OSTEOARTHRITIS,

GOUTY ARTHRITIS,
AND RHEUMATOID
ARTHRITIS

Garcia, Diana Rose

Geromo, Angelica A.
BSN 3-A
Definition Rating Nation & Local
Anatomy and Physiology Signs/Symptoms
Causes Risk Factors
Complications Treatment/Health Educ
Diagnostic

TODAY'S
DISCUSSION
OSTEOARTHRITIS
Osteoarthritis (OA) is a degenerative joint disease that affects the
entire joint, including bone, cartilage, ligaments, fat, and the tissues
lining the joint (the synovium). It is the most common form of
arthritis, affecting more than 32.5 million adults in the United States.
Around 4.2 million Filipinos suffer from osteoarthritis (OA). OA leads
to significant deterioration in quality of life. With increasing obesity
and aging of the population
 Primary osteoarthritis has no known cause.
Secondary osteoarthritis is caused by another
disease, infection, injury, or deformity.
 STAGES OF KNEE OSTEOARTHRITIS
In healthy knee
The articular cartilage is smooth with no fissuring and bone smooth. The synovial fluid is viscous
aid in lubrication. The knee moves full range of motion without pain. Overtime osteoarthritis will
affect bone, cartilage, synovial fluid of the knee.

With mild knee osteoarthritis

It begins with discomfort in the knee joint. Progression of disease may be slow in this stage. Now
the joint space is no more the cartilage begins breakdown from combination of wear and tear and
bone spurs known as osteophytes. They begin with the bone at the end of the joints.
 Moderate knee osteoarthritis
The cartilage surface between bones begins to reduce narrowing gap between femur and tibia.
Hyaluronic acid which help the fluid lubricant the joint becoming less viscous, elastic,
concentrated. Osteoarthritis often effect Subchondral bone located just underneath cartilage.
SubChondral bone provide hydration and oxygen to cartilage.

Severe knee osteoarthritis

Joint space has narrowed causing more rapid and severe destruction of cartilage. The synovial
fluid decreases, increasing friction and pain within synovial membrane destruction. Proteins are
produced which produce degraded cartilage and soft tissue around the knee Osteophyte
increase, bone move against bone in cartilage. Daily activities and quality of life are impacted.
 ANATOMY AND PHYSIOLOGY OF KNEE
Three knee joint compartments are:
Medial
Lateral
Patella - femoral.

