Osteoarthritis

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Osteoarthritis Rheumatoid Arthritis

• Dr.Abdullah Al-Omran

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• NOTE THIS PRESENTATION DOES NOT REPLACE
  ATTENDANCE OR INFORMATION GIVEN IN THE LECTURE.IT
  IS INTENDED AS A HIGHLIGHT FOR THE TOPIC

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O.A(O.Arthrosis)

• 1ry or 2ry
• 1ry Def degen.process of unknow etiology
  affecting articular cartilage of a previously
  healthey joint.
• 2ry Def ?

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O.A(O.Arthrosis)

• 1ry (idiopathic)
• Elderly gt45 yr
• Wear tear process
• Factors age , activity , obesity , heridity
• sex equal

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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

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Pathological changes

• 1.Changes in Articular cartilage
• 2.Changes in synovial membrane
• 3.Changes in subchondral bone
• 4.Osteophytes
• 5.Reduction in joint space
• 6.Bony deformities

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Pathological changes
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Joints affected

• All

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symptoms

• Gradual onset of
• Pain
• Limited R.O.MGreaty sensation
• Swelling
• Deformity

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Signs

• Tender joint line
• Limited R.O.M both active passivecrepitation
• Swelling
• Deformity

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O.A(O.Arthrosis)

• In S.A. medial compartment affected more

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management

• Depend 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 ..

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management

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management

• II.Operative
• 1.Arthroscopic Washout , Debridement
  microfracture .
• 2.High Tibial Osteotomy
• 3.Unicondylar knee Arthroplasty
• 4.Total knee Replacement

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management

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management

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management

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O.A(O.Arthrosis)

• New Advance in management
• 1.Glucosamine Sulphate
• 2.mosaioplasty
• 3.chondrocyte transplant
• 4.resurfacing arthroplasty.

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Rheumatoid Arthritis

• Def ch.inflammatory systemic disease of young
  age adults,have destructive proliferative
  changes in synovial membrane,periarticular
  structures,skeletal muscles, perineural sheaths.
  

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Joints Affected

• 1.PIP MP
• 2.Foot joints
• 3.Knee
• 4.Wrist
• 5.Hip
• 6.Cervical spine

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Symptoms

• 1.Early morning stiffness
• 2.Polyarthralgia
• 3.Weight loss
• 4.Fever
• 5.Malaise fatigue

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Signs

• Extraarticular involvement
• 1.Rheumatoid nodules
• 2.ocularscleritis,keratoconjunctivitis,sicca)
• 3.Cervical myelopathy
• 4.Entrapment neuropathy
• 5.Rheumatoid vasculitis
• 6.Lymphadenopathy anemia
• 7.Pulmonary(pleurisy,effusion,diffuse
  interstitial fibrosis)

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Signs

• Articular involvement
• 1.Symmetrial Small Joint Involvement
• 2.Limited R.O.M
• 3.TenoSynovitis
• 4.Muscle wasting
• 5.Ulnar deviation hand
• 6.Swan neck deformity fingers
• 7.Hallux valgus

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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

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Lab.

1.Anemia ? 2.incr.ESR 3.Raised Rheumatoid
factor 4.Decreased synovial fluid
complement 5.Synovial fluid Glucose, LDH,WBC etc
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Management

• 1. DMAR prevent or reduce joint destruction
  improve function.
• i.Glucocorticoids local/systemic/pregnancy.
• ii.MTX.
• iii.hydroxychloroquinesulfasalazine
• iv.leflunomide.
• v.antiTNFetanercept,infliximab,adalimumab
  but ! infection TB
• vi.Cyclosporine Azathyoprin

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Management

• 2.NSAID for PAIN only.
• 3.Physical therapy,occupational therapy.
• 4.Sx 4 pain,function deformity.
• check c-spine

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