Arthritis:

1. Arthritis:

2. LO Classify joint disorders Describe pathogenesis of osteoarthritis.

3. Arthritis (from Greek arthro-, joint + -itis, inflammation; plural: arthritides) is a group of conditions involving damage to the joints of the body.

4. There are over 100 different forms of arthritis. The most common form, is osteoarthritis (degenerative joint disease)

6. Primary forms of arthritis: Osteoarthritis Rheumatoid arthritis Septic arthritis Gout and pseudo-gout Juvenile idiopathic arthritis Still's disease Ankylosing spondylitis

7. Secondary to other diseases: Ehlers-Danlos Syndrome Sarcoidosis Henoch-Sch�nlein purpura Psoriatic arthritis Reactive arthritis Haemochromatosis Hepatitis Wegener's granulomatosis (and many other vasculitis syndromes) Lyme disease Familial Mediterranean fever Hyperimmunoglobulinemia D with recurrent fever TNF receptor associated periodic syndrome Inflammatory bowel disease (Including Crohn's Disease and Ulcerative Colitis)

8. Diseases that can mimic arthritis include: Hypertrophic osteoarthropathy Multiple myeloma Osteoporosis parvovirus infection)

9. Monoarthritis Poly arthritis Symmetrical Non symmetrical

10. A 49-year-old man has complained of episodes of joint pain for over 10 years. This pain has occurred mostly in his hands and feet, and in a remitting and relapsing pattern. On physical examination there are deformities of his hands involving the fingers, with swan-neck deformities and ulnar deviation.

11. Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks the joints producing an inflammatory synovitis that often progresses to destruction of the articular cartilage and ankylosis of the joints.

13. Rheumatoid Arthritisearly symptoms myopathy, tiredness, weight loss, malaise proximal finger joints wrists, feet, knees, shoulders start up pain tendon crepitus

17. Rheumatoid Arthritislate symptoms joint destruction pain deformity instability

18. A 58-year-old man has the sudden onset of severe pain in his left great toe. There is no history of trauma. On examination there is edema with erythema and pain on movement of the left 1st metatarsophalangeal joint, but there is no overlying skin ulceration. A joint aspirate is performed and on microscopic examination reveals numerous neutrophils. Over the next 3 weeks, he has two more similar episodes. On physical examination between these attacks, there is minimal loss of joint mobility.

19. A 53-year-old man has noted a slowly enlarging "bump" on his left elbow for the past 2 years. On physical examination there is a 2 cm firm, non-tender mass over the left olecranon process. The mass is excised and on sectioning has a chalky white consistency. Microscopically, the mass is composed of elongated, needle-shaped crystals that under polarized light are negatively birefringent. Surrounding the crystals is a granulomatous inflammatory infiltrate.

20. Gouty arthritis refers to a form of arthritis caused by deposits of needle-like crystals of uric acid Gouty arthritis usually strikes a single joint, most commonly the big toe .

23. Over the past 4 days, an 18-year-old man has developed marked pain and swelling in his right hip that makes movement difficult. He has no history of major medical problems. On physical examination there is pain on movement with diminished range of motion of the hip. A joint aspirate from the hip reveals cloudy fluid that on microscopic examination shows numerous neutrophils but no crystals.

24. The term "suppurative arthritis" is a near synonym for septic arthritis. ("Suppurative" refers to the production of pus, without necessarily implying sepsis.)

25. Micro-organisms must reach the synovial membrane of a joint. This can happen in any of the following ways: dissemination of pathogens via the blood, from abscesses or wound infections, dissemination from an acute osteomyelitic focus, dissemination from adjacent soft tissue infection, entry via penetrating trauma entry via iatrogenic means.[6]

26. An otherwise healthy 44-year-old man with no prior medical history has had increasing back pain and right hip pain for the past decade. The pain is worse at the end of the day. On physical examination he has bony enlargement of the distal interphalangeal joints. A radiograph of the spine reveals the presence of prominent osteophytes involving the vertebral bodies. There is sclerosis with narrowing of the joint space at the right acetabulum seen on a radiograph of the pelvis.

27. Osteoarthritis

28. OSTEOARTHRITIS Idiopathic or primary secondary

29. Characteristics of OA Characterized by 2 pathologic features Progressive destruction of articular cartilage Formation of bone at the margins of the joint OA is confined to the affected joint(s).

31. Classification Criteria Inflammation present only after significant articular degeneration Radiographic criteria presence of osteophytes joint space narrowing

32. Clinical picture Clinical criteria based on pain NO clear association between radiographic and clinical criteria. Clinical criteria most predictive of functional deficits Idiopathic: unknown etiology Secondary: identifiable trauma, congenital malformation, or other musculoskeletal disease

33. Epidemiology Common but not always symptomatic, widespread >60 yrs of age Men > women Hip: 3.1% prevalence in 55-74 y. Knee: 13.8% prevalence in 55-74 y.

34. Etiology UNKNOWN predisposition, but contributing factors show associations Increased age, not normal aging Trauma, especially before adulthood, or repetitive microtrauma Occupational/functional tasks Obesity: modifiable Infection

35. Pathology Change in water content of articular cartilage decreases compressive stiffness and elasticity which decreases joint�s capacity to support loading Multiple hypotheses regarding osteophyte formation

36. Pathogenesis Traditionally described as involving articular cartilage, but involves entire joint including subchondral bone and synovium Characterized by early INCREASED synthesis of proteoglycan and collagen

37. MORPHOLOGY Fibrilation and cracking of matrix Bone eburnation Joint mice osteophytes

38. Joint mice

41. Joint ankylosis

43. Osteoarthritis

45. Differential Diagnosis Rule out RA Radiographic findings: RA presents as bone erosions, OA presents with bone formation RA usually affects wrists, MCP joints, uncommonly affects DIP joints and lumbosacral spine

47. OA of the Knee

48. OA of the Knee

49. Clinical features

50. �Arthritis� includes over 100 diseasesDefinitions:Rheumatoid Arthritis (RA): a systemic inflammatory diseaseOsteoarthritis (OA): or Degenerative Joint Disease (DJD): localized process involving cartilage tissue