1. Osteoarthritis & Rheumatoid Arthritis
Dr.Abdullah Al-Omran

2. NOTE : THIS PRESENTATION DOES NOT REPLACE ATTENDANCE OR INFORMATION GIVEN IN THE LECTURE.IT IS INTENDED AS A HIGHLIGHT FOR THE TOPIC

5. O.A(O.Arthrosis) 1ry or 2ry
1ry Def : degen.process of unknow etiology affecting articular cartilage of a previously healthey joint.
2ry Def ?

6. O.A(O.Arthrosis) 1ry (idiopathic): Elderly >45 yr
Wear & tear process
Factors : age , activity , obesity , heridity
sex equal

7. O.A(O.Arthrosis) 2ry causes : 1.Post traumatic :
fracture involve articulr surface incongruent joint
trauma per se
2.Inflammatory : e.g R.A
3.Metabolic Disorders e.g Gout
4.Bleeding Disorders : e.g. Haemophilia
5.Infection
6.Hormonal e.g Acromegaly , hyperthy. etc

8. Pathological changes 1.Changes in Articular cartilage
2.Changes in synovial membrane
3.Changes in subchondral bone
4.Osteophytes
5.Reduction in joint space
6.Bony deformities

9. Pathological changes

10. Joints affected
All

11. symptoms Gradual onset of : Pain Limited R.O.M Greaty sensation
Swelling
Deformity

12. Signs Tender joint line
Limited R.O.M both active & passive crepitation
Swelling
Deformity

13. O.A(O.Arthrosis)
In S.A. medial compartment affected more

15. management Depend on severity , cause , age , activity level.
I.Conservative:
1.NSAIDS
2.wt reduction
3.activity modification
4.physiotherapy(u/s,heat short wave,muscle strengthening )
5.Injections ..

16. management

17. management II.Operative :
1.Arthroscopic Washout , Debridement & microfracture .
2.High Tibial Osteotomy
3.Unicondylar knee Arthroplasty
4.Total knee Replacement

18. management

19. management

20. management

21. O.A(O.Arthrosis) New Advance in management : 1.Glucosamine Sulphate
2.mosaioplasty
3.chondrocyte transplant
4.resurfacing arthroplasty.

22. Rheumatoid Arthritis
Def: ch.inflammatory systemic disease of young age & adults,have destructive & proliferative changes in synovial membrane,periarticular structures,skeletal muscles,& perineural sheaths.

23. Joints Affected 1.PIP & MP 2.Foot joints 3.Knee 4.Wrist 5.Hip
6.Cervical spine

24. Symptoms 1.Early morning stiffness 2.Polyarthralgia 3.Weight loss
4.Fever
5.Malaise & fatigue

25. Signs Extraarticular involvement: 1.Rheumatoid nodules
2.ocular:scleritis,keratoconjunctivitis,sicca)
3.Cervical myelopathy
4.Entrapment neuropathy
5.Rheumatoid vasculitis
6.Lymphadenopathy &anemia
7.Pulmonary(pleurisy,effusion,diffuse interstitial fibrosis)

26. Signs Articular involvement: 1.Symmetrial Small Joint Involvement
2.Limited R.O.M
3.TenoSynovitis
4.Muscle wasting
5.Ulnar deviation hand
6.Swan neck deformity fingers
7.Hallux valgus

27. ACR criteria for Dx of RA
1.Morning stiffness
2.Arthritis of wrist ,MCP or PIP
3.Arthritis of 3 or more joints simultaneously (PIP,MCP,WRIST,ELBOW,KNEE,ANKLE,MTP)
4.Symmetrical Arthritis 5.RHEUMATOID NODULES
6.RHEUMATOID FACTOR +VE
7.X ray findings of wrist or hand typical of rheumatoid arthritis.
_________________________________________________________
* 4 of the 7 criteria in above 18 yr
* 1-4 : at least 6 wk duration

28. Lab. 1.Anemia ? 2.incr.ESR 3.Raised Rheumatoid factor
4.Decreased synovial fluid complement
5.Synovial fluid: Glucose, LDH,WBC etc

29. Management
1. DMAR : prevent or reduce joint destruction & improve function.
i.Glucocorticoids: local/systemic/pregnancy.
ii.MTX.
iii.hydroxychloroquine+sulfasalazine
iv.leflunomide.
v.antiTNF:etanercept,infliximab,adalimumab but ! infection & TB
vi.Cyclosporine & Azathyoprin

30. Management 2.NSAID : for PAIN only.
3.Physical therapy,occupational therapy.
4.Sx :4 pain,function & deformity.
check c-spine