Educational Grand Rounds: Arthritis


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Dr Zahida Chaudnary talks with the students about what causes, and how you treat Arthritis.

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Educational Grand Rounds: Arthritis

  1. 1. JOINT DISORDERS By Zahida Chaudhary MD
  2. 2. List of joint problems Ankylosing Spondylitis Back Pain Behcet's syndrome Carpal tunnel syndrome Diffuse idiopathic skeletal hyperostosis (DISH) Ehlers-Danlos syndrome (EDS) Fibromyalgia Gonococcal arthritis Gout Juvenile Rheumatoid Arthritis (JRA) Systemic Lupus Erythematosus (SLE) Lyme Disease Osteoarthritis Osteomalacia Osteoporosis Paget’s Disease Polymyalgia Rheumatica (PMR) Psoriatic Arthritis Raynaud's phenomenon Reactive arthritis Repetitive strain injury Rheumatoid arthritis
  3. 3. The causes of arthritis The causes of arthritis depend on the form of arthritis. Injury or aging, leading to osteoarthritis metabolic abnormalities such as gout and pseudo gout Hereditary factors and infections Auto immune such as rheumatoid arthritis and systemic lupus erythematosus. systemic lupus erythematosus
  4. 4. How a joint works Basically, a joint is where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move. Cartilage covers the bone surface to stop the two bones from rubbing directly against each other. The covering of cartilage allows the joint to work smoothly and painlessly.
  5. 5. Broad Classification of Arthritis n Degenerative arthritis  Osteoarthritis n Autoimmune arthritis  Rheumatoid arthritis  ANA positive diseases n Infectious arthritis  Bacterial  Viral n Metabolic / endocrine  Hyperthyroidism  Hyperparathyroidism n Crystalline arthritis  Gout  Pseudo gout n Neoplastic arthritis  Primary  Para neoplastic
  6. 6. Osteoarthritis  “Degenerative joint disease  Primary sight of pathology is cartilage and  subchondral bone  Primary vs Secondary  Joints only (no systemic features) While osteoarthritis can damage any joint in our body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.
  7. 7. Symptoms  Pain  Early in disease, pain with use  End stage, pain at rest  May have little or no pain  Stiffness (gel phenomenon) Physical Findings  Bony enlargement of involved joints  Hands  DIP  PIP      First CMC (carpometacarpal) Knees Hips Feet (Bunion joint) Spine
  8. 8. OA of Hands • Hand Involvement “Bony” enlargement Sparing of MCPs Bouchard’s nodes (PIP) Heberden’s nodes (DIP) Little “synovitis”
  9. 9. OA of the spine • • • • • Lumbar spine Xray in a patient with scoliosis (curvature of the spine). The Scoliosis predisposed this Patient to OA of the spine disc space narrowing “bridging” osteophytes sclerosis
  10. 10. Treating Osteoarthritis  Weight loss (knee OA)  Muscle strengthening (knee OA)  Physical therapy  Assistive devices  Canes  walkers  Acetaminophen (for mild disease)  NSAIDs  Glucosamine/Chondroitin Sulfate?  Joint injections  Steroids  Viscos supplements  High molecular weight hyaluronic acid  Surgery  Joint replacements
  11. 11. Treating Osteoarthritis Findings from a newly released CDC report indicate that one third of U.S. adults with arthritis 45 years and older have either anxiety or depression. As shown in the figure on the right, most people who had depression (85%) also had anxiety. However, only 50% of the people who had anxiety also had depression