Arthritis

Dr.A.Prakash M.S. Orthopedics

Fellow in trauma and arthroplasty.
Ortho Life Hospital, Erode.
World arthritis day
• To raise awareness
• 12th October
Arthritis- Definition
• Disease causing painful inflammation and stiffness in the joints.
Arthritis- Pathology
• degradation of cartilage 
• remodelling of bone 
• release of enzymes 
• joint space is progressively lost over time.
Arthritis- Causes
1.Osteoarthritis
2.Rheumatoid arthritis
3.Gout
4.Juvenile idiopathic arthritis
5.Psoriatic arthritis
6.Reactive arthritis
7.Septic arthritis
Arthritis- Clinical features
• Pain areas: in the joints, ankle, back, fingers, hands, muscles, neck,
or wrist
• Pain types: can be intermittent or sharp
• Pain circumstances: can occur while sitting
• Joints: stiffness, tenderness, or swelling
• Muscular: decreased range of motion, difficulty walking, or muscle
weakness
• Hand: bump on the finger or bony outgrowth in fingers or toes
• Whole body: fatigue or malaise
• Also common: flare, physical deformity, redness, or stiff neck
Arthritis- Investigations
• Radiological imaging
• Complete metabolic panel
• Complete blood count
• Uric acid
• Lyme serology
• Human leukocyte antigen tissue typing
• Erythrocyte sedimentation rate
• C-reactive protein
• Antinuclear antibody
• Rheumatoid factor
• Anti-cyclic citrullinated peptide
 Arthritis- Treatment

Medications
•NSAIDs. 
•Counterirritants- topical applicants. 
•Steroids. 
•Disease-modifying antirheumatic drugs (DMARDs). 
Therapy
Surgery
•Joint repair. 
•Joint replacement. 
•Joint fusion. 
Arthritis- Common type- Osteoarthritis
• Affects 80% of people after 55 years of age
• imbalance between degradative and repair mechanisms
• finger joints, knees, hips, shoulders, spine, elbow
• pain that is increased with activity, and relieved by rest
• Early morning stiffness- not more than 30 mins
• prior trauma, a congenital joint abnormality, underlying systemic
disease, or a chronic crystalline arthropathy
• tenderness on palpation, crepitus (palpable friction) with movement,
bony enlargement, abnormal alignment, decreased range of motion,
and sometimes joint effusion.
Arthritis- Common type- Osteoarthritis

Radiologic classification
0 Normal
1 Doubtful narrowing of joint space and possible osteophytic lipping
2 Definite osteophytes and possible narrowing of joint space
3 Moderate multiple osteophytes, definite narrowing of joint space, some sclerosis, and possible
deformity of bone ends
4 Large osteophytes, marked narrowing of joint space, severe sclerosis, and definite deformity of bone
ends. Subchondral cysts may be present.
Arthritis- Common type- Osteoarthritis
• Investigations
• To rule out other pathology
• Radiological
Arthritis- Common type- Osteoarthritis
• Medical management
• Non-pharmacologic
• Pharmacologic
• Surgical management
Arthritis- Common type – Rheumatoid
arthritis.
• a disease of chronic polyarticular inflammation
• Women are slightly more affected than men
• predilection for small joints
• Symmetrical involvement is typical of RA
• Rare- DIP joints and inflammatory spinal involvement
Arthritis- Common type – Rheumatoid
arthritis- Diagnosis
• Morning stiffness for at least one hour and present for at least 6
weeks
• Swelling of three or more joints for at least 6 weeks
• Swelling of wrist, PIP, or MCP joints for at least 6 weeks
• Symmetrical joint swelling
• Hand radiograph changes typical of RA, including erosions or
unequivocal bony periarticular decalcification
• Subcutaneous nodules
• Rheumatoid factor
Arthritis- Common type – Rheumatoid
arthritis- Investigations
• RA factor
• ANA
• Anti- CCP
• ESR
• CRP
Arthritis- Common type – Rheumatoid
arthritis
• Pharmacologic therapy
• Prevention of deformity
• Surgical
Arthritis- Common type-
Spondyloarthropathy
• include ankylosing spondylitis, inflammatory bowel disease arthritis,
reactive arthritis (Reiter's syndrome), and psoriatic arthritis
• axial (spinal) involvement
• Enthesopathy
• Pharmacological treatment
• Non-pharmacological treatment
Arthritis- Common type- Systemic Lupus
Erythematosus
• a multisystemic chronic autoimmune disease that is distinguished by
characteristic organ manifestations
• involves the musculoskeletal, cutaneous, and renal systems
• arthralgias (95%), arthritis (90%), fever (90%), fatigue (81%), skin rashes
(malar rash, discoid lupus, photosensitivity, 74%), or glomerulonephritis
(50%)
• Features similar to RA
• Anti-dsDNA and anti-Sm autoantibodies are more specific
• ANA
• Unexplained leukopenia, lymphopenia, hemolytic anemia, and
thrombocytopenia are hematologic manifestations
Arthritis- Common type- Systemic Lupus
Erythematosus
• Splints may be effective in limiting deformities and, with appropriate
exercise, may preserve function
Arthritis- Common type- Ankylosing
Spondylitis
• Inflammatory back pain, suggesting sacroiliitis and spondylitis
• age less than 40, insidious onset, duration of less than 3 months,
significant morning stiffness, and improvement with exercise
• Early loss of spinal range of motion
• Syndesmophytes –Bamboo spine
Arthritis- Common type- Juvenile Idiopathic
Arthitis (a.k.a. Juvenile Rheumatoid
Arthritis)
Arthritis- Common type- Crystal-Induced
Arthritis
• Gout “is usually sudden, occurring in the night, and is of short
duration.” “The cause of this disease is an immoderate use of
stimulating food and drinks. Plethoric persons are its most frequent
victims.”
• --R.V. Pierce, M.D., The People's Common Sense Medical Advisor
1887
• Calcium Pyrophosphate Dihydrate (CPPD) Deposition Disease
• Basic calcium phosphate
Arthritis- Prevention
Exercises play a major role and prevent morbidity to a large extent.
•Neck- isometric execises, ROM exercises
•Shoulder- Rotator cuff strengthening
•Elbow- Biceps and triceps strengthening
•Hand- General mobilisation exercises
•Back and hip- Back muscle strengthening, pelvic bridging, SLR, etc
•Knee- Quadriceps and hamstring strengthening
•Foot and ankle- Calf muscle exercises, Intrinsic exercises
Arthritis- Role of physiotherapy.
Arthritis- Role of physiotherapy.
Arthritis- Role of physiotherapy.
Arthritis- Role of physiotherapy.
Arthritis- Role of physiotherapy.
Arthritis- Role of physiotherapy.
Arthritis- Role of physiotherapy.
Arthritis- Role of physiotherapy.