ARTHRITIS

Arthritis -“ Rayuma “

- Inflammation of the joints.

- Over 200 forms of arthritis.

- About 30% of adults have arthritis.

Major symptom = in or around jointsPAIN

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 anti- inflammatory 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.

Uric acid underexcretion Accounts for >90% of hyperuricemia Diminished tubular secretory rate, increased tubular

reabsorption, diminished uric acid filtration• Drugs, other systemic disease that predispose people to renal

insufficiency

GoutStages 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

GoutNon- 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

GoutNon- 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

GoutNon- Pharmacologic Treatments

Serious types of arthritis Lupus (systemic lupus erythematosus) Rheumatoid arthritis Scleroderma Sjogren’s 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.