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Osteoarthritis & Rheumatoid Arthritis Dr.Abdullah Al-Omran NOTE : THIS PRESENTATION DOES NOT REPLACE ATTENDANCE OR INFORMATION GIVEN IN THE LECTURE.IT IS INTENDED AS A HIGHLIGHT FOR THE TOPIC O.A(O.Arthrosis) 1ry or 2ry 1ry Def : degen.process of unknow etiology affecting articular cartilage of a previously healthey joint. 2ry Def ? O.A(O.Arthrosis) 1ry (idiopathic): Elderly >45 yr Wear & tear process Factors : age , activity , obesity , heridity sex equal O.A(O.Arthrosis) 2ry causes : 1.Post traumatic : fracture involve articulr surface incongruent joint trauma per se 2.Inflammatory : e.g R.A 3.Metabolic Disorders e.g Gout 4.Bleeding Disorders : e.g. Haemophilia 5.Infection 6.Hormonal e.g Acromegaly , hyperthy. etc Pathological changes 1.Changes in Articular cartilage 2.Changes in synovial membrane 3.Changes in subchondral bone 4.Osteophytes 5.Reduction in joint space 6.Bony deformities Pathological changes Joints affected All symptoms Gradual onset of : Pain Limited R.O.M Greaty sensation Swelling Deformity Signs Tender joint line Limited R.O.M both active & passive crepitation Swelling Deformity O.A(O.Arthrosis) In S.A. medial compartment affected more management Depend on severity , cause , age , activity level. I.Conservative: 1.NSAIDS 2.wt reduction 3.activity modification 4.physiotherapy(u/s,heat short wave,muscle strengthening ) 5.Injections .. management management II.Operative : 1.Arthroscopic Washout , Debridement & microfracture . 2.High Tibial Osteotomy 3.Unicondylar knee Arthroplasty 4.Total knee Replacement management management management O.A(O.Arthrosis) New Advance in management : 1.Glucosamine Sulphate 2.mosaioplasty 3.chondrocyte transplant 4.resurfacing arthroplasty. Rheumatoid Arthritis Def: ch.inflammatory systemic disease of young age & adults,have destructive & proliferative changes in synovial membrane,periarticular structures,skeletal muscles,& perineural sheaths. Joints Affected 1.PIP & MP 2.Foot joints 3.Knee 4.Wrist 5.Hip 6.Cervical spine Symptoms 1.Early morning stiffness 2.Polyarthralgia 3.Weight loss 4.Fever 5.Malaise & fatigue Signs Extraarticular involvement: 1.Rheumatoid nodules 2.ocular:scleritis,keratoconjunctivitis,sicca) 3.Cervical myelopathy 4.Entrapment neuropathy 5.Rheumatoid vasculitis 6.Lymphadenopathy &anemia 7.Pulmonary(pleurisy,effusion,diffuse interstitial fibrosis) Signs Articular involvement: 1.Symmetrial Small Joint Involvement 2.Limited R.O.M 3.TenoSynovitis 4.Muscle wasting 5.Ulnar deviation hand 6.Swan neck deformity fingers 7.Hallux valgus ACR criteria for Dx of RA 1.Morning stiffness 2.Arthritis of wrist ,MCP or PIP 3.Arthritis of 3 or more joints simultaneously (PIP,MCP,WRIST,ELBOW,KNEE,ANKLE,MTP) 4.Symmetrical Arthritis 5.RHEUMATOID NODULES 6.RHEUMATOID FACTOR +VE 7.X ray findings of wrist or hand typical of rheumatoid arthritis. _________________________________________________________ * 4 of the 7 criteria in above 18 yr * 1-4 : at least 6 wk duration Lab. 1.Anemia ? 2.incr.ESR 3.Raised Rheumatoid factor 4.Decreased synovial fluid complement 5.Synovial fluid: Glucose, LDH,WBC etc Management 1. DMAR : prevent or reduce joint destruction improve function. i.Glucocorticoids: local/systemic/pregnancy. ii.MTX. iii.hydroxychloroquine+sulfasalazine iv.leflunomide. v.antiTNF:etanercept,infliximab,adalimumab but ! infection & TB vi.Cyclosporine & Azathyoprin & Management 2.NSAID : for PAIN only. 3.Physical therapy,occupational therapy. 4.Sx :4 pain,function & deformity. check c-spine