Scribd Logo
Upload

Welcome to Scribd!

  • 4 views

    Approach To Arthritis

    Uploaded by

    161220207

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd

    Approach To Arthritis

    Uploaded by

    161220207
    4 views19 pages

    Original Title

    Approach to arthritis

    Copyright

    © © All Rights Reserved

    Available Formats

    KEY, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    4 views19 pages

    Approach To Arthritis

    Uploaded by

    161220207

    Copyright:

    © All Rights Reserved
    Download as KEY, PDF, TXT or read online from Scribd
    Download as key, pdf, or txt
    of 19

    Welcome

    An approach to arthritis
    In this lecture you will be introduced to the types of arthritis
    their causes and how to deal with a patient of arthritis
    Arthralgia is pain in a joint

    100 types

    Arthritis is Non-inflammatory like osteoarthritis


    greek for Inflammatory
    “disease of 1. Autoimmune induced (destructive and non-
    the joints” destructive)

    2. Crystal deposition induced

    3. Infection induced
    Contributary factors:

    Advanced age

    Osteoarthri Female sex

    tis 1886 Joint trauma

    Obesity

    Genetics (Genes encoding collagen)


    Contributary factors:

    Rheumatoi 1. Interplay between several genetic factors


    d arthritis (HRLDRB1 and others)

    2. Environmental factors (Smoking)


    Causes:

    1.Undersecretors

    2. Genetic less then 10%

    Contributing factors:
    Gout Male sex

    Advancing age

    Chronic kidney disease

    Alcoholism

    Drugs like diuretics


    Gram positive Staphylococcus aureus

    Gram negative

    Septic Trauma

    arthritis Intravenous drug use

    Immunosuppression

    Extremes of age
    Osteoarthritis: Progressive cartilage loss causing bone damage

    Rheumatoid : Endothelial cell activationand synovial hyperplasia


    Pathophysi Gout : Needle shaped crystals induce interleukin-1

    ology Septic : Triggered release of cytokines by monobacterial infection

    All are caused by activation of cytokines, chemokines and/or proteolytic


    enzymes
    Articular or non-articular or both e.g. fibromyalgia

    Pain, swelling,loss of function,stiffness,deformity,weakness,instability = arthritis

    Morning stiffness 45 min and pain, evening pain versus diffuse all over

    1. Onset: Insidious versus acute

    History and 2. Number of joints involved: Mono-oligo (2-4), polyarticular

    physical 3. Symmetry (Asymetric, oligoarthritis think of HLA-B27)

    4.Distribution:Axial or peripheral

    5.Pattern: Progressive additive, migratory, intermittent

    6. Age of onset

    7. Associated skin rash


    Inflammatory markers ESR, CRP

    Complete blood count: WBC,HGB,PLT

    Uric acid

    Rheumtoid factor, Anti-citrullinated peptide


    antibodies,ANA,dsDNA

    Synovial fluid analysis, exam, culture, PCR


    Evaluation Xrays ( Always from both joints)

    Ultrasound

    CT scan

    MRI

    Nuclear scan

    Ultrasound guided aspiration


    Limit pain, improve function,if possible cure

    Non-pharmocological:

    Specific exercises

    Treatment/ Physical therapy

    Manageme Bracing
    nt Acupuncture

    Weight reduction

    Meditation

    Leeches
    Pharmacologic

    Local (extra- or intrarticular)or systemic therapy

    NSAID

    Treatment / Capsaicin
    Manageme Duloxetine
    nt Coticosteroids

    DMARD (Disease modifying antirheumatic drugs)

    Biologics like tumor necrosis factor antibody

    Surgical joint replacement


    Nurse ( Education to enhance compliance, stop
    smoking and alcohol)
    Comprehen Dietician (Loss of weight)
    sive
    healthcare Rheumatologist

    an Physical therapist (Water based approach)

    interprofess Orthopedic surgeon


    ional Pain specialist
    approach
    Pharmacist

    Internist

    You might also like