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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