osteoarthritis & rheumatoid arthritis dr.abdullah al-omran
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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 changes1.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
symptomsGradual onset of:
Pain
Limited R.O.MGreaty sensation
Swelling
Deformity
Signs
Tender joint line
Limited R.O.M both active & passivecrepitation
Swelling
Deformity
O.A(O.Arthrosis)
In S.A. medial compartment affected more
managementDepend 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
managementII.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 ArthritisDef: ch.inflammatory systemic disease of young age & adults,have destructive & proliferative changes in synovial membrane,periarticular structures,skeletal
muscles,& perineural sheaths .
Joints Affected1.PIP & MP
2.Foot joints
3.Knee
4.Wrist
5.Hip
6.Cervical spine
Symptoms1.Early morning stiffness
2.Polyarthralgia
3.Weight loss
4.Fever
5.Malaise & fatigue
SignsExtraarticular involvement:
1.Rheumatoid nodules2.ocular:scleritis,keratoconjunctivitis,sicca(
3.Cervical myelopathy4.Entrapment neuropathy
5.Rheumatoid vasculitis6.Lymphadenopathy &anemia
7.Pulmonary(pleurisy,effusion,diffuse interstitial fibrosis)
SignsArticular involvement:
1.Symmetrial Small Joint Involvement2.Limited R.O.M
3.TenoSynovitis4.Muscle wasting
5.Ulnar deviation hand6.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 Arthritis5.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 factor4.Decreased synovial fluid complement
5.Synovial fluid: Glucose, LDH,WBC etc
Management1 .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
Management2.NSAID : for PAIN only.
3.Physical therapy,occupational therapy.
4.Sx :4 pain,function & deformity.
check c-spine