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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