This document provides information on different types of arthritis. It discusses rheumatoid arthritis (RA) in detail, including its characteristics, diagnostic criteria, symptoms, extra-articular features, signs, investigations and management. It also briefly covers osteoarthritis, describing it as the most common form of degenerative joint disease and comparing some of its features to RA such as affected joints, systemic involvement and treatment approaches.
Rheumatoid Arthritis is chronic autoimmune
systemic inflammatory disease that affects the
joints, bones, muscles and other vital organs that
include heart, lungs, eyes etc
Paget’s disease of bone is a condition characterized by abnormal and anarchic resorption and deposition of bone, resulting in distortion and weakening of the affected bones
Rheumatoid Arthritis is chronic autoimmune
systemic inflammatory disease that affects the
joints, bones, muscles and other vital organs that
include heart, lungs, eyes etc
Paget’s disease of bone is a condition characterized by abnormal and anarchic resorption and deposition of bone, resulting in distortion and weakening of the affected bones
An apt yet detailed description of Polyarthritis for undergraduate level with basic definitions, classification, concept, clinical features along with descriptive images, diagnosis & assessment with distinguishing features along with differential diagnosis.
This PPT is mainly for the III yr MBBS - Students for whom this topic is important. Moreover mainly day today clinical practice practising doctors will come across these types of cases.
Acute and Chronic Osteomyelitis - Infection of BoneRahul Singh
Acute and Chronic Osteomyelitis - Infection of Bone
http://essentialinspiration4u.blogspot.com
Osteomyelitis is defined as an acute or chronic inflammatory process of bone, bone marrow and its structure secondary to infection with micro organisms.
Duration , Mechanism & Host response.
Duration - Acute / Subacute / Chronic
Mechanism - Heamatogenous (tonsil , lungs , ear/ GIT) - Exogenous (injection , open fractures)
Host response - Pyogenic / Granulomatous
Introduction of bacteria from :
Outside through a wound or continuity from a neighboring soft tissue infection
Hematogenous spread from a pre existing focus (most common route of infection)
Rheumatoid arthritis is a chronic non-suppurative inflammation of the synovial joints diagnosed as per the criteria laid down by American Rheumatic Association in 1987.
I hope this content helps you in understanding this condition. Thank You for sparing your precious time and going through this PowerPoint presentation.
2. Arthritis
• It is an inflammation of a joint characterized
by pain, swelling and limitation of joint
movement.
• Arthralgia :it is a painful joint without any
associated signs of inflammation.
5. Rheumatoid Arthritis
• RA is a symmetrical destructive and deforming
polyarthritis affecting the small & large joints
with associated systemic disturbance, variety of
extra-articular features and the presence of
circulating anti-globulin antibody.
• Incidence :
-female >male (3:1)
-high incidence at age 20-40 years
-genetic predisposition (HLA DR4 and DR1)
6. Criteria for the diagnosis of
Rheumatoid arthritis
i. Morning stiffness (>1 hr).
ii. Arthritis of three or more joint areas.
iii. Arthritis of hand joints.
iv. Symmetrical arthritis.
v. Rheumatoid nodules.
vi. Radiological changes.
vii. Duration of 6 wks or more.
-diagnosis of RA is made with four or more criteria.
7.
8. Symptoms
I. Insidious onset (70%):
• In majority of patients the onset is insidious with joint
pain,stiffness and symmetrical swelling of peripheral
joints
• Initially pain is only on movement,then rest pain and
early morning stiffness are characteristic.
• First affect the small joints of the fingers & toes then
wrist,elbow,shoulder ,knee e.t.c are involved
ii.Acute onset (15%) acute polyarthritis with morning stiffness
& pitting oedema.
iii.Systemic onset (10%) insidious onset with fever,wt.loss,
profound fatigue.
iv.Palindromic (5%) recurrent acute episode of joint pain &
swelling which last only for few hours or days.
11. Signs
• Swelling: by effusion,synovial proliferation.
-swelling by proximal interpharayngeal joint:spindle
appearance.
-swelling by the meta-tarsophalangeal joint
:broadening of forefoot.
• Warmth
• Tenderness
• Limitation of movement due to muscle
atrophy:tendon sheath and joint destruction.
• Joint instability
• Deformities :swan neck deformity,buttonniere
deformity,Z-deformity of the thumb,muscle wasting.
15. • In the forefoot(sublaxation by metatarso
phalangeal joint is followed by-
-clawing of the toes.
-callosities over the exposed metatarsal heads.
-painful sensation by walking on pebbles.
-calcaneal erosion.
