osteoarthritis and rheumatoid arthritis
TRANSCRIPT
![Page 1: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/1.jpg)
Osteoarthritis and Rheumatoid Arthritis
Presented By Siti Nur Rifhan Kamaruddin
![Page 2: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/2.jpg)
Osteoarthritis : Definition
• A chronic joint disorder in which there a progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins and capsular fibrosis.
![Page 3: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/3.jpg)
CAUSES
• The most obvious feature of OA: it increases with age. – shows that it takes many years to develop.
• OA results from disparity between stress applied to articular cartilage and the ability of the cartilage to withstand cartilage
• Due to combination of 2 processes: - Genetic defect in Type II collagen - Increased mechanical stress in the articular
surface (from excessive impact load or reduced articular contact area)
![Page 4: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/4.jpg)
![Page 5: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/5.jpg)
RISK FACTORS • Older Age - Osteoarthritis typically occurs in older adults. People under 40 rarely
experience osteoarthritis. • Sex - Women are more likely to develop osteoarthritis, though it isn't clear why. • Bone deformities - Some people are born with malformed joints or defective cartilage, which
can increase the risk of osteoarthritis. • Joint injuries - Injuries, such as those that occur when playing sports or from an accident,
may increase the risk of osteoarthritis. • Obesity - Carrying more body weight places more stress on weight-bearing joints,
such as knees. But obesity has also been linked to an increased risk of osteoarthritis in the hands, as well.
![Page 6: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/6.jpg)
CLINICAL FEATURES• Pt usually presents after middle age• Symptoms may confined to 1 or 2 large joints or
involves multiple joints. • Pain starts insidiously, increases slowly over
months or years• It is aggravated by exertion and relieved by rest. • Stiffness is worst after period of rest• Unlike Inflammatory Joint Disease ( i.e RA),
Osteoarthritis is not assoc. with systemic manifestations.
![Page 7: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/7.jpg)
Features of Advanced Disease
Swelling Deformity Tenderness Crepitus on movement Muscle wasting
![Page 8: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/8.jpg)
CLINICAL VARIANT OF OA1) Monoarticular & Pauciarticular OA• Classically, presents with pain and dysfunction
in 1 or 2 large weight-bearing joints. • There may be obvious underlying
abnormalities : Acetabular dysplasia, Old Perthes Disease/Slipped Epiphysis, long standing joint deformity, previous fracture.
• In many cases the abnormality is subtle
![Page 9: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/9.jpg)
CLINICAL VARIANT OF OA2) Polyarticular (generalized) OA• Most common form of OA. • Typically, Pt is middle aged woman presents with
pain, swelling, and stiffness of distal finger joints. • The changes are obvious in the hands - Interphalangeal joints become swollen & tender . - Heberden’s Nodes. Knobbly appearance of distal IP joints d/t osteophytes & soft tissues swelling over the years. - Bouchard’s Nodes. Proximal IP Joints
![Page 10: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/10.jpg)
![Page 11: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/11.jpg)
CLINICAL VARIANT OF OA3) OA in Unusual Sites • OA is uncommon in shoulder, elbow, wrist and
ankle. • If any of this joints is affected one should
suspect a previous abnormality (congenital or traumatic) or an associated generalized disease such as crystal antropathy.
![Page 12: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/12.jpg)
TESTS AND DIAGNOSISHistory & Clinical examination· X-rays. X-ray images of the affected joint may reveal a narrowing space within a joint, which indicates that the cartilage is breaking down and bone spurs around a joint. · Blood tests. To rule out other causes of joint pain, such as rheumatoid arthritis. · Joint fluid analysis. To determine if pain is caused by gout or an infection. · Arthroscopy. In some cases ,arthroscopy to see inside the joint in order to determine the cause of pain.
![Page 13: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/13.jpg)
X-RAY CHANGES IN OSTEOARTHRITIS
![Page 14: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/14.jpg)
(Left) In this x-ray of a normal hip, the space between the ball and socket indicates healthy cartilage. (Right) This x-ray of an arthritic hip shows severe loss of joint space and bone spurs.
