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1. ARTHRITIS
Dr. Krishna Kumar Maharjan
Junior Resident
Dept. of Pathology
BPKIHS, Dharan

2. What is arthritis?

4. Aims:
 Types of arthritis
 Pathogenesis of various types of arthritis
 Signs and symptoms of arthritis
 Treatment of arthritis

5. Types of Arthritis
 Osteoarthritis (OA) (Most Common)
 Rheumatoid arthritis (RA) (Most Important)
 Septic arthritis
 Sero-negative arthritis
 Ankylosing spondylitis
 Reiter’s disease
 Crystal arthropathies

6. What is in common of all these
types of Arthritis?
 Arthralgia (Artho= joint, algia=pain.)
 swelling
 joint stiffness( Decreased Range of Motion ROM)

7. osteoarthritis:
 Osteoarthritis:commonest form of arthritis.
 Degenerative Joint Disease.
 Causes: a)daily wear and tear of the joint.
b)trauma.
 Site: Weight bearing joints (Knee, Cervical and lumbar
vertebrae, hands)
 Disease of Elderly. Almost all develops some degree of
osteoarthritis after 65 years of age.

8. Pathogenesis:
 Functioning of joint Wear and Tear of
Cartilage of Joint Degeneration of
Cartilage of joint Formation of spurs
Ankylosis.

9. Osteoarthritis.

11. Signs and Symptoms:
 Pain aggravated by use of joint and relieved by rest.
 Absence of swelling, Redness and local rise in
temperature.

12. Treatment:
 Decrease Weight bearing
 Hot compressions
 Analgesics ( Acetaminophen, NSAIDs)
 Use of a cane
 Joint replacement.

14. Rheumatoid arthritis
 Chronic autoimmune systemic inflammatory disease
that affects many tissues and organs (skin, blood
vessels, heart, lungs muscles) principally joints.
 Prevalance: 1% world population.
 30 to 50 yrs old
 female> male (3:1)
 Rheumatoid Factor + in upto 90% of cases.

15. Pathogenesis.
Antigens (? EBV, Parvo virus, Human Herpes Virus, Mycoplasma)
Genetically susceptible host : B and T cells are activated.
Synovial cells expresses antigen similar to above mentioned antigens.
T and B cells attacks Synovial cells and produces cytokines which acts as
a chemo-attractant for Neutrophils and other Leucocytes.
Chronic synovitis leads to pannus formation and eventually Ankylosis.

16. Signs and Symptoms:
 Morning Stiffness (>30 mins).
 Joint pain and swelling
 Swan neck deformity
 Boutonniere deformity
 Myopathy
 tiredness
 weight loss
 malaise

17. Rheumatoid Arthritis
extra-articular
 nodules
 tendon sheath
 vasculitis
 myopathy and neuropathy
 reticulo-endothelial system
 visceral - lungs, heart, kidneys, brain, GI

18. Rheumatoid Arthritis
prognosis
 10% improve
 60% intermittent, slowly worsening
 20% severe joint erosion, multiple surgery
 10% completely disabled

21. Rheumatoid Arthritis
early joint changes

22. Rheumatoid Arthritis
advanced joint changes

23. Rheumatoid Arthritis
treatment
 stop synovitis
 prevent deformity
 reconstruct
 rehabilitate
Treatment modalities:
Physical Therapy
NSAIDs
DMARDs (Disease Modifying Anti Rheumatic Drugs)
Methotrexate, Cyclosporine, Corticosteroids, Gold
compounds, Hydroxychloroquine, TNF-alpha
blockers.

24. Crystal induced Arthritis
 Gout (=Podagra) (Uric Acid)
 Pseudogout ( Calcium Pyrophosphate Dihydrate
Deposition CPPD)

25. Classification of Gouty Arthritis.
 Primary gout: Deficiency of Hypoxanthine-guanine
phosphoryribosyl transferase (HGPRT)
 Secondary gout: More common
 Underexcretion of uric acid( lead poisoning, diets rich in
red meat, seafood, alcoholism, beer)
 Overproduction of uric acid ( treating leukemia,
psoriasis)

26. Pathogenesis.
 Increased Serum Uric Acid
 Deposition of Uric Acid in joints (synovium)
 Attracts inflammatory cells into joints
 Acute inflammatory reaction and joint destruction

27. Crystal induced arthritis

28. Signs and Symptoms
 Sudden onset of severe pain esp at mid-night.
 Joint is Hot, Red and Swollen
 Tophi (white amorphous deposit of sodium urate)
 Increased serum uric acid levels.
 Treatment:
 NSAIDs or Colchicine.
 Avoid Alcohol
 Allopurinol, Probenecid.

29. Pseudogout:
 Less common
 Causes degenerative arthritis similar to Osteoarthritis.

30. Sero-negative Arthritis:
 Group of different Arthritis in which Rheumatoid
Factor is negative.
 Ankylosing Spondyloarthritis.
 Reiter Syndrome
 Psoriatic Arthritis
 Enteritis-associated Arthritis

31. Septic Arthritis
 Caused by organisms:
 Staphylococcus aureus
 Neisseria gonorrhoeae
 Borrelia burgdorferi
 Babesia microti
 Pasteurella multocida
 Mycobacterium tuberculi
 Viruses ( HBV, HCV, EBV, B19, rubella)

32. Treatment of septic arthritis:
 Antimicrobials.