most
common manifestation. Inflammation inside a
joint makes it sensitive and tender.
SIGNS & SYMTOMS:
p Skin nodules
p Redness
p Warmth - in large joints especially the knee
Rheumatoid Arthritis:
p This disease often occurs in more than one joint and
can affect any joint in the body.
p ands are most often affected
p Swelling and tenderness are usually noted first at the
metacarpophalangeal and proximal interphalangeal
joints Fusiform swelling at the proximal
interphalangeal joints is typical.
p Distal interphalangeal joints - usually spared.
p Grip strength - decreased because of pain and
mechanical derangement.
Rheumatoid Arthritis:
The hand and wrist are common sites of synovitis in rheumatoid arthritis.
Marked swelling in the wrist and metacarpophalangeal joints is caused by
synovial proliferation. Modest ulnar deviation of the fingers is also
present.
Rheumatoid Nodules:
p Rheumatoid nodules commonly form near the
extensor surface of the elbow. They can be fixed to
the underlying periosteum or can be freely mobile.
Rheumatoid Nodules:
p Rheumatoid nodules are the most common extra-articular
manifestation, occurring in about 15% of patients.
p Subcutaneous
p Found in areas exposed to pressure -- over the extensor
surfaces of the forearm, the olecranon bursa, the knuckles,
the ischial regions, the Achilles tendon, and the bridge of the
nose . Also occur in viscera.
p Firm and are either freely movable or attached to connective
tissues
p Size - from a few millimeters to more than 2 cm in diameter
and often occur in clusters.
p Have a rubbery or gritty feel and can be indistinguishable
from gouty tophi on physical examination.
¦AUSES:
p Unknown
p Autoimmune
p Things that may cause rheumatoid arthritis
are:
1.Genes
2.Environment
3.Hormones
DIAGNOSIS:
p physical exam
p x rays
p lab tests
p Rheumatoid arthritis can be hard to diagnose
because:
1. There is no single test for the disease
2. The symptoms can be the same as other kinds of
joint disease
3. The full symptoms can take time to develop.
Treatment:
The goals of treatment are to:
p Take away pain
p Reduce swelling
p Slow down or stop joint damage
p Maintenance of function.
p ¦ontrol of systemic involvement.
p None of the therapeutic approach is curative, all
are palliative.
p
¦
5
¦
. se of aspirin, other
analgesics
2. se of low dose oral glucocorticoids
3. se of disease modifying or slow acting anti
rheumatoid drugs (
)
4. se of cytokine neutralizing agents
5. se of immunosuppressive cytotoxic drugs
0ifestyle ¦hanges
p Here are some ways to take care of yourself:
p Keep a good balance between rest and
exercise
p Take care of your joints
p 0ower your stress
p Eat a healthy diet.
p
is a chronic multisystem disease of
unknown cause characterized by a symmetrical
arthritis, with pain, swelling and stiffness
p w is a degenerative joint disease, a type of
arthritis that is caused by the breakdown and
eventual loss of the cartilage, it represents failure of
the diarthrodial (movable, synovial lined) joint.
p is a disease that involves the build-up of uric acid
in the body. Excess uric acid causes needle-shaped
crystals to form in the synovial fluid.
OSTEOARTHRITIS
p egenerative rthritis
p Most common
p caused by the breakdown and eventual loss of
the cartilage of one or more joints
p Before age 45, osteoarthritis occurs more
frequently in males.
p After age 55 years, it occurs more frequently
in females
p Hip Osteoarthritis ʹ common in men
p Interphalangeal jont & thumb base
Osteoarthritis ʹ common in women
p hands, feet, spine, and large weight-bearing
joints, such as the hips and knees
¦0ASSIFI¦ATION OF OSTEOARTHRITIS:
p
- most common
a. 0ocalized Osteoarthritis
1. hands
2. feet
3. knee
4. hip
5. spine
6. other single sites (glenohumeral, sternoclavicular
p ë
a. rauma
b. ¦ongenital or developmental
c.
etabolic
d. ndocrine
e. ¦alcium deposition diseases
f. ther bone joint diseases
g.
europathic
h. ndemic
RISK FA¦TORS:
1. AGE ʹ most powerful risk factor
2. Female sex
3. Race
4. Genetics
5. Major joint trauma
6. Repetitive stress
7. Obesity
8. ¦ongenital / developmental disease
9. rior joint disorders
10. Metabolic / endocrine disorders
¦AUSES:
p AGING
- water content of the cartilage increases and the protein
makeup of cartilage degenerates
- Repetitive use of the joints Î irritates and inflames the
cartilageÎ joint pain and swelling. Eventually, cartilage begins
to degenerate by flaking or forming tiny crevasses.
- In advanced cases, there is a total loss of the cartilage
cushion between the bones of the joints.
- 0oss of cartilage cushion Î friction between the bones Î
À When the cartilage deteriorates, the bone next to it
becomes inflamed and can be stimulated to produce new
bone in the form of a local bony protrusion, called a
SIGNS AND SYMTOMS:
p NOT a systemic disease
. pain in the affected joint(s) after repetitive
use À most common symptom of
osteoarthritis. Joint pain is usually worse
later in the day.
2. Swelling
3. Warmth
4. Bony crepitus - characteristic
5. Stiffness of the joints can also occur after
long periods of inactivity
I. Heberden͛s nodes
XBony enlargement of the
distal interphalangeal joint
(DI
XMost common form of
idiopathic osteoarthritis
II. Bouchard͛s nodes
XBony enlargement of
the proximal
interphalangeal joint
(I
DIAGNOSIS:
p ¦0INI¦A0
p RADIOGRAHI¦ EVIDEN¦E
1. loss of joint cartilage
2. narrowing of the joint space between
adjacent bones
3. bone spur formation
TREATMENT:
p Goal of treatment in osteoarthritis:
1. Reduce joint pain
2. Reduce inflammation
3. Maintaining joint function
4. Minimizing disability
SIGNS & Morning stiffness Joint pain; Morning Rapid onset of pain usually in the
SYMPTOMS lasting >45 min. stiffness lasting less than MTP joint followed by warmth,
Swelling ; Pain 30 minutes swelling, reddish discoloration,
aggravated by Joint instability; and marked tenderness
movement; Skin Heberden's and
nodules; Redness Bouchard's nodes
Warmth
DIAGNOSIS medical history Clinical History of repeated attacks of
physical exam Radiographic evidence painful arthritis at the base of the
x rays toes; Physical Exam; Blood tests
lab tests Joint aspiration