This document provides guidance on evaluating and managing patients presenting with monoarthritis or polyarthritis. It discusses common causes of monoarthritis including septic, traumatic, and crystal deposition diseases. It also reviews key questions to ask patients and appropriate diagnostic tests. For polyarthritis, it distinguishes between acute and chronic presentations and lists associated diseases. The document then focuses on osteoarthritis, outlining risk factors, symptoms, diagnostic criteria, and pharmacological and non-pharmacological treatment approaches including exercise, weight loss, analgesics, and surgery.
4_Evaluation and Management of Osteoarthritis.pptbiruktesfaye27
The document provides information on the evaluation and management of osteoarthritis (OA). It presents two case studies: a 65-year-old man with knee pain likely due to past knee injury, and a 75-year-old woman with OA in both knees, hips, and thumbs likely due to family history and genetics. The document discusses risk factors for OA, symptoms, diagnostic studies, pharmacological and non-pharmacological treatment options including exercise, topical agents, braces, and surgery.
Evaluation and Management of Osteoarthritis (2).pptbiruktesfaye27
This document provides information on the evaluation and management of osteoarthritis (OA). It presents two case studies: a 65-year-old man with knee pain likely due to past knee injury, and a 75-year-old woman with OA in both knees, hips, and thumbs likely due to family history and age. The document discusses risk factors for OA, symptoms, diagnostic studies, pharmacological and non-pharmacological treatment options including exercise, topical agents, analgesics and surgery. Management involves a stepped approach starting with non-drug options and progressing to more invasive treatments if needed.
This document discusses calcium pyrophosphate deposition (CPPD) disease, also known as pseudogout. It begins by noting that CPPD disease is underrecognized and can present in varied ways, from acute pseudogout attacks to chronic polyarticular arthritis. It then covers the pathophysiology of CPP crystal deposition, risk factors for acute pseudogout, associated medical conditions, diagnostic findings on imaging and arthrocentesis, and treatment approaches which are all off-label and based on small studies or expert opinion.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation of the joints. The document summarizes the definition, epidemiology, risk factors, pathophysiology, signs and symptoms, complications, diagnosis, and treatment of RA. It describes the clinical presentation of a patient with possible RA and the steps to take which include performing a physical exam, ordering diagnostic tests, making a provisional diagnosis, and referring the patient to a rheumatologist for further evaluation and management. Non-pharmacologic and pharmacologic treatment options for RA are outlined.
This document describes the case of a 41-year-old male presenting with bilateral knee swelling and pain for 10 days. His medical history includes a similar illness 7-8 years ago and a history of heavy alcohol consumption. On examination, he has flushed face, icteric eyes, and tender, swollen knees bilaterally. Laboratory tests show elevated uric acid, liver enzymes, and inflammatory markers. X-rays and microscopy confirm chronic tophaceous gout with an acute gout flare. He is treated with anti-inflammatory medications, urate-lowering therapy, and supportive care, and discharged after 8 days with resolution of symptoms.
This document provides guidance for primary care physicians on approaches to common joint pain conditions. It outlines objectives for understanding acute and chronic joint pain causes like septic arthritis, gout, osteoarthritis, and rheumatoid arthritis. Diagnostic criteria and treatment approaches are described for each condition. Key points emphasize focusing on general measures for osteoarthritis given its permanent structural changes, starting DMARDs early for rheumatoid arthritis to prevent deformities, limiting protein and alcohol for gout prevention, treating septic arthritis as a medical emergency with IV antibiotics, and promptly referring suspected bone cancer cases to higher centers.
Osteoarthritis is a degenerative joint disease characterized by cartilage breakdown. It is the most common form of arthritis, often affecting the knees in 70% of people over age 60. Osteoarthritis can cause functional impairment and disability in older adults and is a leading cause of joint replacement surgery. Risk factors include age, obesity, genetics, and joint trauma. Treatment focuses on reducing pain and preserving function through lifestyle changes, physical therapy, braces, and medications like acetaminophen, NSAIDs, and opioids. Surgery is considered for severe, treatment-resistant cases.
4_Evaluation and Management of Osteoarthritis.pptbiruktesfaye27
The document provides information on the evaluation and management of osteoarthritis (OA). It presents two case studies: a 65-year-old man with knee pain likely due to past knee injury, and a 75-year-old woman with OA in both knees, hips, and thumbs likely due to family history and genetics. The document discusses risk factors for OA, symptoms, diagnostic studies, pharmacological and non-pharmacological treatment options including exercise, topical agents, braces, and surgery.
