This document provides information about various types of arthritis from an expert in rheumatology. It begins with an introduction to arthritis and how it can originate from the joint or surrounding tissues. It then discusses the diagnostic approach and evaluation of a patient with arthritis. The rest of the document discusses specific types of arthritis in more detail, including septic arthritis, gout, osteoarthritis, and rheumatoid arthritis. It provides information on clinical features, investigations, diagnosis, and management for each type.
This presentation focuses on different types of arthritis/joint disorders. It provides stepwise approach to evaluation and diagnoses and it's truly wonderful to have a broad overview of many joint conditions in one presentation - ranging from osteoarthritis, gout, rheumatoid arthritis, septic arthritis, to ankylosing spondilitis, and many others, including fibromyaligia.
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 presentation focuses on different types of arthritis/joint disorders. It provides stepwise approach to evaluation and diagnoses and it's truly wonderful to have a broad overview of many joint conditions in one presentation - ranging from osteoarthritis, gout, rheumatoid arthritis, septic arthritis, to ankylosing spondilitis, and many others, including fibromyaligia.
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.
Rheumatology Sheet from Rheumatology Department, Faculty of Medicine, Zagazig University, Egypt.
Disclaimer : not my slide. Just uploading for my personal use..
Rheumatology Sheet from Rheumatology Department, Faculty of Medicine, Zagazig University, Egypt.
Disclaimer : not my slide. Just uploading for my personal use..
Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine. A type of arthritis that occurs when flexible tissue at the ends of bones wears down.
The wearing down of the protective tissue at the ends of bones (cartilage) occurs gradually and worsens over time.
Joint pain in the hands, neck, lower back, knees or hips is the most common symptom.
Medication, physiotherapy and sometimes surgery can help reduce pain and maintain joint movement.
Rheumatoid arthritis (RA) facts
Rheumatoid arthritis is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body.
It can affect people of all ages.
The cause of rheumatoid arthritis is not known.
In rheumatoid arthritis, multiple joints are usually, affected in a symmetrical pattern.
Juvenile rheumatoid arthritis and other immunological conditionsNeenaV1
Define rheumatoid arthritis
Pathology of Rheumatoid arthritis
Physiotherapy treatment techniques for rheumatoid arthritis
Splints for rheumatoid
Deformities seen in rheumatoid arthritis
Similar to ARTHRITIS - Joint Pain - by Dr KD DELE (20)
Patient safety Incident (PSI) is an unplanned or unintended event or circumstance that could have resulted or did result in harm to a patient while in the care of a health facility. In this presentation, I explored the concepts of patient safety and patient safety incidents. I also explored the concept of Reporting systems, properly now known as reporting and learning systems - because learning is paramount in the reporting system. I focused on the minimal information model, which is more routinely used compared to the intermediate and full information models.
It is unacceptable that there is still a lot of new HIV infections, particularly when there is a known high-risk exposure to the disease. It is important to know that Post-exposure prophylaxis is a medical emergency, and as part of effort to reduce the burden of HIV, post-exposure prophylaxis has been found to be effective when done appropriately. This presentation explores the concept of post-exposure prophylaxis for HIV and the latest changes in the guidelines.
“Undetectable = Untransmittable” (U=U) is a campaign that has caused a few controversies, not to mention the medicolegal implications. This campaign confirms that the sexual transmission of HIV can be stopped once the infected partner is virologically suppressed. How true is this and how relevant is it? In this presentation, I discussed the concept of U=U as one of the measures to reduce the incidence of HIV and help people live a more fulfilling life while also living with the disease.
TB remains an important disease condition globally, particularly with the high prevalence of HIV in many parts of the world. While there is interest in providing the adequate and often readily-available treatment, it might do more harm to the patient. In this presentation, I explored the concept of IRIS in the management of tuberculosis.
Experiencing any type of bleeding can be uncomfortable and frightening for patients, and it is one of the primary reasons they seek medical attention. In this case presentation, I will discuss some crucial approaches to patients who present with lower gastrointestinal bleeding, as well as some key take-home messages.
Headache is a common condition encountered by clinicians in general practice and primary care on a daily basis. Although most headaches are mild, some can be severe and debilitating. It is therefore crucial to recognize common symptoms, identify warning signs, and develop an appropriate management plan for headaches.
This is a presentation about the importance of Evidence Based Medicine and how it acts as a crucial tool in decision making to empower the quality of medical services for better patient outcomes.
It highlights the steps in EBM process, how to identify the parts of a well built clinical question, resources for literature search, critical appraisal of the evidence, and how to apply the evidence to the patient.
