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Dr. Tehreem Nasir MBBS, RMP

Osteoarthritis is the most common form of arthritis caused by cartilage destruction and bone changes. It typically causes joint pain that worsens with activity and improves with rest. Symptoms often start gradually and asymmetrically affect large weight-bearing joints like the hips and knees. Diagnosis is made based on x-rays showing bone spurs, joint space narrowing, and other signs. Treatment focuses on lifestyle changes, physical therapy, medications, and sometimes surgery for advanced cases.

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Ahmed Saeed
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40 views32 pages

Dr. Tehreem Nasir MBBS, RMP

Osteoarthritis is the most common form of arthritis caused by cartilage destruction and bone changes. It typically causes joint pain that worsens with activity and improves with rest. Symptoms often start gradually and asymmetrically affect large weight-bearing joints like the hips and knees. Diagnosis is made based on x-rays showing bone spurs, joint space narrowing, and other signs. Treatment focuses on lifestyle changes, physical therapy, medications, and sometimes surgery for advanced cases.

Uploaded by

Ahmed Saeed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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By

Dr. Tehreem Nasir


MBBS, RMP
Osteo Arthritis
OSTEOARTHRITIS
• Osteoarthritis (OA) is the most common form of arthritis, and is due
to cartilage destruction and changes of the subchondral bone.
• Clinical Presentation
Symptoms
• Joint pain
• Gradual onset
• Asymmetric
• More severe with: Activity, relieved with rest
• Later in the disease:
• Pain is more constant.
• Affects sleep and level of activity
• Morning stiffness
• Duration < 30 minutes
• Restricted joint movement
• Sensation of joint instability and locking
• Signs:
• Soft-tissue swelling
• Warm joints
• Classification and etiology
• Primary OA:
• Idiopathic
• Nodal OA
• Secondary OA:
• Trauma or surgery
• Congenital disorders
• Scoliosis
• Metabolic disorders
• Infection
• Bone disorders
• Paget's disease
Physical exam
• Joint line tenderness
• Limited range of motion (ROM)
• Crepitus with passive ROM
• Evidence of osteophytes
• DIP joints: Heberden's nodes
• PIP joints: Bouchard's nodes
• Commonly affected joints
• Hands:
• Proximal interphalangeal (PIP) joints
• Distal interphalangeal (DIP) joints
• 1st carpometacarpal (CMC) joints
• Hips
• Knees
• Spine:
• Intervertebral discs
• Feet: 1st metatarsophalangeal (MTP) joints
Diagnosis
• X-Rays
• Joint space narrowing
• Subchondral sclerosis
• Subchondral cysts
• Osteophytes
• “Seagull wing” appearance in erosive OA (due to central subchondral erosions)
• Magnetic resonance imaging (MRI)
• More sensitive for early disease
• Cartilage defects
• Bone marrow lesions
• Joint effusions
Management:
• General conservative measures
• Lifestyle modifications:
• Minimize weight bearing.
• Avoid a slumping posture while sitting.
• Sleep on a firm bed.
• Wear supportive shoes or orthoses.
• Weight loss
• Physiotherapy to increase:
• Strength
• Flexibility
• Range of motion
• Endurance
• Assistive devices:
• Unload or redistribute the load on the joint.
• Brace, splints
• Hot and cold therapy
• Medical management
• Topical capsaicin
• Acetaminophen
• Oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs)
• Muscle relaxants
• Corticosteroids
• Can be used orally or as an intra-articular injection
• Hyaluronic acid
• Intra-articular injection
• Glucosamine, chondroitin
• Opioids
• Can be considered for short-term use.
• Surgical management
• Reserved for patients with advanced disease who have failed other treatments
• Total joint arthroplasty (replacement) is the most common procedure.
DIFFERENCE
DIFFERENCE B/W RHEUMATOID
ARTHRITIS AND OSTEOARTHRITIS

Rheumatoid Arthritis Osteoarthritis


• Inflammatory • Degenerative
• Symmetric involvement of small • Asymmetric involvement of large
joints first. joints first.
• Polyarticular • Generally monoarticular
• Other visceral organs also affected. • Not affected.
• Erosion of adjacent bony surface is • Sclerosis of adjacent bony surface
present with destruction of cartilage with the formation of osteophytes.
• Morning Stiffness>1 hour • Morning Stiffness < 1Hour, returns at
the end of the day
Gouty Arthritis
GOUTY ARTHITIS
• Acute inflammatory monoarthritis caused by precipitation of monosodium
urate crystals in joint.
• More common in males.
• Causes: hyperuricemia
• underexcretion of uric acid
• Over production (lesch nyhan syndrome,
increased cell turnover ,von grieke disease,
• SYMPTOMS: asymmetric joint distribution,
swollen, red painful MTP joint of big toe
(podagra)
• Tophus formation: external ear, olecranon bursa,
Achilles tendon)
• Treatment:
• NSAIDs glucocoticoid, colcihcine
• Chronic: Xanthine oxidase inhibitors
(allopurinol, febxostat)
Juvenile Arthritis
Juvenile arthritis
• A heterogeneous group of inflammatory diseases characterized by
inflammation of 1 or more joints and is the most common pediatric
rheumatic disease.
• Classification
• Oligoarticular JIA: arthritis in fewer than 5 joints
• Polyarticular JIA: arthritis in ≥ 5 joints
• Systemic JIA (previously called still’s disease):
• Arthritis in 1 or multiple joints
• Fever
• ≥ 2 weeks that happens daily for at least 3 days
• 1 or more of the following:
• Erythematous rash
• Hepatomegaly
• Splenomegaly
• Lymphadenopathy
• Serositis
• Enthesitis arthritis (also called pediatric spondyloarthropathy):
• Present with arthritis and enthesitis (inflammation of the entheses, the sites where
tendons or ligaments insert into the bone)
Clinical presentation:
• Progressive pattern of symptoms and findings:
• Synovitis
• Joint effusion
• Soft-tissue swelling
• Osteopenia
• Bone edema
• Bony erosions

