for pathology students

1. Pathology
JOINT DISEASES
ARTHRITIS

2. What is arthritis?
• Arthritis literally means “joint inflammation” redness
and warmth within the joint.
• Because inflammation is painful, arthritis limits
movement

4. TYPES OF ARTHRITIS
The three most common types of arthritis are:
• Osteoarthritis
• Rheumatoid arthritis
• Gout

5. Osteoarthritis
intro:
• OA is the “wear-and-tear arthritis,” is also called
degenerative joint disease.
• OA is the most common form of arthritis and the
most common joint disease
• It usually develops after age 45 and progresses slowly,
often over a decade.
• Typically, the hips, hands, knees, lower back and/or
neck are affected

6. Cont..
• Osteoarthritis is an idiopathic disease
characterized by degeneration of
articular cartilage leads to wear and tear,
gross ulceration and finally
disappearance of the full thickness of
articular cartilage

7. Cont..
• As defined by the American College of
Rheumatology (ACR), OA is a
heterogeneous group of condition that
leads to joint signs and symptoms
which are associated with defective
integrity of articular cartilage, in addition
to related changes in the underlying
bone at the joint margins

8. OA
• OA is a disease of
joints that affects
all of the weight-
bearing
components of the
joint:
•Articular cartilage
•Menisci
•Bone

9. Commonly Affects
• – Hips
• –Knees
• – Feet
• – Spine
• – Hands (Interphalangeal joints)

10. Uncommonly Affected
Joints
• • Shoulder
• • Wrist
• • Elbow
• • Metacarpophalangeal joint
• • TMJ
• • SI
• • Ankle

12. Incidence
• Osteoarthritis or OA, is the most common type of
arthritis
• It affects up to 27 million Americans.
• More common in women than men
• Majority of patients are over 65.

13. Pathophysiology
• The disease affects the joint cartilages.
• The cartilage helps bones glide over one another.
• In OA, cartilage within the joint gradually thins and wears away.
• As a result, bones rub against each other causing pain, swelling,
and loss of motion.
• Osteophytes (bone overgrowth) may develop when the ends of
the bone touch each other, and the joint can eventually become
deformed.
• When cartilage wears away, allowing bone to touch bone
completely, advanced or end-stage OA is diagnosed

14. CAUSES
• The root cause of OA is unknown
• the means of developing symptomatic OA is
influenced by multiple risk factors

15. Risk factors
• Age
• Age is the strongest risk factor for OA. Although OA
can start in young adulthood, if you are over 45 years
old, you are at higher risk.
• Female gender
• In general, arthritis occurs more frequently in women
than in men. Before age 45, OA occurs more frequently
in men; after age 45, OA is more common in women.
OA of the hand is particularly common among women.

16. Cont..
• Joint alignment
• •People with joints that move or fit together incorrectly, such as
bow legs, a dislocated hip, or double-jointedness, are at higher
risk
• Obesity/ overweight
• Being overweight during midlife or the later years is among the
strongest risk factors for OA of the knee.
• Trauma-Exercise or sports-generated stress placed on joint
• Sometimes family history

17. Signs and symptoms
• Depending on the joint affected, you may
experience:
• Pain
• Stiffness (especially after periods of inactivity)
• Swelling or tenderness in the joints
• Osteophytes (bony enlargement over the joint)
• Crepitus (crackling sound with joint movement)

18. Diagnosis
• OA is diagnosed with a thorough family history and
physical exam.
• X-rays and magnetic resonance imaging (MRI): help
determine the cause of joint pain and the extent of
the damage.
• If fluid is present in the joint, the doctor may
aspirate (drain the fluid from) a swollen joint to
evaluate it in the laboratory.

19. OA – Disease Management
• OA is a condition which progresses slowly over a period of
many years and cannot be cured
•Treatment is directed at decreasing the symptoms of the
condition, and slowing the progress of the condition
•Functional treatment goals:
•Limit pain
•Increase range of motion
•Increase muscle strength

20. Management cont…
•Pain medications
•Physical therapy
•Walking aids
•Shock absorption
•Re-alignment through orthotics
•Limit strain to affected areas

21. Treatment
Nondrug
therapies for
OA
Drug therapies for OA Nutritional
Supplements
Weight Loss Nonsteroidal anti-inflammatory
drugs (NSAIDs) such as aspirin,
acetaminophen and ibuprofen
Glucosamine
supplements
Physical
therapy and
exercise
Steroid injections when necessary
Education
about lifestyle
modification
Hyaluronan injections(a substance
found in normal joint fluid, can be injected into
arthritic knee joints. Viscosupplementation, may
effectively alleviate pain and increase range of
motion in some patients with OA of the knee
Bracing as
needed

22. End-stage OA calls for surgery
• Total joint replacement.
• Partial knee replacement may be an option when only
one compartment of the knee joint is affected.