Evaluation and Management of Osteoarthritis (2).pptbiruktesfaye27
This document provides information on the evaluation and management of osteoarthritis (OA). It presents two case studies: a 65-year-old man with knee pain likely due to past knee injury, and a 75-year-old woman with OA in both knees, hips, and thumbs likely due to family history and age. The document discusses risk factors for OA, symptoms, diagnostic studies, pharmacological and non-pharmacological treatment options including exercise, topical agents, analgesics and surgery. Management involves a stepped approach starting with non-drug options and progressing to more invasive treatments if needed.
This document discusses calcium pyrophosphate deposition (CPPD) disease, also known as pseudogout. It begins by noting that CPPD disease is underrecognized and can present in varied ways, from acute pseudogout attacks to chronic polyarticular arthritis. It then covers the pathophysiology of CPP crystal deposition, risk factors for acute pseudogout, associated medical conditions, diagnostic findings on imaging and arthrocentesis, and treatment approaches which are all off-label and based on small studies or expert opinion.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation of the joints. The document summarizes the definition, epidemiology, risk factors, pathophysiology, signs and symptoms, complications, diagnosis, and treatment of RA. It describes the clinical presentation of a patient with possible RA and the steps to take which include performing a physical exam, ordering diagnostic tests, making a provisional diagnosis, and referring the patient to a rheumatologist for further evaluation and management. Non-pharmacologic and pharmacologic treatment options for RA are outlined.
This document describes the case of a 41-year-old male presenting with bilateral knee swelling and pain for 10 days. His medical history includes a similar illness 7-8 years ago and a history of heavy alcohol consumption. On examination, he has flushed face, icteric eyes, and tender, swollen knees bilaterally. Laboratory tests show elevated uric acid, liver enzymes, and inflammatory markers. X-rays and microscopy confirm chronic tophaceous gout with an acute gout flare. He is treated with anti-inflammatory medications, urate-lowering therapy, and supportive care, and discharged after 8 days with resolution of symptoms.
This document provides guidance for primary care physicians on approaches to common joint pain conditions. It outlines objectives for understanding acute and chronic joint pain causes like septic arthritis, gout, osteoarthritis, and rheumatoid arthritis. Diagnostic criteria and treatment approaches are described for each condition. Key points emphasize focusing on general measures for osteoarthritis given its permanent structural changes, starting DMARDs early for rheumatoid arthritis to prevent deformities, limiting protein and alcohol for gout prevention, treating septic arthritis as a medical emergency with IV antibiotics, and promptly referring suspected bone cancer cases to higher centers.
Osteoarthritis is a degenerative joint disease characterized by cartilage breakdown. It is the most common form of arthritis, often affecting the knees in 70% of people over age 60. Osteoarthritis can cause functional impairment and disability in older adults and is a leading cause of joint replacement surgery. Risk factors include age, obesity, genetics, and joint trauma. Treatment focuses on reducing pain and preserving function through lifestyle changes, physical therapy, braces, and medications like acetaminophen, NSAIDs, and opioids. Surgery is considered for severe, treatment-resistant cases.
This document discusses rheumatoid arthritis (RA), including its etiology, classification criteria, clinical features, diagnostic testing, complications, and treatment approaches. RA is a chronic inflammatory disorder that primarily involves synovial joints, with symmetric involvement of hands/feet typically seen. Diagnosis relies on clinical exam showing inflamed joints and laboratory tests like rheumatoid factor and anti-CCP antibodies. If left untreated, RA can cause long-term joint damage and functional disability. Treatment involves medications like NSAIDs, DMARDs, steroids, and biologics to reduce inflammation and prevent structural damage.
This document summarizes key points about rheumatology presentations and treatments. It discusses common conditions like back and neck pain, rheumatoid arthritis, gout, and presentations involving hot joints. For rheumatoid arthritis, it emphasizes treating to target and using disease activity scores to monitor treatment response. It provides an overview of conventional and biologic disease-modifying treatments. For gout, it covers diagnosing and treating acute attacks as well as long-term urate-lowering therapy goals and medications like allopurinol.
Rheumatoid arthritis is a chronic inflammatory disease that causes pain, stiffness, and swelling in the joints. It occurs when the immune system mistakenly attacks the joints, causing the synovial membrane to become inflamed. Over time, this can cause cartilage and bone damage and limit function. Treatment focuses on reducing inflammation, managing symptoms, and preventing further joint damage through medications, surgery, and lifestyle changes. While there is no cure, proper treatment can help improve quality of life by reducing pain and disability.
