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ARTHRITIS.pptx Prepared by monika gopal Tutor

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This document provides information on different types of arthritis including osteoarthritis, rheumatoid arthritis, gout arthritis, and septic arthritis. It discusses the causes, risk factors, symptoms, diagnostic testing, treatment options both non-surgical and surgical, and management for each type. For osteoarthritis, it outlines how it is caused by aging and joint damage over time and affects older individuals. Rheumatoid arthritis is an autoimmune disease that causes swelling and damage to joint lining and can affect hands and feet. Gout arthritis occurs when uric acid crystals accumulate in joints, often affecting the big toe. Septic arthritis involves a joint infection from bacteria or other pathogens.

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Prepared by MONIKA GOPAL
TYPES osteoarthritis Rheumatoid arthritis Gout arthritis Septic arthritis
Osteoarthritis is a degenerative joint disease of diarthrodial (synovial) joint, characterized by breakdown of articular cartilage and proliferatative changes of bones. Osteoarthritis (OA) is the most common joint disorder. It is due to aging and wear and tear on a joint.
PRIMARY OSTEOARTHRITIS SECONDARY
AGE: _ Osteoarthritis usually starts from the late 40s onwards. This may be due to bodily changes that come with ageing, such as weakening muscles, weight gain, and the body becoming less able to heal itself effectively. GENDER:- For most joints, osteoarthritis is more common and more severe in women. OBESITY :-Being overweight is an important factor in causing osteoarthritis, especially in weight-bearing joints such as the knee and the hip JOINT INJURY :- A major injury or operation on a joint may lead to osteoarthritis in that joint later in life. Normal activity and exercise dont cause osteoarthritis, but very hard, repetitive activity or physically demanding jobs can increase your risk. JOINT ABNORMALITIES:- If you were born with abnormalities or developed them in childhood, it can lead to earlier and more severe osteoarthritis than usual.
Pain:- Affected joints might hurt during or after movement. Stiffness :-Joint stiffness might be most noticeable upon awakening or after being inactive. Tenderness:- Your joint might feel tender when you apply light pressure to or near it. Loss of flexibility:-You might not be able to move your joint through its full range of motion. Grating sensation.:-You might feel a grating sensation when you use the joint, and you might hear popping or crackling. Swelling:- This might be caused by soft tissue inflammation around the joint.
ARTHRITIS.pptx Prepared by monika gopal Tutor
History examination X Ray Blood test MRI
Medication: Over-the-counter (OTC) pain relievers can help reduce pain and inflammation. You might need medication you take by mouth or topical pain relievers (creams, ointments or patches you put on your skin near your affected joints). Exercise: Moving your joints can relieve stiffness and strengthen the muscles around them. Low-impact activities like swimming, weight training can all help. Your provider might recommend that you work with a physical therapist. Supportive devices: Wearing shoe inserts or a brace can support and stabilize your joints. Using a cane or walker can take pressure off your affected joints and help you move safely. Heat and cold therapies: Applying heat or cold to your affected joints might help relieve pain and stiffness. Your provider will tell you how often (and for how long) you should apply a heating pad, ice packs or a cool compress. NSAIDs
ARTHRODESIS:- surgical immobilization of joint by fusion of bones. Arthrodesis (Fusion)In this process, any diseased cartilage between the two bones is removed, the bone ends are cut off, and the two bone ends are connected to one another using metal internal fixation, such as screws and plates JOINT REPLACEMENT:-surgical procedure to replace some or all of a joint. surgeon will remove the worn-out or damaged parts of your natural joint and replace them with an artificial joint (a prosthesis) made of metal, plastic or ceramic. Total joint replacement (total arthroplasty): During a total joint replacement, your surgeon will replace all the parts of your joint with a prosthetic joint.
Partial joint replacement (partial arthroplasty): A partial joint replacement surgeon will replace only some parts of your joint.
DEFINITION:-It is chronic inflammatory autoimmune disease of joint in which destruction of connective tissue and synovial membrane with in joint.
