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BONE OSTEOPOROSIS OSTEOMALACIA/ OSTEOMYELITIS SYSTEMIC LUPUS OSTEITIS DEFORMAN(PAGET’S

DISORDERS RICKETS ERYTHEMATOSUS DSE

Metabolic bone dse. Metabolic bone dse. Inflammation Chronic, Autoimmune Localized rapid bone turnover

DEFINITION Loss/reduction of bone MASS Nutritional Inflammation of the Inflammation of the CONNECTIVE ↑osteoclast activity w/ compensatory
deficiency BONE TISSUES ↑osteoblast activity
POROUS- brittle bone

ETIOLOGY ? Lack of vit.D=↓ Ca Staphylococcus ? ?


absorption (GIT)

IRREVERSIBLE,PROGRESSIVE REVERSIBLE REVERSIBLE IRREVERSIBLE,PROGRESSIVE IRREVERSIBLE,PROGRESSIVE

RISK FACTORS 1. Post menopausal 1. Hyperthyroidism- 1. OPEN fracture 1. Female>male 1. FHx


↑PTH- ↑Ca
-loss of ESTROGEN=↓osteoblast Grade 1- < 1cm 2. Viral infection 2. Male>female
↑osteoclast
Grade 2- <2cm or 3. Chemical exposure
2. Age (65 y.o and above) 1cm
4. FHx
3. Long term use of steroids Grade 3- extensive
damage (skin)
4. FHx

AFFECTED  VERTEBRAE  LONG  LONG BONES • Skin-rashes (MALAR RASH-  SKULL, VETEBRAE,
AREA BONES butterfly) PELVIS,FEMUR,TIBIA
• Compression fracture • Bone tissue
SIGNS and • Soft bones abcess • Joints- • Highly vascularized WEAK
• Dowager’s hump(kyposis of ARTHRITIS&ARTHRALGIA bone(MOSAIC PATTERN)
Symptoms
dorsal spine) • Deformity • SEQUESTRUM
Late: • Pain
• Loss of height • Bowing of legs TENS
• Heart- PERICARDITIS • Deformities
Chills
• Kidney- LUPUS NEPHRITIS
Pain

↑WBC

DIAGNOSTIC BONE MINERAL DENSITY Bone Biopsy Culture and ANTI-NUCLEAR ANTIBODY BONE BIOPSY- most difinitive
MASS- most definitive Sensitivity TEST (ANA)
Bone scan Bone scan
Bone scan CBC CBC
X-ray X-ray
X-ray X-ray ↑ESR
Serum Calcium Alkaline phosphate
Skin biopsy
Urine hydroxyproline

MANAGEMEN 1. Hormonal replacement therapy 1. Calcium & vit. D 1. MASSIVE 1. Skin care PALLIATIVE
T supplements ANTIBIOTIC Tx
2. Biphosphonates (IV) 2. NSAIDs-pain 1. Provide safety environment
2. NSAIDs-pain
(ALENDRONATE)-give before 2. NSAIDs-pain 3. STEROIDS- anti-inflammatory 2. Massive rehabilitation therapy
meals 3. Prevent and
manage fracture 3. Drainage of the 4. Manage complications 3. NSAIDs-pain
MOA:inhibits osteoclast activity SEQUESTRUM
4. REHAB therapy 4. Biphosphonates
AE:GERD 4. REHAB therpy (ALENDRONATE)-give before
3. Calcium & vit. D supplements meals

4. NSAIDs-pain (PLICAMYCIN)-halt or control the


disease
5. Braces

BONE DISORDER

JOINT DISEASES
RHEUMATOID ARTHRITIS(RA) OSTEOARTHRITIS (OA) GOUTY ARTHRITIS (GA)

Autoimmune Degenerative disease of the joint Metabolic joint disease

DEFNITION systemic inflammation of SYNOVIAL JOINT Distruction in cartilage of joints(wt.bearing) characterized by HYPERURICEMIA(>7mg/dL)

ETIOLOGY ? Trauma to joints GOUT

RISK FACTORS Female>male Femal>male Male>female

Young adult Obesity 35-45 years old

Viral infection 60 and above Purine rich diet


Over used of joints Illnesses and surgery

1ST joint Metacarpal poximal interpalangeal Hip and knees Big toe

-joints of hands -Assymetrical -Assymetrical

-Symmetrical -Unilateral -migrating

-Bilateral -Non-migratory

-migratory

PANNUS BONE SPUR TOPHI

SIGNS/SYMPTOMS SWAN-NECK deformity HEBERDEN’S node Joint pain and stiffness

BOTOMERE’S deformity BROUCHARD’S node Increase risk of UROLITHIASIS and RENAL


FAILURE
Ealy morning stiiffness -joint pain

Fatigue

DIAGNOSTIC (+) RHEUMATOID FACTORS X-RAY POLARIZED LIGHT MICROSCOPY

↑ESR Arthroscopy/Arthrocentesis

ANA(ANTI NUCLEAR ANTIBODY) Serum Uric Acid

CBC

MANAGEMENT Move up to the limit of pain WEIGHT REDUCTION DIET: AVOID PURINE FOODS

Prevent FLEXION Avoid TRAUMA to joints Avoid acute attack

(Contracture)-shortening of joints NSAID’s- pain Regular exercise

ALTERNATING ACTIVITY AND REST PARACETAMOL- fever Monitor serum uric acid

Safety measures Surgery- ESTEOTOMY, ARTHROPLASTY DRUF THERAPY:

NSAID’s- pain Heat Application NSAID’s- pain

STEROIDS- inflammation CHANGE POSITION TO PREVENT Acut attack- COLCHICINE-


DISPLACEMENT HIP JOINT
SLOW DOWN PROGRESSION A. Anti-inflammatory
B. ↓ preecipitation of uric acid crystals

TO CONTROL URIC ACID

1. ALLOPURINOL

2. PROBENICID

3. FEBOXUSTAT