Download - Arthritis Joints
-
7/29/2019 Arthritis Joints
1/32
-
7/29/2019 Arthritis Joints
2/32
Insidious over several weeks usu.
Usu. Not symmetric at the beginning
Must have an inflammatory synovitis
If deformity is in a non-wt bearing jnt, you canassume its due to synovitis
85% have serum RF
May start sero-(-) but become sero(+) w/ progression
ESR is typically helpful to follow the inflammatoryactivity
-
7/29/2019 Arthritis Joints
3/32
Prolonged morning stiffness is universal
Active phase: warm, swollen jnts Structural damage
Bone on bone crepitusTry injected corticosteroids for anti-inflammation
C/sneck stiffness w/ possible loss of motion
C1 transverse lig tenosynovitis and possible z-jntsynovitis
Pain doesnt always accompany instability even in
significant myelopathy
-
7/29/2019 Arthritis Joints
4/32
-
7/29/2019 Arthritis Joints
5/32
-
7/29/2019 Arthritis Joints
6/32
-
7/29/2019 Arthritis Joints
7/32
-
7/29/2019 Arthritis Joints
8/32
-
7/29/2019 Arthritis Joints
9/32
-
7/29/2019 Arthritis Joints
10/32
-
7/29/2019 Arthritis Joints
11/32
-
7/29/2019 Arthritis Joints
12/32
-
7/29/2019 Arthritis Joints
13/32
-
7/29/2019 Arthritis Joints
14/32
-
7/29/2019 Arthritis Joints
15/32
-
7/29/2019 Arthritis Joints
16/32
-
7/29/2019 Arthritis Joints
17/32
Immobilization due to pain is the kiss of death to
joint mobilizations. The result is contractures and
deformity
You need to keep pts ROM esp. in non-wt bearing jnts
like shoulder and hand
Once cartilage is completely gone, bones may fuse ifimmobilized10% remit usu in first two yrs of dz
90% of jnts that are affected are involved during the
1
st
yrSevere dz= 10-15yr decr in life expectancy due to
infection, pulmonary or renal dz, lymphoproliferative
disorders, GI bleeds and cardiovascular
-
7/29/2019 Arthritis Joints
18/32
RA criteria below:
Morning stiffness3+jnts
Arthritis of hand
Symmetric arthritis
Rheumatoid nodules
RF
X-ray changes
Need 4 of the 7
1-4 must occur for at least 6
wks
-
7/29/2019 Arthritis Joints
19/32
Stage I Earlyno destruction
Stage II Moderateno jnt deformity,
osteoporosis w/ or w/out some bone andcartilage destruction
Stage III Severecartilage and bone
destruction with osteoporosis, jnt deformity
Stage IV Terminalfibrous or bony
ankylosis
-
7/29/2019 Arthritis Joints
20/32
GOUT
-
7/29/2019 Arthritis Joints
21/32
GOUT
Monosodium urate deposition - hyperuricemia
Tophi accumulation of crystal in articular, osseous,ST, and cartilage
Recurrent attacks of inflammation
Uric acid calculi in GU; renal fxn impairment calledgouty nephropathy
M/c 5th decade men African-Americans
Serum urate levels rise over time in men but dont in womenuntil after menopause due to estrogen
Gout in women is often due to thiazide diuretic use and renal failure
Blacks due to more HTN, not genetic
-
7/29/2019 Arthritis Joints
22/32
Crystals have decr solubility in low temps thatswhy it likes toes and ears
Likes areas of minor trauma like 1st MTP
Hemiplegiatophi wont form on paralyzed side-> something to do w/ CT structure and turnover
Tophi is inflammatory cells around crystal w/erosion of surrounding cartilage and bone.Fibrous capsule around tophi
Crystals are needle-shaped and formed radially
-
7/29/2019 Arthritis Joints
23/32
Three stages: asymptomatic hyperuricemia,cute intermittent gout, Chronic tophaceous gout.
Initially rubor, tubor, dolor and pain of jnt. Pain
cr. Over hours. Pt. May not be able to walk.ay get fever, chills, malaise. May last up to 2
eeks. Attacks become more frequent w/ time
involve 1st MTP as monoarticular site and 90% ofpts overall
-
7/29/2019 Arthritis Joints
24/32
-
7/29/2019 Arthritis Joints
25/32
CHRONIC TOPHACEOUS GOUT
About 10yrs after initial dx usu.
No pain free period but not as severe as acute
Factors for tophi development: early onset, longactive phases, 4+attacks/yr, UE or polyarticular
episodes
Tophi can also be in heart valves and sclera
Supcutaneous gouty tophy are usu in fingers
heberdens nodes
-
7/29/2019 Arthritis Joints
26/32
Early onset gout
-
7/29/2019 Arthritis Joints
27/32
-
7/29/2019 Arthritis Joints
28/32
-
7/29/2019 Arthritis Joints
29/32
10% die of renal failure; 25% have renal
stones
25-50% have HTN ->due to reduced renal
blood flow from urate
Hyperlipidemia/obesity contraversial
Xray ST swelling -> asymmetric in
peripheral jnts erosions slightly removed from
jnt (unique) (overhanging edge)
No osteopenia, and maintained jnt space until late
-
7/29/2019 Arthritis Joints
30/32
Osteoarthritis
-
7/29/2019 Arthritis Joints
31/32
-
7/29/2019 Arthritis Joints
32/32
OA
Garrod in 1907 differentiated RA from OA10% of OApatients had reduced work hours and 13.7% retired early.
Arthritis is the main reason for decr. Activities in the elderly