Infection Prevention and Control in Hospitals by Dr DeleKemi Dele-Ijagbulu
Infection prevention and control is everybody's business! It is an essential, though often under-recognised and under supported part of the infrastructure of health care. However it saves lives and prevents avoidable morbidity and mortality. This presentation highlights the importance and the practical components of infection prevention and control in the hospital setting.
This presentation on renal function touches on basic anatomy and physiology, investigations relevant to kidney function and clinical practice, and focuses on clinically important disorders - including glomerular diseases - nephrotic syndrome & Glomerulonephritides, acute kidney injury, Chronic kidney disease, HIV and CKD including HIVAN, and renal calculi
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
In the early days of the COVID pandemic, the World Tuberculosis Day was marked, with the Theme: "It is Time". It is time to take action, to ensure universal access to treatment, to stop stigma and discrimination, and to end TB.
I had the opportunity to present this topic as part of the wellness efforts for our staff members. Many of our patients live with TB, many of our staff develop TB in the process, and the COVID pandemic was already in the country, complication case identification and case management of the disease.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
Abortion remains a topical issue, globally, primary because it affects one of the fundamental rights. This presentation is not for debate, but simply highlights the South African laws and regulations as they relate to Termination of Pregnancy (TOP), and the different methods available.
This presentation focuses on the all important topic of childhood malnutrition. It addresses the different components, both acute and chronic, but focuses more on the severe acute malnutrition which is the most important killer, particularly for the under-5s.
terms like kwashiokor and marasmus are no longer in use.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
This presentation addresses respiratory emergencies, and the approach to their management. These include: anaphylaxis, pneumonias, flail chest, pleural effusion, pulmonary embolism,
This presentation focuses on informed decision making in clinical practice making use of evidence based practice. It addresses the use of PICO to formulate clinical question, searching the evidence/literature, critically appraising the evidence, and application of the evidence to improve the quality of clinical practice
Multiple myeloma is mostly a disease of the elderly. It is a form of haematological cancers that affects the Lymphocytes, and causes abnormal proliferation of plasma cells within the bone marrow, thus replacing the marrow, and is associated with multiple organ dysfunction.
This presentation is an introduction to the disease. It however leaves out the specific haematological treatment, because by that point, patient should have been referred to haematology.
Spinal Cord Injuries are uncommon, but they are a leading cause of high cost disability, and with ageing population, the incidence is expected to increase. This presentation looks at the many facets of spinal cord injuries.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
3. INTRODUCTION
• Joint pain can originate from the joint itself or
from the surrounding tissues.
• More than 100 rheumatic conditions
• Overlap in clinical presentations
• Initial presentation may not lead to a precise
diagnosis in up to 50% of cases
• Over time most patients will have characteristic
features of a disease
4. INTRODUCTION, CONT.
• Patients will typically complain of:
• “Dr I have Arthritis”
• Pain specific to certain joints or groups of joints
• “My Body Is Sore!”
• Careful History and Physical examination is required to
discern between pathologies and to make a diagnosis.
• DIAGNOSIS CAN BE MADE BASED ON HISTORY AND
PHYSICAL EXAM FINDINGS 80-90% OF THE TIME
5. THE RHEUMATOLOGIC HISTORY
• Pain is the cardinal symptom of musculoskeletal disorders
DIAGNOSTIC APPROACH :
• Establish the demographics of the patient: Age Gender
Ethnicity Family History
• Characterize joint pain and ask about associated features
• Characterize the pain: Inflammatory vs. Non inflammatory
• Constitutional symptoms
6. EVALUATION OF A PATIENT WITH
ARTHRITIS IN RHEUMATOLOGY OPD
• Articular or non articular
• Inflammatory or non inflammatory
• Acute or chronic
• Monoarticular or polyarticular
• Extra articular signs
7. HISTORY
CONT.
History of presenting complaints
•Onset
•progression
•distribution of disease
•stiffness
•aggravating or relieving factor
•diurnal variation
•other systemic feature
•functional disability
General systematic medical history.
Past medical and surgical history.
Family history.
Drug history.
8. HISTORY
CONT.
Where is the Pain?
•Which joints are involved
•Mono / Polyarticular
For how long have you had pain?
•Acute
•Chronic (>6weeks)
•Intermittent?
History of Trauma?
9. HISTORY CONT.
•Early morning?
•Constant during the day?
•Night waking?
When do you get the pain?
•Work
•Repetitive Stress of joint
•Food / Drink
Aggravating Factors
10. HISTORY
CONT.
• Relieving Factors:
• Rest
• Analgesia – simple; NSAIDS; Opiates
• Effect on Activities of Everyday Living.