The medial compartment: the medial compartment is on the

inner aspect in the leg. it consists of the
✓ Medial femoral condyle
✓ The medial meniscus
✓ The medial tibia plateau.
The lateral compartment: it is on the outer aspect in the leg.
It consists of the:
✓Lateral femoral condyle
✓ Lateral meniscus
✓ Lateral tibia plateau
The patella-femoral compartment:
✔ It consists of the articulation between the patella and the
distal end in the femur.
The patella glides in a groove in the lower part of the femur
every time you bend or straighten in the knee.
 Risk Factors
Symptoms of osteoarthritis
Osteoarthritis has a multifactorial etiology and
The most common symptom is pain in the can be primary (with no obvious cause) or
joints, especially after movement. This secondary (due to trauma, infiltrative disease
discomfort is often worse in the later hours or connective tissue diseases).
Risk factors for primary OA include obesity,
of the day. Symptoms include Joint pain,
advancing age, female gender, and manual
stiffness, swelling, instability, weakness, labor occupations.
cracking (or) crunching. Age.
Joint pain Obesity
Stiffness Occupation
Trauma
Swelling
Genetics
Weakness Heredity
Cracking (or) crunching Gender
Diet
Low levels of vitamin-D, C&K can increase the
development of osteoarthritis.
 Causes of osteoarthritis
✦ Medical history to establish possible genetic links, history of
Osteoarthritis can be caused by several factors such
as: old age, improperly formed joints, being
overweight and stress on the joints.as well as from
certain activities (or) repeating movements over and
over. Joint injury (like from sports can accidents) and
ligament tears and strains. Including genetic defects
in joint cartilage. People over the age of 50 have a
higher risk of osteoarthritis.
DIAGNOSIS OF OSTEOARTHRITIS
trauma, potential repetitive use issues.
✦ Physical exam to check for joint tenderness, swelling
redness, flexibility and ROM.
Imaging tests
X-rays help staging the joint damage and confirming the
disease.it does not show cartilage image. But it shows
narrowing of joint space.
Magnetic resonance imaging (MRI): In MRI it shows bone and
soft tissues and also cartilage.
✦ Joint aspiration and blood test: No blood test for
osteoarthritis.
# test is determine for rheumatoid arthritis and gout
(rheumatoid factor, elevated ESR,high uric acid levels),19,21
✦ Joint fluid analysis: This test is determined
 DIAGNOSIS OF OSTEOARTHRITIS
✦ Medical history to establish possible genetic links, history of trauma, potential
repetitive use issues.
✦ Physical exam to check for joint tenderness, swelling redness, flexibility and
ROM.
Imaging tests
X-rays help staging the joint damage and confirming the disease.it does not show
cartilage image. But it shows narrowing of joint space.
Magnetic resonance imaging (MRI): In MRI it shows bone and soft tissues and also
cartilage.
✦ Joint aspiration and blood test: No blood test for osteoarthritis.
# test is determine for rheumatoid arthritis and gout (rheumatoid factor, elevated
ESR,high uric acid levels),19,21
✦ Joint fluid analysis: This test is determined
whether pain is caused by gout or any infection rather than osteoarthritis.
✦ Joint fluid analysis: This test is determined
whether pain is caused by gout or any infection rather than osteoarthritis.
Management
✦ Pharmacological treatment
✦ Acupuncture
✦ Intra articular injection
◇ Surgical procedures
✦ Physical activity
Pharmacological treatment
Acetaminophen
NSAIDS
Cox-2 inhibitors
Narcotics
Chondroitin and glucosamine sulphate
Intra-articular injection: corticosteroids
Sodium hyaluronate (or) hyaluronic injection
Platelet-rich plasma (PRP)
Bone marrow aspirate concentrate
Autologous cultured chondrocytes
Botox injection
Water-cooled radio frequency ablation
The bottom line.
Acupuncture
Surgical options
Arthroscopic knee surgery
Osteotomy
Stem cells therapy
Arthroplasty
Prevention
Although no treatment halts the degenerative process, certain
preventive measures can slow the progress if undertaken early
enough.

Weight reduction. To avoid too much weight upon the joints,

reduction of weight is recommended.
Prevention of injuries. As one of the risk factors for osteoarthritis
is previous joint damage, it is best to avoid any injury that might
befall the weight-bearing joints.
Perinatal screening for congenital hip disease. Congenital and
developmental disorders of the hip are well known for
predisposing a person to OA of the hip.
 GOUTYARTHRITIS
inflammatory arthritis that can affect anyone. It's characterized by
sudden, severe attacks of pain, swelling, redness and tenderness in one or
more joints, most often in the big toe and usually as flares that last for a
week or two, and then resolve. Gout happens when high levels of urate
build up in your body over a long period of time, which can then form
needle-shaped crystals in and around the joint. This leads to inflammation
and arthritis of the joint. When the body makes too much urate, or
removes too little, urate levels build up in the body
ANATOMY
 FOUR STAGES OF GOUT
Asymptomatic Gout
The characteristic collection of uric acid crystals in the joint begins with the accumulation of uric acid in the blood. Uric acid is a
natural waste product that is formed when the body breaks down purines. Purine is a compound that occurs naturally in our tissue
and in high levels in some foods, including alcoholic beverages, shellfish, and some meats, including bacon, turkey, venison and
organ meats.
Normally, uric acid dissolves in the blood, is filtered by the kidneys and excreted through urine. However, if the body produces too
much uric acid or the kidneys are not efficient at eliminating it, uric acid can reach high levels in the blood, a condition called
hyperuricemia. For some people, hyperuricemia never causes symptoms. For others, it is the first stage of gout.
 Acute Gout
When uric acid levels in the blood become too high, it can seep out and form crystals in the spaces around the joints, causing
intense pain and swelling. The pain often comes on suddenly and unexpectedly (thus the term, “attack”) and can last from a few
days to a few weeks.
Your first attack will likely be the first time you realize or suspect you have gout. Your doctor can make the diagnosis by drawing
some fluid from the affected joints and examining it for uric acid crystals. The presence of crystals is the only way to confirm you
have gout rather than another form of arthritis that would require completely different treatment. One of these is calcium
pyrophosphate deposition disease (CPPD), a condition commonly known as “pseudogout” because of its resemblance to gout.
Similar to gout, pseudogout comes on suddenly and painfully due to crystals that form in the joints. The difference is that the
crystals are composed of calcium pyrophosphate dihydrate. It is unknown why these crystals form in the joint.
Treatment during the acute stage of gout is targeted at relieving the pain and inflammation of the attacks as well as managing
uric acid levels to lessen or prevent further attacks. This often involves a diet low in purines along with the use of medications
that either decrease the body’s production of uric acid or increase uric acid excretion.
 Intercritical or Interval Gout
After your first gout attack(s) you’ll probably experience a time without symptoms until another attack occurs, which could be
months or even years. The stage during which attacks come at intervals short or long is known as “intercritical” or “interval” gout.
Even when attacks are not occurring, uric acid can continue to build in the blood and joints at this stage, so your doctor may
continue to prescribe uric acid-lowering medications to reduce the chance or severity of future attacks.
If you are overweight, losing weight helps in the management of gout. It is also important during this stage to drink plenty of water
and consume a diet low in purines.