A 38-year-old male presents with an extremely painful and swollen right foot that developed over the past 2 days. His history reveals recurrent pain in the right big toe joint over the past 5 years. On examination, he has a swollen tender first MTP joint with restricted movement. Laboratory tests show leukocytosis with neutrophilia and imaging reveals erosion of the first MTP joint. Gout is considered the most likely diagnosis, which is confirmed by joint aspiration demonstrating needle-shaped crystals. The patient is advised on lifestyle modifications and started on allopurinol to prevent recurrent gout attacks.
The document discusses several common rheumatological disorders seen in orthopedic departments, including osteoarthritis, gouty arthritis, calcium pyrophosphate deposition disease, and rheumatoid arthritis. It provides details on the prevalence, clinical features, imaging findings, classifications, and treatment approaches for each condition.
This document provides an overview of metabolic bone diseases with a focus on osteoporosis and Paget's disease. It discusses the clinical approach including history, physical exam, radiological investigations like DXA scans and lab tests. Risk factors, pathophysiology, clinical features and treatment options for osteoporosis like bisphosphonates, teriparatide, and denosumab are explained. Surgical considerations for patients with osteoporosis are also covered. Paget's disease is defined and its etiology, pathophysiology, clinical signs, complications and treatment are summarized. Key references on the diagnosis and management of metabolic bone diseases are listed.
Gout is the most common cause of inflammatory arthritis in the US. Treatment of acute gout flares includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. A randomized controlled trial found that oral prednisolone and naproxen provided equivalent pain relief for acute gout attacks. Colchicine is also effective for treating flares and preventing future attacks by interfering with neutrophil and monocyte activation. Management of gout focuses on both acute flare treatment and long-term urate-lowering therapy to reduce uric acid levels and prevent future attacks.
Gout is a crystal deposition disease caused by monosodium urate crystals in the joints and tissues due to hyperuricemia. It ranges from asymptomatic hyperuricemia to acute gouty arthritis with severe pain, to chronic tophaceous gout with joint damage. Diagnosis involves identifying urate crystals in synovial fluid or tophi. Treatment goals include rapid relief of acute flares, prevention of future flares, and reducing uric acid levels long-term through lifestyle changes and urate-lowering therapy such as allopurinol.
Gout is an inflammatory condition of the arthritis-type that results from deposition of monosodium urate crystals in joint spaces or surrounding tissues, leading to an inflammatory reaction that causes intense pain, erythema, and joint swelling.
It is associated with hyperuricemia, defined as a Serum Uric Acid (SUA) level of 6.8 mg/dL (404 μmol/L) or greater, but not all patients with hyperuricemia demonstrate symptoms.
Inflammation of arthritis type
Hyperuricemia
Metatarsophalangeal joint
Pharmacotherapeutics
M.Pharmacy
Pharmacy practice
Unit 05
This document discusses a case of a patient diagnosed with non-Hodgkin lymphoma (NHL). Key details include:
- The patient has signs and symptoms consistent with NHL such as fever, night sweats, and weight loss. Imaging and labs also confirm NHL.
- The patient's disease stage is determined using an appropriate staging system. Factors like elevated LDH and low albumin affect his prognosis.
- Goals of therapy are to maximize curability while minimizing short and long term complications.
- The recommended treatment regimen is R-CHOP chemotherapy given every 3 weeks for 6 cycles. This includes rituximab, cyclophosphamide, doxorubicin, vincristine,
Rheumatoid arthritis is a chronic inflammatory disease that causes stiffness, swelling, and pain in the joints. It is an autoimmune disorder where the immune system mistakenly attacks the body's own tissues, causing a inflammatory reaction in the synovial membranes surrounding the joints. It most commonly affects the hands, feet and wrists. Risk factors include female gender and genetic factors. Symptoms include symmetric joint pain and stiffness that typically affects the same joints on both sides of the body. Management involves medications to reduce inflammation and prevent joint damage, exercise and physical therapy to maintain joint mobility, and surgery in severe cases.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. It can affect multiple organs in the body. Risk factors include sex, age, family history, smoking, and obesity. Genetic factors contribute to pathogenesis. Symptoms include joint pain, stiffness, and swelling. Diagnosis is based on clinical and lab criteria. Treatments include medications like NSAIDs, DMARDs, steroids, and biologics as well as physical therapy and exercise to preserve joint function and prevent deformity. Surgery may be needed in cases of severe joint damage.
