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- 2. CASE • 41 yearold female • Symptomatic for two years • Pain and swelling in multiple joints for 2 years • Small and large joints • Morning stiffness present • She was on non allopathic medication • No fever • No significant weight loss
- 3. DEFINITION • As theinflammation of one or more joints ,leading to pain and stiffness that can worsen with age . • It affects joints, the tissue that surrounds the joint and the tissues connected with joints .
- 4. STRUCTURE OF JOINTS •Articular cartilage : covers the bone ends in synovial joints. Chondrocytes are responsible for the synthesis and turnover of cartilage .It produces collagen and proteoglycan . • Most important proteoglycan is aggrecan consists of several glycosaminoglycans side chain attached to it . • Most abundant GAGs in aggrecan are chondroitin sulphate and keratin sulphate.
- 5. • Synovial fluid:surface of articular cartilage are separated by a space filled with synovial fluid that lubricate the joints . • Intra articular disc: some joints contain fibro articular disc within the joint space that acts as a shock absorber. clinically important one is meniscus of knee . • Synovial membrane and joint capsule : bones of synovial joint are connected by joint capsule, a fibrous structure supplied by blood vessels ,nerves and lymphatics .
- 6. Inner surface ofjoint capsule is synovial membrane, comprising of outer layer of blood vessels loose connective tissue rich in type 1 collagen and inner layer consists of two types of cells type A synoviocytes and type B synoviocytes. Most inflammatory and degenerative joint disease are associated with thickening of synovial membrane and infiltration by lymphocytes and macrophages. Bursa: hollow sac lined with the synovium and contain small amount of synovial fluid helps tendon and muscles to move smoothly
- 7. ARTHRITISVS ARTHALGIA • Arthritisis basically the diagnosis, joint pain with inflammatory swelling, redness and tenderness. • Limitation in range of motion ,also stiffness can be there . • While arthalgia is basically a symptom, joint pain which is non inflammatory, pain without swelling .
- 8. CLASSIFICATION OF ARTHRITIS •BASED ON DURATION • ACUTE ;presenting within hours to days (<6 weeks) • CHRONIC ;presenting for weeks or longer (>6 weeks ) • NUMBER OF JOINTS INVOLVED • MONO ARTICULAR; pain and swelling affecting a single joint. • OLIGO ARTICULAR; pain and swelling affecting 2-4 joints . • POLY ARTICULAR; pain and swelling affecting 5 or more joints .
- 9. If more thanone joint is involved ; SYMMETRICAL OR ASYMMETRICAL. TYPE; inflammatory and non inflammatory arthritis.
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- 12. CAUSES OF ARTHRITIS •Inflammatory causes • Non-inflammatory causes
- 13. INFLAMMATORY CAUSES • Rheumatoidarthritis • Systemic lupus erythematosus • Spondyloarthropathies • Crystal induced diseases ( e.g. Gout, Pseudogout ) • Septic arthritis (Bacterial or Viral ) • Drug induced arthritis
- 14. N O N INFLAMMATORYCAUSES • Osteoarthritis • T rauma ( e.g., Rotator cuff tear ) • Overuse ( Bursitis,Tendinitis ) • Fibromyalgia • Hemoglobinopathies (Sickle cell disease, • Thalassemia) – Avascular necrosis • Hemarthroses • Amyloid arthropathies • Neoplasms, Pigmented villonodular • synovitis, Joint tumors
- 15. ACUTE POLYARTHRITIS INFECTIOUS • Viral arthritis •Parvovirus B19 • Hepatitis B, Hepatitis C • Chikungunya, Rubella • HIV-associated arthritis • Acute rheumatic fever • Post-streptococcal reactive arthritis
- 16. NON-INFECTIOUS (Inflammatory) •Early rheumatoidarthritis •Spondyloarthropathies •Systemic lupus erythematosus (SLE) •Crystal-induced arthritis (gout, CPPD) •Sarcoidosis (Löfgren syndrome) MALIGNANCY-ASSOCIATED •Leukemia •Lymphoma
- 17. CHRONIC POLYARTHRITIS A. Inflammatory •Rheumatoidarthritis •Seronegative spondyloarthropathies • Ankylosing spondylitis • Psoriatic arthritis • Reactive arthritis • Enteropathic arthritis •Connective tissue diseases • Systemic lupus erythematosus (SLE) • Mixed connective tissue disease (MCTD) • Systemic sclerosis (Scleroderma) • Sjögren’s syndrome •Chronic infections • Tuberculosis • Late (tertiary) syphilis (rare)
- 18. B. Non-inflammatory 1. Mechanical •Osteoarthritis 2.Crystal-induced •Gout •Calcium pyrophosphate deposition disease (CPPD / Pseudogout) 3. Metabolic / Endocrine •Hypothyroidism •Hyperparathyroidism •Hemochromatosis
- 19. ACUTE MONOARTHRITIS / OLIGOARTHRITIS INFLAMMATORY •Crystal disease( Gout, Pseudogout ) • Infectious (Septic arthritis) • Rheumatoid arthritis • Spondyloarthropathy NON INFLAMMOTORY • Osteoarthritis • Hemarthrosis(trauma , hemophilia) • Avascular necrosis • Neuropathic : charcot joint ( DM , Tabes dorsalis )
- 20. CHRONIC MONOARTHRITIS / OLIGOARTHRITIS INFLAMMATORY •-Spondyloarthropathy •-Juvenileidiopathic arthritis •-Indolent infectious arthritis •-Rheumatoid arthritis NON INFLAMMATORY • Osteoarthritis • Avascular necrosis • Neuropathic arthropathy • Pigmented villonodular synovitis
- 21. CHRONIC SYMMETRIC POLYARTHRITIS 1.Autoimmune/ Inflammatory •Rheumatoid arthritis •Systemic lupus erythematosus •Polyarticular juvenile idiopathic arthritis 2. Others (less common) •Chronic viral arthritis (e.g., hepatitis C) •Sarcoidosis (rare)
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