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Rheumatological
What meds will someone take for
low bone density?
Fosamax
Non Steroidal anti-inflammatories
Rheumatoid Arthritis
What is it? Chronic, inflammatory disorder which mainly attacks synovial
joints (but may affect many tissues a& organs)
F to M 3:1
Age Range 20-70
Typical Age 40 - 50 years
S&S morning stiffness for more than 30 min
malaise
arthritis in 3+ joints and soft tissue swelling
arthritis in hand joints rheumatoid nodules (found at elbow or wrist)
symmetrical arthritis
fever
What kind of investigations to
confirm
positive RF
Increased ESR
Increased WBC count
Increased CRP
X ray changes with erosions esp. in wrist hands and feet
Which joints does initially RA affect? 75% at the joints of the hands, wrist and feet
30% at the large joints
Red= more common
Cause / aetiology unknown, considered multi-factorial, with genetic,
environmental and hormonal factor
What is Pannus? Vascularised granulation tissue (rich in fibroblasts,lymphocytes & macrophages) derived from synovial tissue,which overgrows the surface of joint
What is the pathology of RA? Auto-immune response triggered (normal tissue targeted)
Inflammatory reaction in the synovium (& subsequent joint
damage)
Synovium then develops a PANNUS (associated with the
breakdown of the articular surface)
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Effusion distends the capsule & stretches ligaments
Laxity, joint deformity and rheumatoid nodules
Describe what happens to the joint
In brief terms what can happen to
hands with RA?
Differential Diagnosis for RA Gout, OA, SLE ,Psoriatic Arthritis ,Reactive Arthritis
Ankylosis SPondilitisWhat are the TTT goals for RA? Relieve pain
Reduce inflammation
Slow down or haltjoint damage
Improve sense of well being & ability to function
Sjogrens Syndrome
What is it? Autoimmune disease; characterised by inflammation of
exocrine glands that produce tears and saliva
What is its aetiology? Unknown, possible link with HLA DR3?
How prevalent is it in the
population?
Prevalence 1-3%
What is the male to female ratio? Female-Male ratio 9:1
What is the typical age group? 5060
What are the classifications? Primarya disease in its own right
Secondaryas a result of another disease
What other diseases may cause
secondary?
Association with RA, SLE, systemic sclerosis, chronic
acute hepatitis,
What are the symptoms? Dry Mouth - difficulty swallowing or talking for long
periods, tongue fissures, dental caries, oral candidiasis
Dry Eyes - less tears, dry, gritty, reddened
RA - episodic arthritisVaginal Dryness
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Systemic: fever, weight loss, fatigue, Raynauds
Sarcoidosis
What is sarcoidosis? An autoimmune disease in which abnormal collections of chronicinflammatory cells (granulomas) form in multiple organs.
What is its Aetiology? Unknown; environmental, genetic factors link with HLAB8 DR3
AGE 10-40years
S&S May be assymptomatic
Common symptoms are:
Fatigue unchanged by sleep
Lack of energy
Weight loss
Aches & pains
Arthritis
Dry eyes SOB
Blurry vision
Rashes and noduli
Diagnosis Chest x-ray or CT scann
Whatd a hand xray look like? Hand x-ray reveals osseous erosions bilaterally.
Swollen fingersArrows: granulomous erosion
OA
What is it? A degenerative condition of synovial joints affecting the
articular cartilage and subchondral bone.
S&S Joint pain, tenderness, stiffness, locking and effusionCauses Hereditary, mechanical, metabolic, developmental
http://en.wikipedia.org/wiki/Granulomashttp://en.wikipedia.org/wiki/Granulomashttp://en.wikipedia.org/wiki/Granulomashttp://en.wikipedia.org/wiki/Granulomas7/30/2019 Rheumatological
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Progression Slow
Explain the process?
BS RED
1. Breakdown of articular surface cartilage becomes
fissured. Small particles of cartilage of break of down
2. Synovial Irritation
Friction from cartilage particles causes the release ofinflammatory mediators
3. Remodelling
Cartilage is slow to repair due to its poor bloods supply. The
increased pressure on the bone causes excessive subchondral
activity causes increase in bone cells and density giving rise
to osteophytes.
4. Eburnation of bone & cyst formation:
Eventually cartilage layer may be completely eroded. This
causes bone on bone contact pain & the exposed bonebecoming polished & eburnated. This causes changes in
structure & overloads certain parts of the joint causing micro-
fracture in the cancellous (spongy/less dense bone). Healing
via callus formation leading to increased rigidity, increased
density & reduced resilience, in turn there are more micro
fracture
5. Disorganisation
Cells grow back in a disorganised
What is the common demographic
for O/A?
The 4 Fs:
Female Fat
Forty
Fair (Caucasian)
What different physiological
stages/events may occur?
How is O/A classified? Primary O/A(no specific underlying cause)
Secondary O/A(secondary to an identifiable cause) Metabolic: calcium crystal deposition, acromegal
Inflammatory: A/S, septic arthritis
Congenital / Developmental: Perthes disease, slippedupper femoral epiphysis, CDH
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Traumatic:joint trauma, surgery, chronic injury,
neuropathic
What are the risk factors? increasing age, gender, obesity
trauma, repetitive occupational trauma
genetic factors, history of inflammatory arthritis, metabolic
disorderneuromuscular disorder, infection
Which joints are normally involved? Typically the weight bearing joints & hands
How is the patients general health? Systemically well
What is the character of their pain? Often burning or aching in character
What is their pain pattern like? Worse after activity or at the end of the day
What is causing the pain? Inflammatory mediators, intra-articular hypertension,
bursitis, enthesis pain (tendinous attachment to bone), muscle
weakness, lack of use
Relieved by? Relieved by rest
What is the joints quality of motion
like?
Joints feel stiff to move, patients occasionally mention
clicking or crepitus
Is their any weakness? Weakness is usually a secondary issue due to lack of muscle
activity
What are Herbedens Nodes? Heberdens nodes often affects the base of thumb & DIP
joints. Initially are red, swollen & tender, over time swellings
become firm & painless. Despite the nodes function is usuall
good, however the thumb may be a persistent problem.
Typical of OA
What should you observe for? Observation look for altered weight bearing, joint deformity
muscular wasting (secondary to disuse) swelling of whole
joint often with effusion
What should you palpate? Palpate for swelling often with effusion, crepitus on
movement and ROM or joint deformity
What is the aim of osteopathic OA
TTT?
Given that there is no cure for osteoarthritis
Aim of treatment: reducing pain levels
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maintain function
develop muscle strength (OA knees)
Hip OA
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