![Page 15: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/15.jpg)
Bilateral Hip Osteoarthritis – Pelvis radiograph reveals severe bilateral hip osteoarthritis characterized by joint spaced narrowing, cystic changes and severe osseous productive changes and remodeling of the femoral head and acetabulum.
![Page 16: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/16.jpg)
CT-Arthrography shows superior and anterior joint space narrowing (blue circle) with denuded chondral surface (yellow arrow), subchondral cysts and sclerosis. No
femoroacetabular impingement or associated labral tear. Normal mineralization.
![Page 17: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/17.jpg)
(Left) In this x-ray of a normal knee, the space between the bones indicates healthy cartilage (arrows). (Right) This x-ray of an arthritic knee shows severe loss of joint space.
![Page 18: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/18.jpg)
TREATMENTEARLY TREATMENT Aim : Relieve Pain, Increases Movement, Reduce Load.• Pain Relief - Analgesics and NSAIDs • Joint Mobility - Physiotherapy • Load Reduction - Walking stick - Soft-soled shoes - Avoid prolonged, stressful activity - Reduce Weight
![Page 19: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/19.jpg)
TREATMENTINTERMEDIATE TREATMENT Indication: If sx increases despite conservative treatment. This will usually be a “holding” procedure, esp. in younger patients who are not yet ready for joint replacement. • Joint debridement (Knee) - Removal of interfering osteophytes, cartilage tags & loose bodies • Realignment Osteotomy (Hip & Knee) - Provide vascular decompression of subchondral bone redistribution of load forces to less damaged parts.
![Page 20: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/20.jpg)
TREATMENTLATE TREATMENT Joint Replacement • Procedure of Choice for - Patient with severe symptoms - Marked loss of function - Significant restriction of daily activities• Total joint replacement by modern techniques promises improvement lasting for 15 years or longer.
![Page 21: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/21.jpg)
RHEUMATOID ARTHRITIS (RA)
![Page 22: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/22.jpg)
DEFINITION
Rheumatoid Arthritis (RA) is a chronic inflammatory disorder that may affect many tissues and organs, but mainly attacks the joints producing an inflammatory synovitis.
![Page 23: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/23.jpg)
ETIOLOGY• The cause is unknown • It is believed that a foreign antigen sets off a a chain of events culminating in a chronic inflammatory disorder in which immunological reactions are prominent. • Production of auto antibodies (IgM & IgG) that attacks body own’s antibodies • This abnormal immune response may be genetically pre-determined – RA patients assoc with increased frequency of HLA-DR4
![Page 24: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/24.jpg)
PATHOLOGY• STAGE 1: Pre-clinical -Before RA becomes clinically apparent, immune pathology already beginning – Raised ESR, C-reactive protein & Rheumatoid Factor.• STAGE 2 : Synovitis - Synovial membrane inflamed & thickened. Joints & tendon are still intact. • STAGE 3 : Destruction - Persistent inflammation causes joint & tendon destruction - Articular cartilage eroded d/t proteolytic enzymes - Bone eroded by granulation tissue & osteoclastic resorption• STAGE 4 : Deformity - d/t articular destruction,capsule stretching, tendonrupture
![Page 25: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/25.jpg)
![Page 26: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/26.jpg)
CLINICAL FEATURES EARLY STAGE• Swelling, Stiffness, Increased Warmth, Tenderness of proximal finger joints and the wrists• X-ray shows soft tissue swelling and periarticular osteoporosis
DISEASE PROGRESSION• Joint movement becomes restricted • Isolated tendon ruptures at the wrists• Subcutaneous nodule felt Olecranon process – Pathognomonic of RA
![Page 27: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/27.jpg)
Swelling at proximal finger joints and wrists.
![Page 28: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/28.jpg)
LATER STAGES• Joint deformity becomes apparent• Acute pain of synovitis is replaced by more constant ache of joint destruction• “Rheumatoid Deformities”: - Ulnar deviation of fingers - Radial displacement of wrists - Valgus Knees - Clawed Toes• Function is increasingly disturbed. Pt need help
dressing, eating.
