JOINT SYNDROME

Osteoarthritis Rheumatoid Arthritis SLE Gout

Osteoarthritis

Osteoarthritis is a non-inflammatory, degenerative condition of joints Characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes.

Common in weight-bearing joints such as hip and knee.

Also seen in spine and hands. Both male and females are affected. But more common in older women i.e. above

50 yrs,particularly in postmenopausal age.

Risk factors Obesity esp OA knee

Abnormal mechanical loading eg.meniscectomy, instability

Inherited type II collagen defects in premature polyarticular OA

Inheritance in nodal OA

Occupation eg farmers

Infection:Non-gonococcal septic arthritis

Hereditary

Poor posture

Injured joints

Ageing process in joint cartilage

Defective lubricating mechanism

Incompletely treated congenital dislocation of hip

Classification of Osteoarthritis

1- Localized –Ankle / knee/ hip/ spine/ hands2- Generalized3- Erosive4- Crystal associated OA

According to Nodules1- Nodular (Haberden’s, Bouchard’s)2- Non-Nodular

X-Ray Classification of OA

1- No Osteophytes / Minimal changes2- Single osteophytes / Subchondrial sclerosis / Widening3- Significant narrowing, Multiple osteophytes4- Narrowing osteophytes, Deformity, Ankylosis

According to Limitation of Activity

1- Patient is able to do physical activity2- Moderate decrease of physical activity3- Significant decrease of physical activity4- Total Ankylosis and no activity

Clinical features of OA

Pain Stiffness Muscle spasm Restricted movement Deformity Muscle weakness or wasting Joint enlargement and instability Crepitus • Joint Effusion

Pain syndrome

•Morning stiffness <20 mins•Pain is worst at the end of the day•Present muscular spasms•Inflammatory sinovits

Movement abnormalities‘Gelling’: stiffness after periods of

inactivity, passes over within minutes (approx 15min.) of using joint again

Coarse crepitus: palpate/hear (due to flaked cartilage & eburnated bone ends)

DeformitiesSoft tissue swelling:

○mild synovitis ○small effusions

OsteophytesJoint laxityAsymmetrical joint destruction leading to angulation

Osteoarthritis of the DIP joints. This patient has the typical clinical findings of advanced OA of the DIP joints, including large firm swellings (Heberden’s nodes), some of which are tender and red due to associated inflammation of the periarticular tissues as well as the joint.

Knee joint effusion

Special Investigations

Blood tests: Normal

Radiological features:Cartilage lossSubchondral sclerosisCystsOsteophytes

COMPLAINSa.Patient complains of pain of

insidious onset in the knee joints. The pain is aching and poorly localized.

b.Pain first occurs after normal joint use and can be relieved by rest. As the disease progresses, pain during rest develops. Morning stiffness lasts less than a half hour.

c. Systemic symptoms are absent.

varus angulation of the knee joints

Hallux valgus deformation

Varus angulation of the knee joints

RESULTS OF ANALYSES

CBA- without pathology CUA- without pathology CRP 3 mg/l Synovial fluid is

noninflammatory with less than 2000 white blood cells/mm3

OA-Plus tissue diseas(osteophytes)

X-ray of painful knee joint

PLAN OF TREATMENT?

TREATMENT

A. Correction of predisposing factors

B. Patient education

C. Joint rest1. Obesity. Weight reduction is important.2. Malalignment. Valgus-varus knee deformity and

eversion-inversion ankle deformity may require surgical correction.

3. Occupational changes may be necessary to protect diseased joints.

D. Physical therapy1. Therapeutic exercise. 2. Heat generally relieves pain and muscle spasm.

E. Occupational therapy

Drug therapy

•AnalgesicsAcetaminophen

1.Nonsteroidal anti-inflammatory drugs

Choice of NSAID. Salicylates.

- Enteric-coated aspirin. - Salsalate

Indoleacetic acid. Oxicam. Propionic acid. Fenamic acid. Pyrazolone.

NIMESULIDE

LORNOXICAM

Less than 3 days. For sharp pain

PATHOGENETICAL THERAPY

Chondroprotection a) systemic - 1500mg atleast 1yr,

glucosamine, chondroitin sulfate, (most slowly influencing drugs

b) local- Intrarticular injections (Hyaluronic acid, ) ), Traumeel, Alflutop) (A joint should not be injected more than 3 times a year. Intraarticular corticosteroids have an adverse effect on local car-tilage metabolism. )

Surgery

1. Indicationsa. Relief of pain or severe

disability after failure of conservative measures to reverse or alleviate the pathologic process.

b. Correction of mechanical derangement that may lead to OA.

Contraindicationsa. Infection.b. Poor vascular supply.c. Emotional instability or occupational

factors that make surgical rehabilitation unlikely to succeed.

d. Obesity (relative contraindication).e. Serious medical illness (relative

contraindication).

Knee proceduresf. Osteotomy.g. Arthrodesis.h. Total knee prosthesis.i. Arthroscopic debridement.

Hipa. Osteotomy. b. Excision arthroplasty. .c. Arthrodesis. d. Total hip replacement

Joint replacement surgery (arthroplasty)

THANK YOU

Manj -2012 KSMU