arthritis

ARTHRITIS

Osteoarthritis (OA)Osteoarthritis (OA)

Epidemiology

• The most common joint disorder worldwide• Before age 50, men are more likely to have

OA than women.• After age 50, women are more likely

affected.• Most commonly affects the weight bearing

joints in the leg (hip, knee, ankle), spine (cervical, lumbar) and the hand

OsteoarthritisOsteoarthritis

• Defined as a gradual loss of joint cartilage, combined with bony outgrowths at joint margins and mild synovial inflammation.

• X-ray findings: decreased joint space, spurs

Cartilage Stages Stage 1 – normal cartilage Stage 2 – aging cartilage Stage 3 – osteoarthritis


Multiple Factors• Excess body weight• Previous injury to joint• Genetics• Developmental deformities • Gender


Clinical Features• Joint pain that lessens with rest• Morning stiffness of less than 30 minutes• Crepitus• Bony tenderness and enlargement• No palpable warmth• Monoarticular and asymmetric involvement of

joint• For advanced cervical and lumbar spine

involvement: numbness, weakness, “sciatica”• Limitation of range of motion


Treatment Goals• Relieve symptoms• Maintain range of motion• Maintain functionality, activities of daily

living• Limit physical disability• Avoid drug toxicity


Treatment• Non pharmacologic therapy A. Physical Therapy * Exercises: range of motion, strengthening, aerobic conditioning * Modalities: Hot/Cold compress with TENS B. Occupational Therapy * Assistive devices for activities of daily living C. Weight loss program for ideal body weight D. Patient education * Joint protection techniques, home exercises

etc.


• Pharmacologic Therapy A. Oral * Anti-inflammatory agents * Glucosamine sulfate – slows joint

damage * Collagen hydrolysate B. Local * Corticosteroid injections * Viscosupplementation - Hyaluronic acid


• Surgery - for patients with severe functional

impairment and pain not adequately controlled with medical therapy - Arthroscopic debridement and lavage - Total Joint Arthroplasty * significant pain relief offered * possible complication: loosening of

prostheses * indicated for older patients

Gouty ArthritisGouty Arthritis


• A disease mostly of adult men (30-60yrs old)

caused by the deposition of monosodium urate

crystals in joint tissue.


Multiple Factors• Genetics• Diet * beans, nuts, organ meat, sardines, anchovies mushrooms, spinach, asparagus, cauliflower, gravies, beer and other alcoholic beverages• Excess body weight• Medication * thiazide diuretics, aspirin, cyclosporine, chemotherapy agents


Clinical Features• Warm, swollen, red, and painful joint most

commonly affecting the big toe * other joints that may be affected are the

ankle, midfoot, heel and knee• Walking is difficult or impossible• After many years, tophi may develop over

the fingers, ears, knees, or elbows * monitor kidney function (BUN, Creatinine)


Treatment• Cold compress• Pharmacologic Therapy A. Colchicine B. Anti-inflammatory agents C. Allopurinol• Diet modification• Weight loss: target ideal body weight

SummarySummary

• Different kinds of arthritis and treatment options

• Arthritis is a joint problem vs. Osteoporosis which is a bone problem (demineralization)

• Be informed, ask questions• You can and should exercise• Practice moderation• Do not self medicate• Listen to your body and listen to your doctor• Ultimately, the decision is yours

arthritis

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