Presentation on Sarcoidosis by S.K Jindal | Jindal Chest Clinic, ChandigarhJindal Chest Clinic
When the immune system overreacts, granulomas are formed, leading to a condition known as sarcoidosis. This disorder can cause mild to severe symptoms, or no symptoms at all. This Presentation describes sarcoidosis and gives an overview on Sarcoidosis including causes, symptoms, diagnosis, complications, supplements for sacrcoidosis, and treatment strategies. For more information, please contact us: 9779030507.
Arthritis is inflammation of the joints that can affect people of all ages. The joints are made of cartilage, synovial membrane, and bone. There are two main types - inflammatory arthritis like rheumatoid arthritis which causes persistent joint inflammation, and degenerative arthritis from normal wear and tear. Rheumatoid arthritis specifically affects the synovium and causes symmetrical joint pain, stiffness, and swelling. It is assessed based on symptoms, physical exam, blood tests for rheumatoid factor and anti-CCP antibodies, and x-rays. Treatment involves medications like NSAIDs for pain and swelling, DMARDs to slow disease progression, and corticosteroids for flares, with the goal of relieving symptoms and preventing long-
This document provides an overview of rheumatoid arthritis (RA) and evaluating patients with rheumatic diseases. It discusses evaluating joint swelling based on distribution, acute vs chronic symptoms, and evidence of systemic inflammation. Common tests in rheumatology like joint aspiration and antibodies are also outlined. RA is introduced as a chronic inflammatory disease affecting the synovium. Diagnostic criteria, manifestations, associated syndromes, laboratory findings, and treatment options for RA are summarized. Complications of RA like atlantoaxial subluxation are also mentioned.
1) She reports the classic symptoms of dry eyes and dry mouth.
2) A Schirmer's test confirmed decreased tear production, a hallmark of Sjögren's, as it showed a tear absorption rate of only 3mm in 5 minutes (normal is 5mm or more).
3) She also reports joint pain, another common extraglandular manifestation seen in Sjögren's syndrome.
In summary, the combination of dry eyes, dry mouth, and decreased tear production on objective testing, along with joint pain, are
RHEUMATOLOGY DISEASES TABLE ALL IN ONE..LaibaFatima27
This document provides information on several seronegative spondyloarthropathies including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. It discusses the history, symptoms, diagnostic criteria and labs, diagnosis, and treatment for each condition. It also covers osteoarthritis, summarizing it as a chronic, progressive, non-inflammatory joint disease most commonly affecting the hands and weight-bearing joints. Rheumatoid arthritis is characterized as a chronic inflammatory systemic disease highlighted by severe joint pain that can affect multiple areas and have systemic complications if left untreated.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints, characterized by progressive destruction of symmetric joints. It is caused by a combination of genetic and environmental factors that lead to an immune system attack on the joints. The disease causes pain, swelling, stiffness, and loss of function in the affected joints. Treatment involves medications to reduce inflammation and prevent further joint damage, including NSAIDs, steroids, DMARDs, and biologic DMARDs. Lifestyle changes and surgery may also be used to treat rheumatoid arthritis and improve quality of life.
This document discusses rheumatoid arthritis (RA), including its etiology, classification criteria, clinical features, diagnostic testing, complications, and treatment approaches. RA is a chronic inflammatory disorder that primarily involves synovial joints, with symmetric involvement of hands/feet typically seen. Diagnosis relies on clinical exam showing inflamed joints and laboratory tests like rheumatoid factor and anti-CCP antibodies. If left untreated, RA can cause long-term joint damage and functional disability. Treatment involves medications like NSAIDs, DMARDs, steroids, and biologics to reduce inflammation and prevent structural damage.
This document summarizes key points about rheumatology presentations and treatments. It discusses common conditions like back and neck pain, rheumatoid arthritis, gout, and presentations involving hot joints. For rheumatoid arthritis, it emphasizes treating to target and using disease activity scores to monitor treatment response. It provides an overview of conventional and biologic disease-modifying treatments. For gout, it covers diagnosing and treating acute attacks as well as long-term urate-lowering therapy goals and medications like allopurinol.
Rheumatoid arthritis is a chronic inflammatory disease that causes pain, stiffness, and swelling in the joints. It occurs when the immune system mistakenly attacks the joints, causing the synovial membrane to become inflamed. Over time, this can cause cartilage and bone damage and limit function. Treatment focuses on reducing inflammation, managing symptoms, and preventing further joint damage through medications, surgery, and lifestyle changes. While there is no cure, proper treatment can help improve quality of life by reducing pain and disability.