• Age and Gender of Patient.
12. CHRONOLOGY OF COMPLAINTS CONT.
•Monoarticular (one joint involved)
•Oligo- or pauci- articular (2-4 joints are involved)
•Polyarticular (> 4 joints are involved)
Extent of articular involvement
•Symmetrical: upper and lower limb; e.g. RA, SLE
•Asymmetrical: e.g. psoriatic arthritis, spondylo-arthropathy, gout
•Involvement of axial skeletal: e.g. AS, OA, RA (only cervical
spine)
Distribution of joint involvement
14. PHYSICAL
EXAMINATION
Head to toe evaluation:
Rashes,
telangiectasias,
nail changes,
pigmentation changes
Peripheral pulses,
bruits
Back exam
Joint exam
17. ARTICULAR AND NON-ARTICULAR PAIN
ARTICULAR
• Deep or diffuse pain.
• Painful or limited range of
movement - both active and
passive
• Swelling of joint
• Crepitation.
• Joint instability.
• Locking of joint.
• Deformity.
NON-ARTICULAR
• localised pain
• Point or local tenderness
• Painful active movements
but not on passive
• Physical findings are remote
from joint capsule.
• swelling, crepitation, joint
instability, deformity are rare.
18. ARTICULAR AND NON-ARTICULAR
PAIN
• Articular structures include the synovium, synovial fluid,
articular cartilage, intraarticular ligaments, joint capsule,
and juxta-articular bone.
• Non articular (or periarticular) structures include:
supportive extra articular ligaments, tendons, bursae,
muscle, fascia, bone, nerve, and overlying skin,
32. INTRO
• Medical Emergency!
• Rapid onset monoarticular joint inflammation
• Rapid destructive joint disease
• Morbidity and mortality of 10%
• Patients with septic arthritis already have a bacteraemia!
33. RISK FACTORS
• Extremes of Age
• Pre-existing joint disease
• Immunosuppression
• Prosthetic hip / knee joint / Joint surgery
• Skin Infection
• Rheumatoid Arthritis.
• Diabetes Mellitus.
• Elderly patients over age 80 years old.
• Intravenous drug use (unusual joints affected).
34. AETIOLOGY
• Young sexually active adults
• Neisseria gonorrhoeae (most common, and more common in women
• Staphylococcus aureus
• Streptococcus
• Older adults
• Staphylococcus aureus (50%)
• Streptococcus species
• Gram Negative Bacilli
• Most common organism Staph. Aureus, however important to rule out
disseminated gonococcal infection in young sexually active patient.
35. CLINICAL FEATURE OF SEPTIC
ARTHRITIS
• Acute onset
• Typical joints include knee and hip
• Swollen joint.
• Erythema
• Warm joint.
• Held in position of least resistance
36. CLINICAL FEATURE OF SEPTIC
ARTHRITIS
Joints affected in bacterial infection
• Septic Knee (50% of cases),
• Hip (children),
• Ankle,
• Shoulder
Joints affected with intravenous
Drug Abuse
• SI joint,
• SC joint.
• Pubic symphysis,
• Vertebral spaces
37. INVESTIGATION:
• Joint Aspiration and MCS
• Sterile procedure
• Fluid may appear purulent / turbid, bloodstained or normal
• Infective Markers
• Blood Culture
38. MANAGEMENT:
• Hospitalization
• Analgesia
• IV Antibiotics: e.g. Cloxacillin 200mg / kg / day
• Surgical Drainage
• Rehabilitation
• Oral Antibiotics: e.g. Flucloxacillin 100mg / kg / day for 3
weeks
44. CLINICAL FEATURE GOUT:
• Joint Inflammation - Asymmetric joint involvement.
May only involve one side with the first attack
• Acute , intermittent and recurrent
• Chronic Tophaceous Gout
• Severe pain (Worst ever)
• Extreme tenderness
• Swelling, erythema and hot joint.
• Fever and chills
45. MOST COMMON JOINTS
• 1st Metatarsophalangeal joint (MTP) – 50%
• Ankle
• Midfoot
• Knee
• Small joints of hand
• Wrist
• Elbow
48. INVESTIGATION:
• It is a clinical diagnosis
• investigations is to rule out other pathology:
• Aspiration of Synovial Fluid: Sodium urate crystals / Neutrophils
• Serum Urate / Uric Acid: No bearing on diagnosis and
management as often is normal during attacks
• UEC
• FBC / ESR - Rule out myeloproliferative disorders
• X-rays
52. OSTEOARTHRITIS
• Most common form of arthritis.