Exact cause unknown, RA caused by combination of genetics, hormones and environmental factors. Infection, smoking or physical or emotional stress may be triggering. Most common RA is PIP (proximal intes phalangeal joint) MCP (Meracarpo- phalangeal joint)
Polyarthritis (synovitis) of hand stiffness Limited joint ROM Fever Warm swellon joint fatigue
ARTHRITIS.pptx Prepared by monika gopal Tutor
ARTHRITIS.pptx Prepared by monika gopal Tutor
Ulnar deviation: fingerpiont toward ulnar side Z - thumb
History taking Physical examination CT SCAN MRI USG Antibody test - Rheumatic factor (normal 0 to 39 IU/ml Weakly reactive 40 to 79 IU/ml Reactive higher than 80 IU/ml CRP ESR
Pharamacological Management:- 1.DMARDs (Disease modifying anti Rheumatic drug)- used to slow or stop immune system attacking joints. Help Relieve inflammation32 methotrexate sulfasalazine Hydroxychloroquine 2.NSAIDs 3.Cortisteroids Non pharmacological management:- Provide ROM Apply parrafinbath(mixture of 15-30ml mineral oil to 1 pound of paraffin wax) Avoid weight bearing on inflamed joint
ARTHRODESIS:-Arthrodesis (Fusion)In this process, any diseased cartilage between the two bones is removed, the bone ends are cut off, and the two bone ends are connected to one another using metal internal fixation, such as screws and plates. SYNOVECTOMY:-is a procedure where the synovial tissue surrounding a joint is removed. This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone ARTHROPLASTY (joint replacement)
Joints can become infected through spread of pathogens from other parts of the body (hematogenous spread) or directly through trauma or surgical instrumentation, causing septic arthritis. single knee or hip joints are most commonly infected in patients with septic arthritis,
Gram positive organism common eg. Staphylococcus aureus , streptococcus ,H.influenza . risk include older adults, particularly those older than 80 years; people with comorbid conditions such as diabetes, rheumatoid arthritis, skin infection, or alcoholism. people with a history of a joint replacement or other joint surgery or IV drug abuse. S. aureus is the most common cause of joint infections in all age groups, followed by other Gram- positive bacteria, including streptococci. Gonococcal infection may cause septic arthritis through hematogenous spread
painful, warm swollen joint with decreased range of motion. Systemic chills, fever, and leukocytosis are sometimes present
History taking Physical examination ESR Fluid analysis
Prompt treatment is essential and may save the prosthesis for patients who have had joint replacement surgery or prevent sepsis. Broad-spectrum IV antibiotics are started promptly and then changed to organism-specific antibiotics after culture results are available The IV antibiotics are continued until symptoms resolve. The synovial fluid is aspirated and analyzed periodically for sterility and decrease in WBCs. The primary provider may aspirate the joint with a needle to remove excessive joint fluid, exudate, and debris. Occasionally arthrotomy or arthroscopy is used to drain the joint and remove dead tissue
Gout a painful metabolic disorder involving an inflammatory reaction within the joints, usually affects the feet (especially the great toe), hands, elbows, ankles and knees.
Abnormal purine metabolism.Increased rate of protein synthesis with overproduction of uric acid or underexcertion of uric acid. Excessive ingestion of purines (organs meats, shell fish,sardines). Increased cellular turnover, as in leukemia, multiple myeloma other cancers. Altered renal tubular function
Increased Uric acid Deposition of uric acid in soft bony tissue It cause local inflammation and irritation Collection of urate (salt and uric acid) called tophi are found in cartilage of the out ear, (pinna) joints, ligaments, bursae and tendons These deposit accumulate, they destroy the joins Chronically swollen
Sudden onset of acute pain and tenderness in one joint. The skin turns red and the joints swells so that it is warm and hypersensitive to touch. Fever. Tophi may be palpated around the fingers or earlobes particularly if the client has chronic and severe hyperuricemia The attack may last 1 to 2 week, but moderate swelling and tenderness may persist beyond that time. Repeated episodes in the same joints may deform the joint. Pruritis
History and physical examination. Synovial fluid aspiration with the help Needle-like monosodium urate crystals in synovial fluid (shown by needle aspiration) or tissue sections of tophaceous deposits hyperuricemia Elevated 24-hour urine uric acid (usually higher in secondary than in primary gout). X-rays initially normal; in chronic gout, damage of articular.
Gout is not curable condition Encourage a high intake of fluids to prevent renal stone The aim of the treatment is to decrease the amount of sodium urate in the extracellular fluid so that deposit do not from Using uricosuric drugs that promotes renal execrtion of urates by inhibiting the reasbsoprtion of uric acid in the renal tubules. Decreasing the ingestion of purine
PHARMACOLOGICAL MANAGEMENT Maintenance dosage of allopurinol (Zyloprim) to suppress uric acid formation or control uric acid levels, preventing further attacks (use cautiously in patients with renal failure). Colchicine to prevent recurrent acute attacks until uric acid returns to its normal level Immobilization and protection of the inflamed, painful joints
SURGICAL MANAGEMENT Surgery is performed to remove the large tophi of advanced gout. The three main types of surgery for more advanced gout include 1. tophi removal, 2. joint fusion, and 3. joint replacement.