A 38-year-old male presents with an extremely painful and swollen right foot that developed over the past 2 days. His history reveals recurrent pain in the right big toe joint over the past 5 years. On examination, he has a swollen tender first MTP joint with restricted movement. Laboratory tests show leukocytosis with neutrophilia and imaging reveals erosion of the first MTP joint. Gout is considered the most likely diagnosis, which is confirmed by joint aspiration demonstrating needle-shaped crystals. The patient is advised on lifestyle modifications and started on allopurinol to prevent recurrent gout attacks.
The document discusses several common rheumatological disorders seen in orthopedic departments, including osteoarthritis, gouty arthritis, calcium pyrophosphate deposition disease, and rheumatoid arthritis. It provides details on the prevalence, clinical features, imaging findings, classifications, and treatment approaches for each condition.
This document provides an overview of metabolic bone diseases with a focus on osteoporosis and Paget's disease. It discusses the clinical approach including history, physical exam, radiological investigations like DXA scans and lab tests. Risk factors, pathophysiology, clinical features and treatment options for osteoporosis like bisphosphonates, teriparatide, and denosumab are explained. Surgical considerations for patients with osteoporosis are also covered. Paget's disease is defined and its etiology, pathophysiology, clinical signs, complications and treatment are summarized. Key references on the diagnosis and management of metabolic bone diseases are listed.
Gout is the most common cause of inflammatory arthritis in the US. Treatment of acute gout flares includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. A randomized controlled trial found that oral prednisolone and naproxen provided equivalent pain relief for acute gout attacks. Colchicine is also effective for treating flares and preventing future attacks by interfering with neutrophil and monocyte activation. Management of gout focuses on both acute flare treatment and long-term urate-lowering therapy to reduce uric acid levels and prevent future attacks.
Gout is a crystal deposition disease caused by monosodium urate crystals in the joints and tissues due to hyperuricemia. It ranges from asymptomatic hyperuricemia to acute gouty arthritis with severe pain, to chronic tophaceous gout with joint damage. Diagnosis involves identifying urate crystals in synovial fluid or tophi. Treatment goals include rapid relief of acute flares, prevention of future flares, and reducing uric acid levels long-term through lifestyle changes and urate-lowering therapy such as allopurinol.
Gout is an inflammatory condition of the arthritis-type that results from deposition of monosodium urate crystals in joint spaces or surrounding tissues, leading to an inflammatory reaction that causes intense pain, erythema, and joint swelling.
It is associated with hyperuricemia, defined as a Serum Uric Acid (SUA) level of 6.8 mg/dL (404 μmol/L) or greater, but not all patients with hyperuricemia demonstrate symptoms.
Inflammation of arthritis type
Hyperuricemia
Metatarsophalangeal joint
Pharmacotherapeutics
M.Pharmacy
Pharmacy practice
Unit 05
This document discusses a case of a patient diagnosed with non-Hodgkin lymphoma (NHL). Key details include:
- The patient has signs and symptoms consistent with NHL such as fever, night sweats, and weight loss. Imaging and labs also confirm NHL.
- The patient's disease stage is determined using an appropriate staging system. Factors like elevated LDH and low albumin affect his prognosis.
- Goals of therapy are to maximize curability while minimizing short and long term complications.
- The recommended treatment regimen is R-CHOP chemotherapy given every 3 weeks for 6 cycles. This includes rituximab, cyclophosphamide, doxorubicin, vincristine,
Rheumatoid arthritis is a chronic inflammatory disease that causes stiffness, swelling, and pain in the joints. It is an autoimmune disorder where the immune system mistakenly attacks the body's own tissues, causing a inflammatory reaction in the synovial membranes surrounding the joints. It most commonly affects the hands, feet and wrists. Risk factors include female gender and genetic factors. Symptoms include symmetric joint pain and stiffness that typically affects the same joints on both sides of the body. Management involves medications to reduce inflammation and prevent joint damage, exercise and physical therapy to maintain joint mobility, and surgery in severe cases.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. It can affect multiple organs in the body. Risk factors include sex, age, family history, smoking, and obesity. Genetic factors contribute to pathogenesis. Symptoms include joint pain, stiffness, and swelling. Diagnosis is based on clinical and lab criteria. Treatments include medications like NSAIDs, DMARDs, steroids, and biologics as well as physical therapy and exercise to preserve joint function and prevent deformity. Surgery may be needed in cases of severe joint damage.