• Results from disparity between stress applied to a joint
and the ability of the joint to withstand the stress
• Degenerative disorder characterised by progressive loss
of articular cartilage, capsular fibrosis and new bone
formation
53. OSTEOARTHRITIS
• Prevalence directly increases with age:
• Almost universal after 65 years but only 50% of patients
are symptomatic
• Associated functional impairment
• Primary - No demonstrated cause
• Secondary - Due to abnormal stress on joint
• Marginal osteophytes
54. CLINICAL FEATURES OF OSTEOARTHRITIS
• Pain: Aggravated by stress on joint / motion; and
relieved by rest.
• Stiffness: Progressive loss of range of motion (initially
after use of joint). Typically Morning stiffness of short
duration (<30 minutes)
• Crepitus
• Deformity
• Swelling - Persistent or intermittent
55. DISTRIBUTION OF OSTEOARTHRITIS
• Typical joints involved:
• Small joints in hands
• DIP (Heberden’s Nodes)
• PIP (Bouchard's Nodes)
• First CMC joint (thumb)
• Hip / Knee / Feet and Shoulder joint.
• Cervical and lumbar spine
58. INVESTIGATION:
• It is a clinical diagnosis.
• X ray is non essential but may help in differentiating OA
from other arthritis
• XR Features of OA:
• Joint space narrowing
• Subchondral sclerosis
• Osteophyte formation
• Bone Cysts formation.
• No osteopenia
• Evidence of previous disorders e.g. trauma or congenital
problem.
59.
60.
61. MANAGEMENT: EARLY
• Reduce Load: Reduce weight / Avoid abnormal
loading / Use walking stick
• Increase Movement: Physiotherapy
• Pain Relief:
• Simple analgesia
• NSAIDS if inflammatory component noted.
• Hyaluronic Acid (still no compelling evidence)
62. MANAGEMENT: LATE
• This is when there's failure of conservative
management
• Joint debridement
• Osteotomy
• Arthroplasty
• Arthrodesis
• Decompression
63. MANAGEMENT: LATE
When to Operate
• Patient’s symptoms are interfering with ADL
• Benefits of surgery outweigh risks
• Preventative surgery
66. RHEUMATOID ARTHRITIS
• Symmetrical, deforming small and large joint polyarthritis,
often associated with systemic disturbance and extra articular
features
• 3% of population
• Affects all ethnic groups
• Peak incidence 4-6th decades
• Lowest in Black Males / Highest in White Females
• Pathology is based on synovial proliferation with inflammatory
destruction of the joint
67. CLINICAL FEATURE RHEUMATOID
ARTHRITIS:
• 1. Morning stiffness: in and around the joint lasting 1 hr before maximal improvement.
• 2. Arthritis of 3 or more joint area observed by the physician: 14 possible joint area
involved are Right &Left PIP,MCP, wrist, elbow, knee, ankle and MTP joint.
• 3. Arthritis of hand joints: wrist, MCP & PIP joint.
• 4. Symmetrical arthritis.
• 5. Rheumatoid nodule.
• 6. Serum Rheumatoid factor (supports diagnosis – 20% are seronegative).
• 7. Radiographic changes – erosion or bony decalcification in or adjacent to involved
joints.
• NEED TO HAVE 4 OF 7
68. SCORING CRITERIA- AMERICAN
COLLEGE OF RHEUMATOLOGY 2010
• A. Joint involvement
• 1 large joint: 0
• 2-10 large joints: 1
• 1-3 small joints (+/- large joints): 2
• 4-10small joints (+/- large joints): 3
• >10 joints (at least 1 small joints): 5
69. SCORING CRITERIA- AMERICAN
COLLEGE OF RHEUMATOLOGY 2010
• B. Serology. At least 1 test result is needed for scoring:
• Neg RF+ & ACPA* (</= ULN**): 0
• Low positive RF or ACPA (</=3 X ULN): 2
• High positive RF or ACPA(>3 X ULN): 3
• *ACPA – Anti-citrullinated protein antibody
• **ULN – upper limit of normal
• +RF – Rheumatoid Factor
70. SCORING CRITERIA- AMERICAN
COLLEGE OF RHEUMATOLOGY 2010
• C. Acute phase reactants (at least 1 test result needed for
classification)
• Normal CRP or ESR: 0
• Abnormal CRP or ESR: 1
72. NB
• Score >/= 6/10 is RA
• Large joints: shoulders, elbows, hips, knees, ankles
• Small joints: PIP, MCP, MTP, wrists (Spares DIP)
• Diff diagnosis: SLE, Psoriatic arthritis, etc.
