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Inflammation & Infection in bones & joint
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Inflammation & Infection in bones & joint


This presentation is made by Dr Ashok Jaisingani for study purpose if any one like this than please give your comments.

This presentation is made by Dr Ashok Jaisingani for study purpose if any one like this than please give your comments.

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  • 1. Dr. Ashok Jaisingani
  • 2. Rheumatoid Arthritis The commonest type of inflammatory arthritis is rheumatoid arthritis affects approx. 3% of women & 1% men. The disease appear to arise from cell-mediated (T-cell) autoimmune response, but there may be underlying infectious etiology. After triggering of T-cell response there release of cytokines, Interleukin – I & 6 (IL-I & IL-6) Tumor Necrosis Factor (TNF) The disease mostly affect small joints of hands & feet, however any joint of body or soft tissue can be involved. A layer of inflammatory tissues called „panus‟ spread over the joint surface erode subchondrial bone, denuding articular cartilage. Rheumatoid Factor (RF) is +ve in 80% of cases
  • 3. Extra-articular Manifestation Extra-articular manifestation of rheumatoid arthritis include: Skin – Subcutaneous Nodules Eyes – Scleritis, iritis Lungs – Interstitial lung disease, pleural effusion. Heart – Myocarditis Kidneys – Nephritis Amyloid – Lungs, kidney, heart & bowl Compression & vascular neuritis.
  • 4. Clinical Features Mostly the disease onset insidiously, with joint stiffness & polyarthritis, some time disease may onset acutely in about 30% of the pts & may present with malaise & low grade fever. Hands & feet are commonly affected in early stage of the disease. On examination there may be effusion & synovitis of affected joints, which may cause Swelling Warmth Erythema Stiffness of affected joints with pain on movement.
  • 5. Characteristic pattern Of Disease There may be deformity seen in hand & wrist Inflammation of tendon (Tenosynovitis), commonly affect flexor & extensor muscles of hand & wrist. Rupture of extensor tendon, most commonly of little finger. ESR & CRP are usually elevated Radial deviation of wrist Ulner deviation of metacarpophalangeal joints Z – deformity of thumb Boutonniere deformity of thumb Swan neck deformity Carpel tunnel syndrome
  • 6. Rheumatology Criteria For Diagnosis Of RA This involve pt having four of seven criteria 1- Morning stiffness lasting atleast 1 – hour 2- Active arthritis of three or more joints 3- Active arthritis of atleast one hand joint (wrist, MCPJ, PIPJ) 4- Symmetrical arthritis 5- Subcutaneous rheumatoid nodules on extensor surface, juxta -articular or bony prominences 6- Rheumatoid factor positive 7- Radiographic changes of particular erosion, or osteopenia in affected joints not osteoarthritis.
  • 7. Treatment Long standing, stable, mild cases of rheumatoid arthritis can be treated with analgesic and NSAIDs. The disease – modifying anti-rheumatic drugs (DMARDs) can be useful in preventing long term recruitment of autoimmune cascade. DMARDs are following 1- Methotrexate 2- Gold 3- Sulphasalazine/ Salazopyrine 4- Lefunomide 5- Penicillamine 6- Ciclosporine The most recent development of anti – TNF drugs such as “Etanercept & Infliximab” may revolutionize treatment Corticosteroid therapy continue to be useful systemically & locally and by injection into joints or around tendon.
  • 8. Surgery For Rheumatoid Arthritis Splints can be useful to reduce the pain & improve function (unstable wrist, swan neck deformity) Orthotics are useful for the foot & ankle joints Arthodesis (fusion) for cervical spine, finger (PIPJ), wrist, ankle & hind foot. Joint replacement for major joints including hip, knee, elbow & shoulder joints. There are few sites where excision arthoplasty is used such as distil ulna & radial head. Tenosynovectomy for inflamed tendon sheath in case of resistant to medical treatment to prevent tendon rupture. In case of resistant to anti-inflammatory treatment perform synovectomy