23. Partial knee replacement
• Partial knee
replacement may be an
option when only one
compartment of the
knee joint is affected.

25. Total joint replacement

26. Group assignment/ presentation
4 groups of 3
• Topics
 Osteomyelitis
 Alzhemer’s disease
 Ankylosing spondylitis
 Myositis
• Subtopics
 Introduction/definition of term
 Etiology
 Pathogenesis/pathophysiology
 Diagnosis
 Risk factors
 Signs and symptoms
 Treatment/management
 Prevention
 References

28. Rheumatoid arthritis
Definition:
• Rheumatoid arthritis is a type of chronic (ongoing) arthritis that
occurs in joints on both sides of the body (for instance, both
hands, wrists, and/or knees)
• Rheumatoid arthritis is an autoimmune disease, meaning that
patient’s immune system (the body’s infection-fighting system) is
overreacting against itself.
• While OA is confined to the joint(s), RA is systemic and can
affect the entire body.

30. Rheumatoid arthritis
• RA commonly affects small joints such as the fingers
and toes, and can progress to large ones such as the
knees and shoulders.
• Typically, joints on both sides of the body are
similarly affected, but RA can involve a single joint
anywhere in the body

31. other parts of the body affected
• Skin
• Eyes
• Lungs
• Heart
• Blood
• Nerves
• Kidneys.

32. Incidence
• RA affects about 1% of the US population (about
2.1 million people).
• Often begins in middle age
• More frequent in the older generation
• RA can develop at any age but is most common between
ages 30 and 60, or during childhood.

33. Pathophysiology
• In RA, the immune system loses its ability to distinguish between
healthy joint cells and “foreign invaders.”
• The immune system attacks healthy cells causing inflammation in
the joint.
• The inflamed joint then starts attracting more immune cells
which results in swelling and fluid buildup at the joint.
• As the disease progresses, joint cartilage then wears away.
• Without treatment, joint destruction may occur quickly.
• Fortunately, the chances of maintaining joint function and
mobility in RA are very good with early treatment.
• Exposure to bacterial or viral infections and increased stress can
worsen RA.

36. Risk factors
• Family history of RA
• Age between 30 and 60
• Being female (70 percent of sufferers are women)
• Smoking
Obesity and prior joint injury will not increase your
risk of developing RA

37. Diagnosis
• Evaluation for RA involves a thorough history and
physical exam
• blood tests to detect antibodies.
• The two blood tests that are helpful in diagnosing
RA are:
• rheumatoid factor
• anti-CCP(Anti-cyclic citrullinated peptide is an antibody
present in most rheumatoid arthritis patients).

38. Common symptoms
• Fatigue
• Low-grade fevers
• Warm, tender, stiff joints
• Joints on both sides of the body affected (usually, but not always)
• Bumps under the skin (rheumatoid nodules)

39. Medical treatment
• hydroxychloroquine
• methotrexate
• sulfasalazine
• leflunomide (Arava®)

40. Surgical management
• Total joint replacement.

41. Gout
• Gout is an increasingly common form of arthritis in
people over 40 years of age.
• It involves sudden severe inflammation of a joint in which
uric acid crystals have collected
• Gout pain is described as being so intense that even
placing a sheet over the affected joint seems intolerable.
• Gout typically affects a single joint such as the big toe,
ankle or knee.
• The attacks may last from several days to two weeks and
can recur if not treated.

44. Pathophysiology
• Gout is caused by an inherited enzyme defect that
prevents the body from eliminating uric acid.
• Uric acid deposits that accumulate can cause white
bumps around the joint called tophi, usually in more
advanced disease.

46. Incidence
• Gout is 10 times more common in men than in
women

47. Risk factors
• Frequent alcohol consumption
• Use of certain medications (thiazide diuretics to control
high blood pressure)
• Being male (gout is 10 times more common in men than
in women)
• Certain medical conditions (metabolic syndrome — the
combination of high blood pressure, high cholesterol,
diabetes and obesity — or heart failure)
• A family history of gout

48. Diagnosis
• The diagnosis of gout is based on a thorough history
and physical examination (the history is especially
helpful).
• To confirm the diagnosis, fluid may be aspirated
from the joint and examined under a microscope for
uric acid crystals.

49. Signs and symptoms
• Sudden onset of joint pain
• Warmth and swelling in the joint
• Affected area turns red or purple
• Usually just one joint is affected

50. Lifestyle modification.
• Drinking less alcohol and avoiding red meats, organ
meats and other foods that are rich in uric acid can
help reduce gout to a lesser degree.

51. Medications
• NSAIDs
• Steroids
• Allopurinol and febuxostat are medications used to
control uric acid levels and prevent or reduce the number
of gout attacks.
• Probenecid, a medication used to prevent the formation
of kidney stones from uric acid are also helpful.
• Colchicine may be used as well.

52. •THANK
YOU