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Osteoarthritis (Degenerative Joint Dissorder)
- Most common joint disorder affecting more than 40 million people in US
- the overall prevalence is expected to continue to grow significantly in the coming years (we are heavier w/ increased activity & older life expectancy)
- Most commonly involved the weight bearing joints (hip & knee), also includes shoulder and joints of the neck & hands (cervical spine)
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Etiology of Osteoarthritis
- Weight
- Genetics
- Biomechanics (expecially ligamentous laxity--pigon toes, locked knees, ect)
- High impact sports (increased risk w/ increased age)
- Occupational activities w/ repeated kneeling, squatting, or repetitive use of heavy equipment
- Historically considered localized disease focused on ARTICULAR CARTILAGE
- Now, likely a broader etiology more active w/ joint detruction being "cellular" rather than "wear" cause
- Once articular cartilage begins to break down, the destruction of accompanying structure becomes progressive more quickly
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Signs & Symptoms of OSTEOARTHRITIS
- Aching pain w/ weight bearing and movement
- Joint movement is limited
- Recreational and social activities become limited due to pain
- Difficulty walking
- Predisposition to falls
- Mastication and speaking difficulty w/ TMJ
- Heberden's Nodes: Bony enlargement of DIP
- Bouchard's Nodes: Bony enlargement PIP
- X rays aften reveal changes in the joint space (narrowed joint space)
- Bone Sclerosis
- Bone Cysts (fluid filled sac)--Baker's cyst, common w/ knee replacement on the posterior portion of the knee. May be drained. These are very painful.
- Osteophytes (bone spurs)
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Treatment of Osteoarthritis
- Stress on joint minimized by use of adaptive devices (cane)
- Pacing activity
- Mild exercise program to maintain fitness and joint function
- Supports such as hand brace to facilitate movement
- Orthotic inserts in shoes
- Massage Therapy
- Physiotherapy
- Acupuncture
- Occupational Therapy
- Glucosamine-chondrotin Supplements
- Injection of synthetic synovial fluid (hyaluronic acid)--SYNVISC
- NSAIDs
- Analgesics
- Surgical Joint Replacement
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Rheumatoid Arthritis
- Autoimmune Disorder
- Systemic in nature
- Characterized by period of exacerbation and remission
- Causes chronic systemic inflammatory disease
- Higher incidence in women
- Affects all ages w/ peak onset b/t 20-50yr/olds
- Often extends beyond the muskuloskeletal system w/ the systemic finding impacting cardiovascular and pulmonary systems
- More than 2 million ppl in US w/ RA
- Women who have had children and those who use oral contriceptives have a lower incidence of the diease than other similarly aged women
- May be associated w/ other auto immune dieases particularly thyroid conditions Characterized by a massive infiltration of T-Lymphocytes into the synovium
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Pathophysiology of Rheumatoid Arthritis (RA)
- 1) Synovitis: Marked inflammation, cell proliferation
- 2)Pannus Formation: Grannulation tissue spreads
- 3)Cartilage Erosion: Creates unstable joint
- 4)Fibrosis: Calcifies and obliterates joint space-->
- -->Ankylosis: Joint fixation and deformity develop if untreated
- Muscle atrophy
- Bone alignment shifts
- Muscle spasms due to inflammation/pain
- Contracture and deformity develop
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Synovitis
- Inflammation of the synovial membrane
- Painful during motion
- Accumulation of fluid in the synovial membrane
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Pannus Formation
- Membrane of granulation tissue composed of mesenchyme and bone-marrow derived cells.
- Causes cartilage destruction & bone errosion
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Cartilage Erosion
Results in loss of joint function due to instability
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Fibrosis
Calcifies and obliterates joint space
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Ankylosis
- Joint fixation and deformity develop if untreated
- (stiffness/fusion of a joint)
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Systemic Effects of Rheumatoid Arthritis
- Marked Fatigue
- Depression
- Malaise
- Anorexia
- Low-grade Fever
- Iron deficiency anemia that is resistant to iron therapy
- Generalized aching
- Generalized lymphadenopathy
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Etiology of Rheumatoid Arthritis
- Exact cause not known
- Genetic factor is present
- Familian predisposition
- Some links to viral infections
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Signs & Simptoms of Rheumatoid Arthritis
- Affected joints are extremely painful
- Stiffnes of joints
- Redness and swelling of joints
- Joint involvement includes small joints and is often bilateral
- Joint movement impaired
- Eventually joint becomes fixed and deformed
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Treatment for Rheumatoid Arthritis
- Balance b/t rest & moderate activity
- Heat and cold applications
- Physical and occupational therapy
- NSAIDs
- Glucocorticoids for severe inflammation
- Analgesia for pain
- Disease-modifying anti-rheumatic drugs-e.g. gold salts, methotrexate, hydroxychloroquine
- Biologic response (modifying agents): Infliximad, Rituximad, & Anakinra
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Juvenile Rheumatoid Arthritis
- Several different types
- Onset more acute than adults form
- Large joints frequently affected
- Still disease (systemic form): fever, rash, lymphadenopathy, hepatomegaly, joint involvement
- Second form of JRA causes polyarticular inflammation
- Third form of JRA involves 4 or fewer joints but causes uveitis (inflammation of iris, ciliary body, and choroid of eye)
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Infectious Arthritis
- Also known as septic arthritis
- Develops in single joint
- Joint red, swollen, painful decreased movement
- Direct Cause: Introduction of bacteria into joint (trauma, non-sterile, injection or surgery)
- Secondary Cause: Infection due to bacteremia
- Treated w/ antimicrobials over sustained period; often requires IV administration
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Gout
- Also know as gouty arthritis
- Results from deposits of uric acid and crystals in the joint, causing inflammtion
- Formation of tophus (large, hard nodule of urate crystals)
- Tophi cause local inflammation and occur after the first attack of gout
- Uric acid and crystal formation resulting from inadequate renal excretion, chemotherapy, metabolic abnormality, and/or genetic factor
- Inflammation causes redness, swelling & pain
- Treated by reducing uric acid levels by drugs and dietary changes
- Diagnosed by examination of synovial fluid and blood tests (use of NSAIDs produce a false negative)
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Ankylosing Spondylitis
- Chronic, progressive inflammatory condition
- Affects sacroiliac joints, intervertebral spaces, costovertebral spaces
- More common in men age 20-40
- Cause has not yet been determined (deemed an autoimmune disorder w/ genetic basis)
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Progression of Ankylosing Spondylitis
- Vertebral joints inflamed
- Fusion of joint (loss of mobility)
- Inflammation in lower back, then up spine
- Kyphosis develops
- Osteoporosis common
- Lung expansion limited
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Signs, Systemic Signs & Treatment of Ankylosing Spondylitis
- Signs: LBP (low back pain)/ morning stiffness, pain when lying down, spine becomes rigid
- Systemic Signs: Fatigue, fever, weight loss, uveitis
- Treatment: drugs to relieve pain, daily exercise, physiotherapy, and occupational therapy
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