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ARTHRITIS.pptx Prepared by monika gopal Tutor

  • 3. Osteoarthritis is a degenerative joint disease of diarthrodial (synovial) joint, characterized by breakdown of articular cartilage and proliferatative changes of bones. Osteoarthritis (OA) is the most common joint disorder. It is due to aging and wear and tear on a joint.
  • 5. AGE: _ Osteoarthritis usually starts from the late 40s onwards. This may be due to bodily changes that come with ageing, such as weakening muscles, weight gain, and the body becoming less able to heal itself effectively. GENDER:- For most joints, osteoarthritis is more common and more severe in women. OBESITY :-Being overweight is an important factor in causing osteoarthritis, especially in weight-bearing joints such as the knee and the hip JOINT INJURY :- A major injury or operation on a joint may lead to osteoarthritis in that joint later in life. Normal activity and exercise dont cause osteoarthritis, but very hard, repetitive activity or physically demanding jobs can increase your risk. JOINT ABNORMALITIES:- If you were born with abnormalities or developed them in childhood, it can lead to earlier and more severe osteoarthritis than usual.
  • 6. Pain:- Affected joints might hurt during or after movement. Stiffness :-Joint stiffness might be most noticeable upon awakening or after being inactive. Tenderness:- Your joint might feel tender when you apply light pressure to or near it. Loss of flexibility:-You might not be able to move your joint through its full range of motion. Grating sensation.:-You might feel a grating sensation when you use the joint, and you might hear popping or crackling. Swelling:- This might be caused by soft tissue inflammation around the joint.
  • 8. History examination X Ray Blood test MRI
  • 9. Medication: Over-the-counter (OTC) pain relievers can help reduce pain and inflammation. You might need medication you take by mouth or topical pain relievers (creams, ointments or patches you put on your skin near your affected joints). Exercise: Moving your joints can relieve stiffness and strengthen the muscles around them. Low-impact activities like swimming, weight training can all help. Your provider might recommend that you work with a physical therapist. Supportive devices: Wearing shoe inserts or a brace can support and stabilize your joints. Using a cane or walker can take pressure off your affected joints and help you move safely. Heat and cold therapies: Applying heat or cold to your affected joints might help relieve pain and stiffness. Your provider will tell you how often (and for how long) you should apply a heating pad, ice packs or a cool compress. NSAIDs
  • 10. ARTHRODESIS:- surgical immobilization of joint by fusion of bones. Arthrodesis (Fusion)In this process, any diseased cartilage between the two bones is removed, the bone ends are cut off, and the two bone ends are connected to one another using metal internal fixation, such as screws and plates JOINT REPLACEMENT:-surgical procedure to replace some or all of a joint. surgeon will remove the worn-out or damaged parts of your natural joint and replace them with an artificial joint (a prosthesis) made of metal, plastic or ceramic. Total joint replacement (total arthroplasty): During a total joint replacement, your surgeon will replace all the parts of your joint with a prosthetic joint.
  • 11. Partial joint replacement (partial arthroplasty): A partial joint replacement surgeon will replace only some parts of your joint.
  • 12. DEFINITION:-It is chronic inflammatory autoimmune disease of joint in which destruction of connective tissue and synovial membrane with in joint.
