Providing the basic information for the two most common forms of arthritis

1. Case Study #3
Tracy Ho

2. RANKL AND OPG
Normal process
Abnormal process

3. Syndrome of joint pain and
loss of form and function
caused by generally
progressive loss of
articular cartilage
accompanied by
attempting to repair of
articular cartilage,
remodeling and sclerosis of
subchondral bone,
formation of subchondral
bone cysts and osteophytes

11. Chronic systemic autoimmune
inflammatory disease affecting
all joints covered by synovium
leading to destructive
polyarthritis

12.  World wide prevalence: 1-3%
 Age distribution: all 4F:1M
 Peak onset: (35-50)
 It can affect any age from childhood
up to the age of 75
 Life expectancy is reduced by
approximately 7 yrs (♂) 3 yrs (♀)
 Due to
 Cardiovascular disease
 Infection
 Renal disease
 Respiratory disease
 Vasculitis
 Malignancy
 GI disease

13. HLA class II is
strongly linked to
RA.
HLA DR4- , most
common, HLA DR1 and
HLA DW15
Genetically linked
 50-70 % of Caucasian RA patients are
HLA DR4, Compared to 20-25 % of the
population at large.
 1st degree relatives of RA patients are 4x
 25 % frequency in identical twins
 5 % Frequency in non-identical twins

14. Arthritogenic
antigen
Exogenous
Viral
EBV, Hepatitis,
Paro Virus B19
Bacterial
Mycoplasma,
mycobacterium,
yarsenia,
streptococcus
Endogenous
Citrullinated
peptide

15.  T cell activation
 Rheumatoid factor production
 Anti- Ig antibody (IgM) in high
percentage in patients
 Pannus formation

18. Fibrovascular tissue
Fibroblast, macrophages,
T cells and plasma cells
Invade surrounding
tissue, Bone, cartilage and
tendon

21.  No definitive test
 Symptoms mimic other autoimmune
disease

24.  40 yo women
 c/o fatigue, anorexia, weakness
for 6 months
 Difficult to ambulate on rising
from bed, but better after 30 mins
 Stiffness and pain in wrists,
fingers, compromising manual
dexterity
 Swelling in joints of fingers
 Physical exam
 Knees swollen, tender and limited
ROM in knees and hips
 Knees and wrist were warm no
erythema
 Proximal interphalangeal joints of
both hands were warm and enlarged
with nonbony fusiform swelling
 Two small nonpainful subcutaneous
nodules along proximal ulna of left
arm
 X-rays: soft tissue swelling, joint
effusion, juxta-articular osteopenia
 Synovial fluid aspirated- low viscosity,
clear yellow color, WBC with 50%
neutrophils, no crystals, no bacteria

25.  HLA-DR4 positive
 Rheumatoid factor positive titer of 1:
500
 Erythrocyte sedimentation rate-
increased
 Serum cyclic citrullinated protein
(CCP) antibodies- positive
 Family history- sister with arthritis,
right hip prosthetic replacement
 40yo obese white woman with deep,
achy, poorly localized pain in right hip
and knee
 Similar symptoms as sister
 Bony, nonpainful swellings along the
medial aspect of two distal
interphalangeal (DIP) joints of each
hand. Erythrocyte sedimentation rate
was normal
 Synovial fluid- viscosity normal, clear
yellow, minimal WBC and neutrophils,
no crystals
 RF negative CCP negative
 X-ray narrowing of the joint space,
subchondral bone sclerosis, subchondral
cysts and osteophytes

26.  In DJD- found in the distal
interphalangeal joints, are bony and
not symmetric
RA- the proximal interphalangeal
and metacarpophalangeal joints

28.  Successful interprofessional
treatment of juvenile rheumatoid
arthritis: A case report
 Integrative Medicine April 2017
 9 yo boy- symptoms started at 2
years of age

29.  Aquatic exercise for the treatment of
hip and knee osteoarthritis
 Physical Therapy- July 2017
 Conservative treatment: medication,
education, weight loss, exercise
 Aquatic exercise- 32C-36C/ 90-97F
 Reduce pain and stiffness and cause
muscle relaxation
 1 hour session twice a week for 3
months
 Warm-up, lower limb ROM,
strengthening, and stretching
exercises, balance and coordination
exercise and general cardiovascular
conditioning

30.  Critical review: Vegetables and fruit
in the prevention of chronic diseases
 European Journal of Nutrition 2012
 Fruits and veggies provide:
nutrients, dietary fiber,
phytochemicals
 Chronic diseases: obesity, T2DM,
HTN, CHD, CVA, cancer, IBD, RA,
COPD, asthma, osteoporosis, eye
disease and dementia
 Increased intake of fruits and
veggies decreases risk of chronic
diseases and decreases severity of
chronic diseases

31.  Boeing, H., Bechthold, A., Bub, A., Ellinger, S., Haller, D., Kroke, A., … Watzl, B.
 (2012). Critical review: Vegetables and fruit in the prevention of chronic diseases.
European Journal of Nutrition, 51, 637–663.
 Boothby, J., & Turnbull, T. (2017). Successful interprofessional treatment of
juvenile
 rheumatoid arthritis: A case report. Integrative Medicine, 16(2), 55–60.
 Franco, M. R., Morelhao, P. K., de Carvalho, A., & Pinto, R. Z. (2017). Aquatic
exercise
 for the treatment of hip and knee osteoarthritis. Physical Therapy, 97(7), 693–697.
 Rosenberg, A. E. (2013). Bones, Joints, and Soft Tissue Tumors. In V. Kumar, A. K.
 Abbas, & J. C. Aster, Robbins Basic Pathology (pp. 765-797). Philadelphia: Elsevier
Saunders.