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