• Arthritis

• Present for at least 6 weeks before diagnosis

• Morning stiffness or, after a long period of inactivity

• Limping, which may improve during the day with activity

• Eye redness and pain suggestive of uveitis,Can have significant impact on vision-related quality of life
in children
Diagnosis:
• Laboratory findings
• Inflammatory markers may be elevated in systemic JIA and polyarticular
JIA:
• Increased ESR, CRP
• ANA:
• Up to 70% children have positive ana.
• HLA-B27: may be positive in enthesitis-related arthritis
• Radiology
• Plain x-rays:
• May demonstrate:
• Erosions and loss of joint space
• Cervical spine radiographs
• MRI:
• Gold standard
• Particularly sensitive for evaluating synovitis
• Evaluate synovial hypertrophy and bone and cartilage erosions
• Ultrasonography:
• Allows for dynamic joint assessment
• May show:
• Synovial thickening
• Joint effusion
Management:
• Pharmacological therapy:
• NSAIDs
• Disease-modifying anti-rheumatic drugs (DMARDs)
• Intra-articular and oral steroids
• Nutrition: diet improvement for IDA
• Physiotherapy and occupational therapy
• Joint protection and optimizing function
• Consider orthoses to protect the joint.
• Psychosocial: family, school issues
• Medical therapy/medications for JIA are best guided by a pediatric
rheumatologist.
Haemophilic Arthropathy
HAEMOPHILIC ARTHROPATHY
• Hemophilic arthropathy is a systemic arthropathy most commonly caused by
hemophilia, and characterized by repetitive hemarthroses(bleeding inside joint)
and progressive joint disease.
• Haemophilia is a X- linked recessive bleeding disorder caused by congenital
deficiency
• Factor VIII (haemophilia A)
• Decreased factor IX (hemophilia B)
• Young males
• Affects patients between 3-15 years old
• Anatomic location
• Knee is most commonly affected
• Elbow, ankle, shoulder and spine are also involved
• Mechanism of injury
• Persistent minor trauma
PRESENTATION:

• Symptoms
• Painful range of motion of joints
• Hemarthrosis
• The knee is most commonly affected
• Paresthesias
• In the L4 distribution
• Caused by iliacus hematoma that compress femoral nerve
DIAGNOSIS
• X-rays
• Knee
• Squaring of patella and femoral condyles (jordan's sign)
• Ballooning of distal femur
• Widening of intercondylar notch
• Joint space narrowing
• Patella appear long and thin on lateral
• MRI:
• Can be used to identify early degenerative joint disease
• Ultrasound:
• Often helpful to follow intramuscular hematomas
• Histology
• Hypertrophy and hyperplastic changes to the synovium
• Labs:
• APTT prolonged
TREATMENT
• Non-operative: • OPERATIVE:
• Compressive dressings • SYNOVECTOMY (SURGICAL REMOVAL
OF SYNOVIUM,CAUSING PAIN)
• Analgesics
• Short term immobilization • SYNOVIORTHESIS
followed by rehabilitation • DESTRUCTION OF SYNOVIAL TISSUE WITH
INTRA-ARTICULAR INJECTION OF
• Steroids for to help reduce RADIOACTIVE AGENT
inflammation
• TOTAL JOINT ARTHROPLASTIES
• Splints and braces
• ARTHRODESIS (SURGICAL
• Physical therapy to prevent IMMOBALIZATIO N OF JOINT)
contracture development
• Desmopressin
Complications

• Orthopaedic manifestations
• Hemarthrosis
• Intramuscular hematoma (pseudotumor)
• May lead to nerve compression
• Femoral nerve palsy may be caused by iliacus hematomas
• Fractures
• Due to generalized osteopenia
Neuropathic Arthritis
NEUROPATHIC ARTHRITIS:
• It is rapidly destructive arthropathy due to impaired pain perception, position
sense. It can result from various underlying causes most common disease is
diabetes.
• Symptoms:
• Joint swelling, effusion, deformity, pain is mid because underlying neuropathy.
• Diagnosis: bone fragmentation, bone destruction , new bone formation, loss of
joint space
• Treatment:
• Stabilization (splints special bone calipers)
• Arthrodesis (internal fixation, bone graft)
THANK YOU

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