  • 13. Exact cause unknown, RA caused by combination of genetics, hormones and environmental factors. Infection, smoking or physical or emotional stress may be triggering. Most common RA is PIP (proximal intes phalangeal joint) MCP (Meracarpo- phalangeal joint)
  • 14. Polyarthritis (synovitis) of hand stiffness Limited joint ROM Fever Warm swellon joint fatigue
  • 17. Ulnar deviation: fingerpiont toward ulnar side Z - thumb
  • 18. History taking Physical examination CT SCAN MRI USG Antibody test - Rheumatic factor (normal 0 to 39 IU/ml Weakly reactive 40 to 79 IU/ml Reactive higher than 80 IU/ml CRP ESR
  • 19. Pharamacological Management:- 1.DMARDs (Disease modifying anti Rheumatic drug)- used to slow or stop immune system attacking joints. Help Relieve inflammation32 methotrexate sulfasalazine Hydroxychloroquine 2.NSAIDs 3.Cortisteroids Non pharmacological management:- Provide ROM Apply parrafinbath(mixture of 15-30ml mineral oil to 1 pound of paraffin wax) Avoid weight bearing on inflamed joint
  • 20. ARTHRODESIS:-Arthrodesis (Fusion)In this process, any diseased cartilage between the two bones is removed, the bone ends are cut off, and the two bone ends are connected to one another using metal internal fixation, such as screws and plates. SYNOVECTOMY:-is a procedure where the synovial tissue surrounding a joint is removed. This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone ARTHROPLASTY (joint replacement)
  • 21. Joints can become infected through spread of pathogens from other parts of the body (hematogenous spread) or directly through trauma or surgical instrumentation, causing septic arthritis. single knee or hip joints are most commonly infected in patients with septic arthritis,
  • 22. Gram positive organism common eg. Staphylococcus aureus , streptococcus ,H.influenza . risk include older adults, particularly those older than 80 years; people with comorbid conditions such as diabetes, rheumatoid arthritis, skin infection, or alcoholism. people with a history of a joint replacement or other joint surgery or IV drug abuse. S. aureus is the most common cause of joint infections in all age groups, followed by other Gram- positive bacteria, including streptococci. Gonococcal infection may cause septic arthritis through hematogenous spread
  • 23. painful, warm swollen joint with decreased range of motion. Systemic chills, fever, and leukocytosis are sometimes present
  • 24. History taking Physical examination ESR Fluid analysis
  • 25. Prompt treatment is essential and may save the prosthesis for patients who have had joint replacement surgery or prevent sepsis. Broad-spectrum IV antibiotics are started promptly and then changed to organism-specific antibiotics after culture results are available The IV antibiotics are continued until symptoms resolve. The synovial fluid is aspirated and analyzed periodically for sterility and decrease in WBCs. The primary provider may aspirate the joint with a needle to remove excessive joint fluid, exudate, and debris. Occasionally arthrotomy or arthroscopy is used to drain the joint and remove dead tissue
  • 26. Gout a painful metabolic disorder involving an inflammatory reaction within the joints, usually affects the feet (especially the great toe), hands, elbows, ankles and knees.
  • 27. Abnormal purine metabolism.Increased rate of protein synthesis with overproduction of uric acid or underexcertion of uric acid. Excessive ingestion of purines (organs meats, shell fish,sardines). Increased cellular turnover, as in leukemia, multiple myeloma other cancers. Altered renal tubular function
  • 28. Increased Uric acid Deposition of uric acid in soft bony tissue It cause local inflammation and irritation Collection of urate (salt and uric acid) called tophi are found in cartilage of the out ear, (pinna) joints, ligaments, bursae and tendons These deposit accumulate, they destroy the joins Chronically swollen
  • 29. Sudden onset of acute pain and tenderness in one joint. The skin turns red and the joints swells so that it is warm and hypersensitive to touch. Fever. Tophi may be palpated around the fingers or earlobes particularly if the client has chronic and severe hyperuricemia The attack may last 1 to 2 week, but moderate swelling and tenderness may persist beyond that time. Repeated episodes in the same joints may deform the joint. Pruritis
  • 30. History and physical examination. Synovial fluid aspiration with the help Needle-like monosodium urate crystals in synovial fluid (shown by needle aspiration) or tissue sections of tophaceous deposits hyperuricemia Elevated 24-hour urine uric acid (usually higher in secondary than in primary gout). X-rays initially normal; in chronic gout, damage of articular.
  • 31. Gout is not curable condition Encourage a high intake of fluids to prevent renal stone The aim of the treatment is to decrease the amount of sodium urate in the extracellular fluid so that deposit do not from Using uricosuric drugs that promotes renal execrtion of urates by inhibiting the reasbsoprtion of uric acid in the renal tubules. Decreasing the ingestion of purine
  • 32. PHARMACOLOGICAL MANAGEMENT Maintenance dosage of allopurinol (Zyloprim) to suppress uric acid formation or control uric acid levels, preventing further attacks (use cautiously in patients with renal failure). Colchicine to prevent recurrent acute attacks until uric acid returns to its normal level Immobilization and protection of the inflamed, painful joints
  • 33. SURGICAL MANAGEMENT Surgery is performed to remove the large tophi of advanced gout. The three main types of surgery for more advanced gout include 1. tophi removal, 2. joint fusion, and 3. joint replacement.