Presentation on Sarcoidosis by S.K Jindal | Jindal Chest Clinic, ChandigarhJindal Chest Clinic
When the immune system overreacts, granulomas are formed, leading to a condition known as sarcoidosis. This disorder can cause mild to severe symptoms, or no symptoms at all. This Presentation describes sarcoidosis and gives an overview on Sarcoidosis including causes, symptoms, diagnosis, complications, supplements for sacrcoidosis, and treatment strategies. For more information, please contact us: 9779030507.
Arthritis is inflammation of the joints that can affect people of all ages. The joints are made of cartilage, synovial membrane, and bone. There are two main types - inflammatory arthritis like rheumatoid arthritis which causes persistent joint inflammation, and degenerative arthritis from normal wear and tear. Rheumatoid arthritis specifically affects the synovium and causes symmetrical joint pain, stiffness, and swelling. It is assessed based on symptoms, physical exam, blood tests for rheumatoid factor and anti-CCP antibodies, and x-rays. Treatment involves medications like NSAIDs for pain and swelling, DMARDs to slow disease progression, and corticosteroids for flares, with the goal of relieving symptoms and preventing long-
This document provides an overview of rheumatoid arthritis (RA) and evaluating patients with rheumatic diseases. It discusses evaluating joint swelling based on distribution, acute vs chronic symptoms, and evidence of systemic inflammation. Common tests in rheumatology like joint aspiration and antibodies are also outlined. RA is introduced as a chronic inflammatory disease affecting the synovium. Diagnostic criteria, manifestations, associated syndromes, laboratory findings, and treatment options for RA are summarized. Complications of RA like atlantoaxial subluxation are also mentioned.
1) She reports the classic symptoms of dry eyes and dry mouth.
2) A Schirmer's test confirmed decreased tear production, a hallmark of Sjögren's, as it showed a tear absorption rate of only 3mm in 5 minutes (normal is 5mm or more).
3) She also reports joint pain, another common extraglandular manifestation seen in Sjögren's syndrome.
In summary, the combination of dry eyes, dry mouth, and decreased tear production on objective testing, along with joint pain, are
RHEUMATOLOGY DISEASES TABLE ALL IN ONE..LaibaFatima27
This document provides information on several seronegative spondyloarthropathies including ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and enteropathic arthritis. It discusses the history, symptoms, diagnostic criteria and labs, diagnosis, and treatment for each condition. It also covers osteoarthritis, summarizing it as a chronic, progressive, non-inflammatory joint disease most commonly affecting the hands and weight-bearing joints. Rheumatoid arthritis is characterized as a chronic inflammatory systemic disease highlighted by severe joint pain that can affect multiple areas and have systemic complications if left untreated.
Rheumatoid arthritis is a chronic inflammatory disease that affects the joints, characterized by progressive destruction of symmetric joints. It is caused by a combination of genetic and environmental factors that lead to an immune system attack on the joints. The disease causes pain, swelling, stiffness, and loss of function in the affected joints. Treatment involves medications to reduce inflammation and prevent further joint damage, including NSAIDs, steroids, DMARDs, and biologic DMARDs. Lifestyle changes and surgery may also be used to treat rheumatoid arthritis and improve quality of life.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
4. Important questions?
What should you ask the patient?
What’s critical to determine ASAP?
What’s the most useful test to determine
etiology?
What other labs/studies should be obtained?
5. The patient with polyarticular symptoms
Diseases that present with acute polyarticular sx:
Chronic polyarticular sx?
10. Osteoarthritis: Case 1
• A 65-year-old man comes to your office
complaining of knee pain that began insidiously
about a year ago. He has no other rheumatic
symptoms
• What further questions should you ask?
• What are the pertinent physical findings?
• Which diagnostic studies are appropriate?