![Page 29: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/29.jpg)
![Page 30: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/30.jpg)
EXTRA- ARTICULAR SURFACES(Apparent in pt with severe disease) • Muscle wasting• Lymphadenopathy• Skin atrophy/ulceration• Scleritis• Vasculitis • Peripheral sensory neuropathy
![Page 31: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/31.jpg)
![Page 32: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/32.jpg)
X-RAY CHANGES IN RA
• In Early Stages, X-rays show only the features of synovitis : soft tissue swelling and periarticular osteoporosis
• Later Stages are marked by appearance of marginal body erosions and narrowing of the articular space esp. in proximal joints of hands and feet
• In Advanced Disease, articular destruction and joint deformity are obvious.
![Page 33: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/33.jpg)
![Page 34: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/34.jpg)
TESTS
• X Rays– X rays of hands and feet are generally performed
in people with RA.• Magnetic Resonance Imaging (MRI)• Ultrasounds
![Page 35: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/35.jpg)
• Blood Tests– Rheumatoid Factor (RF)• RF is a specific antibody in the blood.• A negative RF does not rule out RA. The arthritis is then
called seronegative, most common during the first year of illness and converting to seropositive status over time.
– Anti-citrullinated Protein Antibodies (ACPAs)• Like RF, this testing is only positive in a proportion of all
RA cases. • Unlike RF, this test is rarely found positive if RA is NOT
present, giving it a specificity of about 95%.
![Page 36: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/36.jpg)
• At least FOUR criteria MUST be met for classification of RA.– Morning stiffness of more than 1 hour most mornings
for at least 6 weeks.– Arthritis and soft-tissue swelling of more than 3 of 14
joints, present for at least 6 weeks.– Arthritis of the hand joints, present for at least 6 weeks.– Symmetric arthritis, present for at least 6 weeks.– Subcutaneous nodules in specific places.– Rheumatoid Factor at a level above the 95th percentile.– Radiological changes suggestive of joint erosion.
DIAGNOSIS
![Page 37: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/37.jpg)
PROGNOSIS• Disability– Daily living activities are impaired.– After 5 years of disease, approximately 33% of
sufferers can no longer work.– After 10 years of disease, approximately 50% of
sufferers have substantial functional disability.
• Some people have mild or short-term symptoms, but in most cases, the disease is progressive for life.
• The life shortening effect of RA varies. Most sources cite a lifespan reduction of 5 to 10 years
![Page 38: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/38.jpg)
COMPLICATIONS• Infections - Pt with RA, even more so with steroid tx are susceptible to infection. Sudden deterioration or increased pain -> alert for septic arthritis• Tendon Rupture - Seen most often at wrist• Joint Rupture - Occasionally, joint lining ruptures and synovial contents spill into soft tissues. • Secondary Osteoarthritis
![Page 39: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/39.jpg)
TREATMENTThere is NO cure for RA Medical ManagementAim: Control Inflammation as rapidly as possible• Corticosteroids - Rapid action, oral 30mg Prednisolone followed with IM 120mg Methyprednisolone. Tapered dose• DMARDs - 10-25mg /week Methotrexate • NSAIDs - To control pain & stiffness• Biological Therapies (TNF inhibitors: Infliximab)
![Page 40: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/40.jpg)
Physiotherapy and Occupational Therapy
• To maintain muscle tone and joint mobility• Measures: - Balanced programme of exercise - Advice on coping with daily living activities - Preventive splinting - Orthotic devices
![Page 41: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/41.jpg)
Surgical ManagementIndication: Indicated at any stage of disease. Ifconservative measures alone are not effective.Early stage (Soft tissues procedures): • Synovectomy• Tendon repair/replacement• Joint StabilizationLate Stage Indications for Reconstructive Surgery:Severe joint destruction, fixed deformity and loss ofFunction• Antrodesis• Osteotomy• Arthroplasty
![Page 42: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/42.jpg)
• Apley and Solomon’s Concise System of Orthopedics and Trauma 4th Edition. CRC Press
REFERENCES
![Page 43: Osteoarthritis and Rheumatoid Arthritis](https://reader035.vdocuments.pub/reader035/viewer/2022062503/58ece76d1a28abde438b45e3/html5/thumbnails/43.jpg)
THANK YOU..