Chronic Tophaceous Gout

If uric acid levels are not well controlled during the interval stage, gout may progress to its final and most problematic stage —
chronic tophaceous gout. Chronic gout is characterized by accumulations of urate crystals called tophi that can appear as bumps
or nodules under the skin. A tophus can form in a joint, in the bursa that cushions and protects the joint, in the bones or cartilage
and under the skin.
Tophi that form in the small joints of the fingers can cause physical changes and restrict movement. Tophi in the cartilage and
bone can eventually lead to joint damage and deformity, and tophi under the skin can be unsightly and become infected and
sometimes painful.
Other problems that can occur during this chronic stage include painful joints, aching and kidney stones.
 SIGNS &
SYMPTOM
Gout symptoms come and go (recur) in episodes called
flares or gout attacks. Gout attacks are very painful and
can happen suddenly, often overnight. During a gout
attack, symptoms in your affected joints may include:

Intense joint pain

Lingering discomfort
Inflammation and redness
Limited range of motion/stiffness
 CAUSE
Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate
crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines
(substances that are found naturally in your body).

Purines are also found in certain foods, including red meat and organ meats, such as liver. Purine-rich seafood includes
anchovies, sardines, mussels, scallops, trout and tuna. Alcoholic beverages, especially beer, and drinks sweetened with fruit sugar
(fructose) promote higher levels of uric acid.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes either your body
produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp,
needlelike urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling. Having temporarily high uric
acid levels doesn’t mean you’ll definitely develop gout. Many people with hyperuricemia never get gout.
 RISK FACTORS

You're more likely to develop gout if you have high levels of uric acid in your body. Factors that increase the uric acid level in your
body include:

Diet
Weight
Medical conditions
Certain medications
Family history of gout
Age and sex
DIAGNOSIS & TEST
A gout diagnosis by a healthcare professional involves a physical examination. They will
inquire about your symptoms and inspect the joints that are affected. Inform your
healthcare provider about when you initially observed symptoms such as pain and
swelling in your joint, and provide details on the frequency of these symptoms
appearing and subsiding.
Other common tests to diagnose gout include:

Joint fluid analysis

Blood test to check uric acid levels.
Imaging tests
TREATMENTS
A healthcare professional may recommend medications to assist in alleviating
your symptoms, such as:
NSAIDs ( like ibuprofen and naproxen)
Colchicine
Corticosteroids

Your provider might prescribe medications to help lower your uric acid levels.
The most common medications that lower uric acid include:
Allopurinol.
Febuxostat.
Pegloticase.
Probenecid.
HEALTH EDUCATION

Several actions can be taken to effectively control gout. Implementing lifestyle

modifications can contribute to reducing the frequency of gout flares and
effectively managing symptoms. These changes may include:

Advice the patient to reduce their weight

Making diet changes to help reduce blood urate levels and gout flares
Advice to elevate their affected joints above the level of heart.
Advice to put ice unto affected joints.
Limiting stress on joints
Rheumatoid arthritis (RA) is an autoimmune disease that is
chronic (ongoing). It occurs in the joints on both sides of
your body, which makes it different from other types of
arthritis. You may have symptoms of pain and
inflammation in your:
Fingers. Hands. Wrists Knees Ankles. Feet. Toes.