11. OA: Symptoms and Signs
Pain is related to use
Pain gets worse
during the day
Minimal morning
stiffness (<20 min)
and after inactivity
(gelling)
Range of motion
decreases
Joint instability
Bony enlargement
Restricted movement
Crepitus
Variable swelling
and/or instability
12. OA Case 1: Radiographic Features
Joint space narrowing
Marginal osteophytes
Subchondral cysts
Bony sclerosis
Malalignment
MAKE THE
DIAGNOSIS
13. OA: Laboratory Tests
No specific tests
No associated laboratory abnormalities;
eg, sedimentation rate
Investigational: Cartilage degradation products in
serum and joint fluid
17. TNFa
IL-1B
IL-6
IL-8
MCP-1
NO
PGE2
IL-18
0 20 40 60 80 100
IL-18
PGE2
NO
MCP-1
IL-8
IL-1b
TNFa
IL-6
0 20 40 60 80 100
ELISA
Units
Spontaneous Production of Inflammatory Mediators
by Normal and OA-affected Cartilage
Attur et al. Osteoarthritis and Cartilage 2002
18. Candidate Biomarkers in OA
• CRP (obesity??)
• COMP, Keratan sulfate, HA, YPL-70
• Type II collagen fragments
• Type II C-propeptide (synthesis)
• Proteoglycan/aggrecan fragments
• Markers of bone turnover
(osteocalcin,NTx)
• Imaging (x-ray, MRI, ultrasound)
20. OA: Risk Factors (cont’d)
Age: 75% of persons over age 70 have OA
Female sex
Obesity
Hereditary
Trauma
Neuromuscular dysfunction
Metabolic disorders
21. Case 1: Cause of Knee OA
On further questioning, patient recalls fairly
serious knee injury during sport event many
years ago
Therefore, posttraumatic OA is most likely
diagnosis
22. QuickTime™ and a
Photo CD Decompressor
are needed to use this picture
Case 1: Prognosis
Natural history of OA: Progressive cartilage loss,
subchondral thickening, marginal osteophytes
23. OA: Case 2
A 75-year-old woman presents to your office with
complaints of pain and stiffness in both knees,
hips, and thumbs. She also has occasional back
pain
Family history reveals that her mother had similar
problems
On exam she has bony enlargement of both
knees, restricted ROM of both hips, squaring at
base of both thumbs, and multiple Heberden’s
and Bouchard’s nodes
24. Distribution of Primary OA
Primary OA typically
involves variable
number of joints in
characteristic locations,
as shown
Exceptions may occur,
but should trigger
consideration of
secondary causes of OA
25. 0
20
40
60
80
20 40 60 80
Men
Age (years)
Prevalence
of
OA
(%)
0
20
40
60
80
20 40 60 80
Women
Age (years)
Prevalence
of
OA
(%)
Age-Related Prevalence of OA:
Changes on X-Ray
DIP
Knee
Hip
DIP
Knee
Hip
27. Radiograph shows
severe changes
Most common
location in hand
May cause significant
loss of function
Case 2: Carpometacarpal Joint
28. X-ray shows
osteophytes,
subchondral sclerosis,
and complete loss of
joint space
Patients often present
with deep groin pain
that radiates into the
medial thigh
Case 2: Hip Joint
29. What If Case 2 Had OA in the
“Wrong” Joint, eg, the Ankle?
• Then you must consider secondary causes of OA
• Ask about previous trauma and/or overuse
• Consider neuromuscular disease, especially
diabetic or other neuropathies
• Consider metabolic disorders, especially
CPPD (calcium pyrophosphate deposition
disease—aka pseudogout)
30. Secondary OA: Diabetic Neuropathy
MTPs 2 to 5 involved
in addition to the 1st
bilaterally
Destructive changes
on x-ray far in excess
of those seen in
primary OA
Midfoot involvement
also common
31. Underlying Disease Associations of
OA and CPPD Disease (pseudogout)
Hemochromatosis
Hyperparathyroidism
Hypothyroidism
Hypophosphatasia
Hypomagnesemia
Neuropathic joints
Trauma
Aging, hereditary
32. Management of OA
• Establish the diagnosis of OA on the basis of
history and physical and x-ray examinations
• Decrease pain to increase function
• Prescribe progressive exercise to
• Increase function
• Increase endurance and strength
• Reduce fall risk
• Patient education: Self-Help Course
• Weight loss
• Heat/cold modalities
34. Strengthening Exercise for OA
• Decreases pain and increases function
• Physical training rather than passive therapy
• General program for muscle strengthening
• Warm-up with ROM stretching
• Step 1: Lift the body part against gravity, begin
with 6 to 10 repetitions
• Step 2: Progressively increase resistance with
free weights or elastic bands
• Cool-down with ROM stretching
Rogind, et al. Arch Phys Med Rehabil. 1998;79:1421–1427.
Jette, et al. Am J Public Health. 1999;89:66–72.