• Nodules
• Popliteal cysts or baker’s cyst.
16.
17. Investigation
I. To establish diagnosis :
• Clinical criteria
• Markers of inflammation
• Serological test :RA test, ANA test, rose waaler test.
• Radiographs: peripheral osteoporosis & fluid loss of joint
spaces.
• Synovial analysis
ii. To document of pathological changes
:radiographs,occasionally-
arthrography,scintigraphy,USG,CT,MRI.
iii. To monitor disease activity in response to therapy :
• Pain
• Early morning stiffness
• Joint tenderness
• ESR,acute phase protien (CRP)
• Hb%
18. iv. To assess progression of disease: by
• Radiographs
• Functional assesment
v. To monitor for safety of drug therapy :
• Haematology
• Urine analysis
• Biochemistry.
19. Management
A. General management of the active phase:
a) Physical rest
b) Anti-inflammatory drugs
c) Maintenance exercises
B. Local measures
• Rest splints
• Intra-articular :corticosteroids inj.
• methyl-prednisolone acetate (20-80 mg :large joints,
4-10 mg:small joints ) or triamcinolone.
C. NSAIDs:
• Low risk : ibuprofen - <1600 mg/day
• Average risk : indomethacin 75-150 mg/day
piroxicam 10-30 mg/day
diclofenac 75-150 mg/day
• High risk azapropazone : 1200-1800 mg/day
20. D. Disease modifying drugs :
a) Chloroquine phosphate
b) Sulphasalazine
c) Methotrexate
d) Gold salts : Na aurothiomalate
e) Oral gold : auranofin
f) Penicillamine
g) Prednisolone.
E. immunomodultion:
• Azathioprine oral
• Cyclophosphamide oral
• Cyclosporin oral
F.Immunotherapy
G.Other measures :
• Medical synovectomy :by osmic acid or radiocolloid 90 ytrium
• Surgery :synovectomy,osteotomy,arthodesis,arthoplasty.
22. osteoarthritis
Is the most common form of
degenerative joint disease
characterized by degeneration of
cartilage and hypertrophy of bone at
the articular margins.
23. Types
• Primary osteoarthritis :common form where
no predisposing factors are present.it occurs
in old age mainly in weight bearing joints.in
generalize variety,the trapezio-metacarpal
joint of the thumb and the distal
interphalangeal joints of the fingers are also
affected.
24. • Secondary osteoarthritis : less common,there
is an underlying primary disease of the joint
which leads to the degeneration of the
joints,occurs commonly at hip joint.
25. The Predisposing Factors are
• Congenital maldevelopment of a joint
• Irregularity of the joint surface from previous
trauma.
• Previous disease of gout: gout, septic arthritis
• Metabolic disorder:
haemochromatosis,hyperparathyroidism.
• Neurological disorder: tabes dorsalis
• Obesity
• Bow legs
• Most common joint to be affected is the knee,
second most common site for OA is the thumb
base.
26. Clinical Features
i. Symptoms :
• Insidious onset of joint stiffness
• Deep, aching pain, which worsens with
repetitive movement
• Swelling of the joint
• Feeling of instability of joint and locking of
joint.
27. On examination :
-tenderness on the joint line
-crepitus on moving the joint
-irregular and enlarged joint
-joint deformity
-restriction of range of motion
-joint effusion and swelling
-wasting of muscles
28. Investigation
X-ray of affected joint:
• Narrowing of the joint space due to loss of
cartilage.
• Osteosclerosis and bone cysts.
• Osteophyte.
Other investigation :
• CBC,Hb%,ESR,C-reactive protien.
• Serum uric acid .
• Arthoscopy.
29. • Diagnosis : clinical features + radiological findings
• Methods of treatment :
I. Supportive treatment :
• weight reduction in an obese patient
• Avoidance of stress and strain to the affected joint
• Local heat provides relief of pain and stiffness
• Exercise for building up the muscles controlling the joint help
in providing the stability of the joint.
31. osteoarthritis Rheumatiod arthritis
Degenerative disease of joint Non-suppurative inflammatory disease of
joint
Age : elderly Age : middle
Degeneration of articulating cartilage Proliferation of synovial membrane
Weight bearing joints knee, hips and spine
mainly involved
asymmetrical
Small hand joints are involved
symmetrical
Systemic features absent Systemic features present
Rheumatiod nodules negative RA factor +ve
Worsen on movement Improves on movement
ESR , Hb normal ESR raised,Hb decreased
No role of steroid therapy and no use of
gold and cytotoxic agent.
role of steroid therapy and use of gold and
cytotoxic agent.