Uncontrolled inflammation damages cartilage, which

normally acts as a “shock absorber” in your joints. In time,
this can deform your joints. Eventually, your bone itself
erodes. This can lead to the fusion of your joint (an effort
of your body to protect itself from constant irritation).
Symptoms of rheumatoid arthritis
include:
Pain, swelling, stiffness and tenderness
in more than one joint.
Stiffness, especially in the morning or
after sitting for long periods.
Pain and stiffness in the same joints on
both sides of your body.
Fatigue (extreme tiredness).
Weakness.
Fever.
What causes rheumatoid arthritis?
The exact cause of rheumatoid arthritis is
unknown. Researchers think it’s caused by a
combination of genetics, hormones and
environmental factors.
Normally, your immune system protects your
body from disease. With rheumatoid
arthritis, something triggers your immune
system to attack your joints. An infection,
smoking or physical or emotional stress may
be triggering.
 WHAT ARE THE FOUR STAGES OF
RHEUMATOID ARTHRITIS?

Stage 1: In early stage rheumatoid arthritis, the tissue around your joint(s) is inflamed. You may have
some pain and stiffness. If your provider ordered X-rays, they wouldn’t see destructive changes in
your bones.
Stage 2: The inflammation has begun to damage the cartilage in your joints. You might notice
stiffness and a decreased range of motion.
Stage 3: The inflammation is so severe that it damages your bones. You’ll have more pain, stiffness
and even less range of motion than in stage 2, and you may start to see physical changes.
Stage 4: In this stage, the inflammation stops but your joints keep getting worse. You’ll have severe
pain, swelling, stiffness and loss of mobility.
 WHAT’S THE AGE OF ONSET FOR
RHEUMATOID ARTHRITIS?

RA usually starts to develop between the ages of 30 and 60. But anyone can develop
rheumatoid arthritis. In children and young adults — usually between the ages of 16 and
40 — it’s called young-onset rheumatoid arthritis (YORA). In people who develop
symptoms after they turn 60, it’s called later-onset rheumatoid arthritis (LORA).
RISK FACTORS FOR DEVELOPING
RHEUMATOID ARTHRITIS.
Family history: You’re more likely to develop RA if you have a close relative who also has
it.
Sex: Women and people designated female at birth are two to three times more likely to
develop rheumatoid arthritis.
Smoking: Smoking increases a person’s risk of rheumatoid arthritis and makes the
disease worse.
Obesity: Your chances of developing RA are higher if you have obesity
 How is rheumatoid arthritis diagnosed?
They’ll do a physical exam and ask you about your medical history and symptoms. Your rheumatologist will order
blood tests and imaging tests.
The blood tests look for inflammation and blood proteins (antibodies) that are signs of rheumatoid arthritis. These
may include:
Erythrocyte sedimentation rate (ESR) or “sed rate” confirms inflammation in your joints.
C-reactive protein (CRP).
About 80% of people with RA test positive for rheumatoid factor (RF).
About 60% to 70% of people living with rheumatoid arthritis have antibodies to cyclic citrullinated peptides (CCP)
(proteins).
Your rheumatologist may order imaging tests to look for signs that your joints are wearing away. Rheumatoid arthritis
can cause the ends of the bones within your joints to wear down. The imaging tests may include:
X-rays. Ultrasounds. Magnetic resonance imaging (MRI) scans.
In some cases, your provider may watch how you do over time before making a definitive diagnosis of rheumatoid
arthritis
 MANAGEMENT AND TREATMENT
Joint damage generally occurs within the first two years of diagnosis, so it’s important to see your
provider if you notice symptoms. Treating rheumatoid arthritis in this “window of opportunity” can
help prevent long-term consequences.

Treatments for rheumatoid arthritis include lifestyle changes, therapies, medicine and
surgery. Your provider considers your age, health, medical history and how bad your
symptoms are when deciding on a treatment.
What medications treat rheumatoid arthritis?
Early treatment with certain drugs can improve your long-term outcome. Combinations of drugs may be more
effective than, and appear to be as safe as, single-drug therapy.

There are many medications to decrease joint pain, swelling and inflammation, and to prevent or slow down the
disease. Medications that treat rheumatoid arthritis include:
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs decrease pain and inflammation.

When is surgery used to treat rheumatoid arthritis?

Surgery may be an option to restore function to severely damaged joints. Your provider may also recommend surgery if
your pain isn’t controlled with medication. Surgeries that treat RA include:

Knee replacement.
Hip replacement.
Other surgeries to correct a deformity.
Outlook / Prognosis
THANK
YOU!
Do you have any questions?