35. Reconditioning Exercise
Program for OA
• Low-impact, continuous movement exercise for
15 to 30 minutes 3 times per week
• Fitness walking: Increases endurance, gait
speed, balance, and safety
• Aquatics exercise programs—group support
• Exercycle with minimal or no tension
• Treadmill with minimal or no elevation
36. Nonopioid Analgesic Therapy
• First-line—Acetaminophen
• Pain relief comparable to NSAIDs, less toxicity
• Beware of toxicity from use of multiple
acetaminophen-containing products
• Maximum safe dose = 4 grams/day
37. Nonopioid Analgesic Therapy (cont’d)
• NSAIDs
• Use generic NSAIDs first
• If no response to one may respond to another
• Lower doses may be effective
• Do not retard disease progression
• Gastroprotection increases expense
• Side effects: GI, renal, worsening CHF, edema
• Antiplatelet effects may be hazardous
38. Nonopioid Analgesics in OA
• Cyclooxygenase-2 (COX-2) inhibitors
• Pain relief equivalent to older NSAIDs
• Probably less GI toxicity
• No effect on platelet aggregation or bleeding
time
• Side effects: Renal, edema
• Older populations with multiple medical
problems not tested
• Cost similar to generic NSAIDs plus proton
pump inhibitor or misoprostol
Medical Letter. 1999;41:11–12.
39. Medical Letter. 1999;41:11–12.
Nonopioid Analgesics in OA (cont’d)
• Tramadol
• Affects opioid and serotonin pathways
• Nonulcerogenic
• May be added to NSAIDs, acetaminophen
• Side effects: Nausea, vomiting, lowered
seizure threshold, rash, constipation,
drowsiness, dizziness
40. Opioid Analgesics for OA
• Codeine, oxycodone
• Anticipate and prevent constipation
• Long-acting oxycodone may have fewer CNS
side effects
• Propoxyphene
• Morphine and fentanyl patches for severe pain
interfering with daily activity and sleep
41. Topical Agents for Analgesia in OA
• Local cold or heat: Hot packs, hydrotherapy
• Capsaicin-containing topicals
• Use moderately supported by evidence
• Use daily for up to 2 weeks before benefit
• Compliance poor without full instruction
• Avoid contact with eyes
42. OA: Intra-articular Therapy
• Intra-articular steroids
• Good pain relief
• Most often used in
knees, up to q 3 mo
• With frequent
injections, risk
infection, worsening
diabetes, or CHF
• Joint lavage
• Significant
symptomatic benefit
demonstrated
• Hyaluronate injections*
• Symptomatic relief
• Improved function
• Expensive
• Require series of
injections
• No evidence of long-
term benefit
• Limited to knees
* Altman, et al. J Rheumatol. 1998;25:2203.
43. OA: Unconventional Therapies
• Polysulfated glycosaminoglycans—nutriceuticals
• Glucosamine +/- chondroitin sulfate:
Symptomatic benefit, no known side effects
• Doxycycline as protease/cytokine inhibitors
• Under study
• Have disease-modifying potential
44. OA: Unconventional Therapies (cont’d)
• Keep in touch with current information.
• ACR Website
(http://www.rheumatology.org)
• Arthritis Foundation Website (www.arthritis.org)
45. Referral and Imaging
If pain out of proportion to XRAY findings, can
refer to rheum or ortho, and get MRI
Also, for unstable joints, need MR
Primary or secondary failure of treatment regimen
should prompt further imaging and referral
Please obtain imaging BEFORE THE PATIENT
GETS TO THE CONSULTANT
If there is any question of systemic inflammatory
disease, check labs including CBC, ESR, CRP,
rheumatoid factor, anti-CCP, (ANA), IgGs as well
46. Surgical Therapy for OA
• Arthroscopy
• May reveal unsuspected focal abnormalities
• Results in tidal lavage
• Expensive, complications possible
• Osteotomy: May delay need for TKR for
2 to 3 years
• Total joint replacement: When pain severe and
function significantly limited
47. OA: Management Summary
• First: Be sure the pain is joint related (not a
tendonitis or bursitis adjacent to joint)
• Initial treatment
• Muscle strengthening exercises and
reconditioning walking program
• Weight loss
• Acetaminophen first
• Local heat/cold and topical agents
48. OA: Management Summary (cont’d)
• Second-line approach
• NSAIDs if acetaminophen fails
• Intra-articular agents or lavage
• Opioids
• Third-line
• Arthroscopy
• Osteotomy
• Total joint replacement