ARTHRITIS

Arthritis

- Rayuma
- Inflammation of the joints. - Over 200 forms of arthritis. - About 30% of adults have arthritis. Major symptom = joints

PAIN

in or around

Arthritis

COMMON:
- Osteoarthritis - Rheumatoid Arthritis - Gouty Arthritis

Osteoarthritis

Most common Degenerative or aging bone disease Universal aged 65 and older Primarily affects weight-bearing joints such as the knees, hips, and lumbrosacral spine

Osteoarthritis
Classification: PRIMARY: Degenerative wear and tear process at 5th and 6th decade with no apparent predisposing abnormalities

Osteoarthritis
Classification: SECONDARY: Degeneration caused by congenital

abnormality in joint structures eg: hypermobility abnormally shaped joint surfaces trauma, obesity, crystal deposits

Osteoarthritis

Death of bone beneath the Cartilage ( SCLEROSIS)

Bone proliferation with bone outgrowth (OSTEOPHYTES)

Loss of bony cartilage

Osteoarthritis

Early:, pain after joint use and is relieved by rest

Late: pain occurs with minimal motion or even at rest Nocturnal pain is commonly associated with severe disease

Osteoarthritis treatment

Pain medications

Osteoarthritis treatment

PT Exercises/ Diet modification

To maintain ideal Body wt Low impact aerobic ex, Quads strengthening, stretching

Osteoarthritis treatment
Joint protection

Osteoarthritis treatment
Surgery

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease in which the normal immune response is directed against an individual's own tissue, including the joints, tendons, and bones, resulting in inflammation and destruction of these tissues
The cause of rheumatoid arthritis is not known

Investigating possibilities of a foreign antigen, such as a virus

Rheumatoid Arthritis

Rheumatoid Arthritis
Initial stages of each joint involvement, warmth, pain, and redness, with corresponding decrease of range of motion of the affected joint Reducible and later fixed deformities

Rheumatoid Arthritis

Medications
NSAIDS - only one should be given at a time. - titrated every two weeks until max dosage or response is obtained. - least 2 to 3 wk before assuming inefficacy. Disease-modifying drug - eg, gold, hydroxychloroquine, sulfasalazine, penicillamine - 2 to 4 mo of disease despite treatment with aspirin or other NSAIDs,) - Methotrexate, an immunosuppressive drug - second-line potentially disease-modifying drugs

Rheumatoid Arthritis

Corticosteroids - most effective short-term relief as an antiinflammatory drugs - recent report may slow erosions. - Severe rebound follows the withdrawal of corticosteroids in active disease. Immunosuppressive drugs - eg, methotrexate, azathioprine, cyclosporine) - severe, active RA. They can - suppress inflammation and may allow reduction of corticosteroid doses..

Rheumatoid Arthritis

Surgery:
Removal of inflamed synovium Arthroplasty

Physical therapy

Gout

Deposition of uric acid salts and crystals in and around joints and soft tissues

crystallization of uric acid in the urinary tract.

Uric acid is the normal end product of the degradation of purine compounds.

Major route of disposal is renal excretion Humans lack the enzyme uricase to break down uric acid into more soluble form.

Gout

Uric acid overproduction

Accounts for 10% of hyperuricemia

Acquired disorders
Excessive cell turnover rates such as hemolytic anemias

Genetic disorders: Derangements in mechanisms that regulate purine neucleotide synthesis. Accounts for >90% of hyperuricemia Diminished tubular secretory rate, increased tubular reabsorption, diminished uric acid filtration

Uric acid underexcretion

Drugs, other systemic disease that predispose people to renal insufficiency

Gout
Stages of Classic Gout

Asymptomatic hyperuricemia

Acute Intermittent Gout (Gouty Arthritis)

Episodes of acute attacks. Frequently starts nocturnally Joint is warm, red, and tender Confined to a single joint

Gout

Intercritical Gout

Symptom free period interval between attacks. May have hyperuricemia and MSU crystals in synovial fluid

Chronic Tophaceous Gout

Refers to stage of deposition of urate, inlammatory cells and foreign body giant cells in the tissues. Deposits may be in tendons or ligaments. 10 or more years of acute intermittent gout.

Gout

Presenting Symptoms

Musculoskeletal: - Acute onset of monoarticular joint pain. - First MTP/Big toe: most common. 90% of patients with gout. - Other joints knees, foot and ankles. - Less common in upper extremities Postulated that decreased solubility of MSU at lower temperatures of peripheral structures such as toe and ear

Skin: warmth, erythema and tenseness of skin overlying joint. May have pruritus and desquamation GU: Renal colic with renal calculi formation in patients with hyperuricemia

Gout

Acute Gout Treatment

NSAIDs Continue meds until pain and inflammation have resolved for 48hr
Colchicine

Inhibits microtubule aggregation which disrupts chemotaxis and phagocytosis

Inhibts crystal-induced production of chemotatic factors

Gout

Corticosteriods

Patients who cannot tolerate NSAIDs, or failed NSAID/colchicine therapy

Improvement seen in 12-24hr

Intra-articular injection with steroids

One or two large joints affected Good option for elderly patient with renal disease

Gout
Non- Pharmacologic Treatments

Immobilization of Joint Ice Packs Abstinence of Alcohol

Consumption can increase serum urate levels by increasing uric acid production. When used in excess it can be converted to lactic acid which inhibits uric acid excretion in the kidney

Gout
Non- Pharmacologic Treatments

Dietary modification

Low carbohydrates Decrease in dietary purine-meat and seafood. Dairy and vegetables do not seem to affect uric acid
Bing cherries and Vitamin C

Gout
Non- Pharmacologic Treatments

Serious types of arthritis Lupus (systemic lupus erythematosus) Rheumatoid arthritis Scleroderma Sjogrens syndome Lyme disease Ankylosing spondylitis Psoriatic arthritis Infectious arthritis

When to see a doctor for arthritis Joint is red, hot or very painful. Other symptoms such as fever, tiredness,

weight loss, rash, skin thickening, hair loss, ulcers in the nose or mouth or on the fingers, cold sensitivity in the hands, swollen fingers or toes, muscle weakness, numbness or tingling. Pain persists despite over the counter medication.