Inflammatory & Inflammatory & Degenerate Bone and Degenerate Bone and

Joint DiseasesJoint Diseases

By By Dr. Abdullah H.A. Juma Dr. Abdullah H.A. Juma

FRCSEd.FRCSEd.

Associate Professor & Associate Professor & Consultant Orthopaedic Consultant Orthopaedic

SurgeonSurgeon

Inflammatory Disorders

• Introduction : •Those conditions are

characterized by the presence of inflammation and NOT infection.

•They affect primarily the joints. Bones are affected secondarily and to a lesser degree.

• Pathophysiology :

• Age .. Any age but commonly middle aged patients.

• Sex .. Female show slight increase in incidence.

• Causes .. Not clearly known but genetic and environmental factors are well observed. Possible viral provacation is there.

• Target organs .. Synovium , tendon sheaths.

• Types of inflammatory disorders : Rheumatoid Arthritis. Seronegative Arthritis.. Posriasis. Ankylosing Spondylitis. Reiter’s disease. Behcet’s disease. Enteropathic Arthritis. Systemic Lupus Erythematosis. Scleroderma (Progressive Systemic

Sclerosis ). Polyarteritis Nodosa. Polymyositis & Dermatomyositis.

Rheumatoid Arthritis

•Age.. Middle aged.

•Sex.. F : M = 2.5 : 1 .Unknown ,but likely to be hormonally related.

•Onset.. Gradual , on & off with acute relapses.

•Systemic manifestations but early presentation of local problem is common.

•Syemmetrical polyarthritis is the classical mark.

American Rheumatism Association criteria for the diagnosis of rheumatoid

arthritis1. Morning stiffness.2. Pain on motion or tenderness in a joint.3. Swelling of joint due to fluid or soft tissue.4. Swelling of a second joint.5. Symmetrical joint swelling,ie.Rt&Lt.6. Typical rheumatoid nodules.7. Xray finding of peri-articular osteopenia.8. Rheumatoid factor is positive.9. Synovial fluid form poor mucin clot with

acetic acid.10.Characteristic synovial histology.11.Characteristic histology of rheumatoid

nodule.

Pathogenesis of Rh.A.

• 3 stages are noted :

1. Synovitis.. Cellular & enzymatic with/or without synovial thickening. Pannus formation can occur.

2. Destruction.. Joint , soft tissues.

3. Deformity.. With sublaxation or dislocation.

Clinical presentation of Rh.A.

•Slowly progressive polyarthritis.

•Episodic polyarthritis.

•Mono-articular or Oligo-articular arthritis.

•Fulminating polyarthritis.