Arthritis

Osteoarthritis
OA primarily starts as a cartilage problem, later involving other structures. Once these are affected, the patient
starts to develop the pain characteristic of this condition.
Osteoarthritis
Cartilage Degradation: loss of matrix integrity
There is a role: cytokines, enzymes and nitric oxide
Risk factor :
 Age (strongest)
 Obesity
 Injury muscle weakness
Knees and pelvis are the most common sites
Heberden and Bouchard Nodes
Mechanical pain, no systemic symptoms
Clinical Findings
 The oncet is insidious
 Articular stiffness < 15 minutes
 Pain in motion
- Worse by activity / weight bearing
- relieved by rest
 Deformity maybe absent or minimal
 Bony enlargement of the interphallangeal occasionaly prominent
 Limitation of motion of affected joint is common
 Joint effusion and other articular signs of inflammation are mild
 No systemic manifestation
Laboratory Findings :
Elevated sedimentation rate and other laboratory signs of inflammation are not present.

Imaging :
Radiographs may reveal :
 Narrowing of the joint space
 Sharpened articular margin
 Osteophyte formation
 Lipping of marginal bone
 Thickened, dense subchondral bones
 Bone cysts may also be present
Flow chart for Therapy of OA
Diagnosis
Physical measures
Patient Education
Medication

Analgesics Anti imflalatory drugs Intraarticular Agents

Acetaminophen GI Low Risk GI High Risk Corticosteroids

Tramadol COX 2 Inhibitors
Capsaicin Low Dose Misoprostol
Propoxyphen Hyaluronate
NSAID PPI
Codein Subst Salicylate

High Dose
Scheduled Opioids
NSAID

Surgery
Gout
Gout
Very painful episodes of arthritis
Intermittent, usually monoarticular in the toes, ankles
and knees
May develop into oligo or polyarthicular
 Associated with the concentration of uric acid in the
plasma
Risk Factor
•Alcohol
•Dyslipidemia
•Hypertension
•Urolitiasis
• Drugs such as pyrazinamide, low-dose ASA
•Kidney illness
•Myeloproliferative Disorders
• Gout history in family
Gout
RHEUMATOID ARTHRITIS
(Auto immune Desease)
RHEUMATOID ARTHRITIS
(Auto immune Desease)

Rheumatoid Arthritis (RA) is a chronic systemic inflammatory

disease of unknown cause, chiefly affecting synovial membranes of
multiple joints.
Has a wide clinical spectrum with considerable variability in joint
and extra articular manivestation.
Female : male = 3 : 1
Usual age at onset is 20-40 years, although may begin at any age
RHEUMATOID ARTHRITIS
(Auto immune Desease)
Pathologic findings in the joints include chronic synovitis with pannust
formation.
The pannust erodes cartilage, bone, ligaments and tendons
In acute phase, effusion and other manifestations of inflammation are
common
In late stage, organization may result in fibrous ankylosis (true bony
ankylosis is rare)
in acute and chronic phases, inflammation of soft tissues around the
joint may be prominent and is a significant factor in joint damage
Clinical Finding of RA
Clinical manifestation are highly variable
Onset of articular signs of inflammation is usually insidious
Prodromal symptoms : malaise, weight loss, vague periarticular pain or
stiffness
The trigger of acute onset by infection, surgery, trauma, emotional strain or
post partum period
There is characteristically symmetric joint swelling with associated stiffness,
warmth, tenderness and pain
Clinical Finding of RA
Stiffness persisting for over 30 minutes is prominent in the morning &
subsides during the day
Any joint may be affected, the proximal interphalangeal &
Metacarpophalangeal joints of the fingers as well as the wrists, knees, ankles
and toes are most often involved
Monoarticular is occasionally seen early
Synovial cysts and rupture of tendons may occur
Palmar erythema is noted occasionaly, as are tiny hemorragic
Infarct in the nail folds or finger pulps, which are signs of vasculitis
 conclusion
Osteoarthritis Gout Rheumautoid Arthritis

Etiology: Etiology : Etilogy : Autoimune, genetic

Inflamation Metabolic, It results from an increased
idiopatik body pool of urate with hyperuricemia.
Predilection: Predilection: Predilection:
Knees and pelvis are the most common usually monoarticular in the toes, Any joint may be affected, the proximal
sites ankles and knees, MTP -1 interphalangeal & Metacarpophalangeal
joints of the fingers as well as the wrists,
knees, ankles and toes are most often
involved

Clinical: Clinical: Clinical:

Articular stiffness < 15 minutes Anytime Stiffness persisting for over 30 minutes is
prominent in the morning & subsides
during the day

Imagging: Radiographic Features: Cystic changes, Immaging:

Osteophyte formation
well-defined erosions with sclerotic
margins (often with overhanging bony
edges), and soft tissue masses arc
characteristic radiographic features of
The first 6 months  normal
Soft tissue swelling and juxta articular
demineralization
Later : narrowed joint space, joint
errosions
Merci 