• Duration of symptoms is as self reported by patient
79. INVESTIGATION:
• Confirmed according to clinical criteria
• Rheumatoid Factor : Not positive in all patients, and
Not all positive pts. have RA
• X-ray Features:
• Periarticular Soft Tissue Swelling
• Joint Space Narrowing
• Bony erosions
• Subchondral cysts
• Periarticular Osteopenia
83. 1. STOP SYNOVITIS:
• NSAIDS: Gives Symptomatic relief, non curative
• DMARDS:
• Corticosteroids:
• Ineffective Response to DMARDs
• Acutely ill
• Significant systemic disease
• Social Problems
84. 1. STOP SYNOVITIS: DMARDS:
• Chloroquine:
• Safe, little need for laboratory follow up / Inexpensive / Ocular Toxicity
• METHOTREXATE (MTX):
• Low dose is the Gold Standard for DMARDS
• Rapid Disease Suppressing effect
• Baseline UEC / LFT and Hep Screen
• LFT’s 4-8 weeks
• DOSAGE IS WEEKLY
• NEVER GIVE WITH COTRIMOXAZOLE (Haemotoxic)
• Others : Gold / Sulphasalazine / D-Penicillamine / Azathroprine
85. MANAGEMENT CONT.:
2. Prevent Deformity
• Physiotherapy
• Occupational Therapy
• Surgery – Tendon Repair or replacement
3. Reconstruct
• Arthrodesis
• Arthroplasty
4. Rehabilitate
• Accompanies all stages of treatment
• OT and work training
90. ANKYLOSING SPONDYLITIS
• Inflammatory arthropathy with emphasis on involvement
of spine and sacroiliac joints.
• Characterised by progressive stiffening and fusion of the
axial skeleton.
• Sacroiliatis / Syndesmophytes / Bamboo spine /
Inflammatory Backache
91. CLINICAL FEATURES:
• Young males (20’s-30’s / 3:1 Male: Female Ratio)
• Chronic insidious onset
• Recurrent episodes of low back pain and stiffness
• Radiation to buttocks and thighs (symmetrical)
• Marked after rest and improve with movement
92. ON EXAMINATION
• Pain on SI joint compression
• Restriction of movement of lumbar spine
• Limited Chest expansion
• Schober’s Test is positive
97. MANAGEMENT:
• Relieve Pain and Stiffness
• Maintain maximal mobility
• Avoid deformity
• NSAIDS particularly long acting, given at night may
provide symptomatic relief
• Surgery: Osteotomy of spine to correct deformity
Arthroplasty of destroyed joints
99. FIBROMYALGIA
• Common cause of multiple regional musculoskeletal pain and disability
• No underlying identifiable pathology
• Assoc. physiological abnormalities of sleep patterns and pain processing
• Reduced amount of Delta sleep during night
• Reduced threshold to pain perception and tolerance at characteristic
sites throughout the body.
• Associated with other medically unexplained symptoms in other
systems of the body
100. CLINICAL FEATURES:
• Multiple body pains – Eventually affecting all body quadrants
• Both arms, legs, neck , back
• Reported disability is marked – Able to dress, eat, groom
• Unable to work etc
• Fatigability is often marked – (especially in morning)
• On Examination
• No overt musculoskeletal pathology (may have signs of other
arthropathy not consistent with symptoms)
• Hyperalgesia at recognised trigger points producing a wince / withdrawal
101.
102. CLINICAL FEATURES CONT’D:
• Criteria for Fibromyalgia:
• Appropriate symptoms including pain in all body quadrants
• Positive Hyperalgesic tender sites in each arm and leg and
axially
• Negative control tender sites.
• (Pressure on Forehead, squeezing distal radius/ulna,
pressure over proximal fibular head does not elicit any pain)
103. INVESTIGATION:
• Fibromyalgia is not associated with test abnormalities
• Tests are based on ruling out organic pathology
• FBC - Anemia, lymphopenia of lupus
• ESR, CRP - Inflammatory disease
• TFT’s - Hypothyroidism
• CMP - Hyperparathyroidism
• ANA - Lupus
104. MANAGEMENT:
• Education for patient and family
• Sleep hygiene
• Graded aeorobic exercise programme
• Low dose amitriptyline
• Fluoxetine
106. MUSCULOSKELETAL MANIFESTATIONS
OF SYSTEMIC DISEASE
• Many systemic diseases result in musculoskeletal
symptoms and signs.
• A thorough history and PE is essential to avoid treating
patient’s musculoskeletal symptoms rather than their
systemic disease
• “ALL THAT ACHES IS NOT ONLY BONE”
