1. RHEUMATIC DISEASES: DEFINITIONS AND CLASSIFICATIONS Dr. Femi Adelowo, FMCP, FWACP,FACR,FRCP Edin FRCP Lond Professor of Medicine and Consultant Rheumatologist, LASUTH. Ikeja

2. INTRODUCTION MISCONCEPTIONS 1.Arthritis is not one disease: more than 200 types or causes 2.Arthritis is not exclusive disease of elderly 3.Arthritis affects all age groups 4- Rheumatology is the specialty of Internal Medicine that deals with diagnosis and management of all types of arthritis,as well as systemic auto immune Connective Tissue Diseases 5. Arthritis affects hard tissue of joints and synovial membrane while rheumatism(soft tissue,non articular) involves capsule,tendon,ligaments,muscles. Rheumatologist treats medically, Orthopaedic Surgeon treats with surgery.They are both complimentary, as well as other medical personnel-Physiotherapist,occupational therapists,nutritionist,podiatrist etc

3. CONTD The word - Rheumatic derived from the word Rheuma In Broad usage - refers to diseases of the joints Arthritis and Rheumatism

4. EXTENT OF ARTHRITIS 355 million people have different types of arthritis world wide By year 2025, degenerative joint diseases will be most common cause of physical disability Socio economic impact of rheumatic diseases on the rise

5. CONTD USA – 315 million physician visits per year 8 million hospital admissions per year 17 million people with activity limitation Prevalence in a rural Nigeria community – 31%

6. HEALTH IMPACT. Decreased physical functioning -Increased psychological distress -Decreased social functioning -Increased health care utilization -Increased work disability

7. CLASSIFICATION 1.DEGENERATIVE ARTHRITIS – Osteoarthritis – Spondylosis- Cervical, Lumbar – D I S H. Diffuse Idiopathic Skeletal Hyperostosis 2. CONNECTIVE TISSUE DISEASES(SYSTEMIC AUTO IMMUNE) Undifferentiated, Overlap, MCTD Systemic Lupus Erythematosus Anti phospholipid syndrome Scleroderma Dermatomyositis/ Polymyositis (Inflammatory Myositis) Sjogren’s syndrome

8. CONTD CHARACTERISTICS 1 Female preponderance 2. Overlap 3. Familiar clustering 4. Multisystemic 5. High acute phase proteins – ESR, CRP 6. HLA typing SLE- HLA DR2,3 SSc DR 3,5 PM DR 3 7. Serological-RF. ANA, DNA, ENA, Ro, La, Sm, RNP 8. Good response to steroids/immunosuppressives

9. CONTD 3. INFLAMMATORY ARTHRITIS A. Rheumatoid Arthritis(seropositive) B.SPONDYLO ARTHROPATHY(seronegative) Ankylosing Spondylitis

10. CONTD – Psoriatic arthropathy – Reiter’s disease – Inflammatory Bowel arthropathy – Undifferentiated

11. CHARACTERISTICS OF SPONDYLOARTHROPATHY Male preponderance Buttock pain - Sacro– iliitis Uveitis Back pain associated with stiffness(inflammatory) Oligoarthropathy – large joints lower limbs Association with urethritis and diarrhea HLA B – 27 positive Good response to NSAIDs

12. CLASSIFICATION CONTD JUVENILE CHRONIC(IDIOPATHIC ARTHRITIS) Systemic Pauciarticular Polyarticular Juvenile SLE Juvenile Dermatomyositis

13. CLASSIFICATION CONTD 4INFECTIVE ARTHRITIS – All infective agents including TB.Staph,Strept, Gonococci 5.REACTIVE ARTHRITIS – Reiter’s Disease – Rheumatic fever – Post streptococcal Arthritis

14. CONTD 6.VASCULITIS(Pauci immune complexes) Primary or Secondary Systemic or Cutaneous – Large vessel- Giant Cell arteritis, Takayasu – Medium vessel-Polyarteritis nodosa, Behcet’s Disease, Kawasaki – Small vessel(AASV)- Wegeners Granulomatosis, Churg-Strauss, Microscopic Polyangiitis. – Secondary vasculitis- RA,SLE,HIV,HCV,HBV Syphilis,Drugs-(sulphonamides, ofloxacin),infections meningococcus,Staph,

15. CONTD 7.CRYSTAL – Gout – Pseudogout – Cholesterol 8.BONE DISORDERS – Osteoporosis – Osteomalacia

16. 9.HYPERMOBILITY SYNDROME Heritable – Ehler – Danlos Syndrome – Pseudoxanthoma Elasticum – Marfan’s Syndrome Benign Hypermobility Syndrome

17. CONTD 10.SOFT TISSUE RHEUMATISM – Bursitis – Tendinitis – Enthesopathies – De Quervain tenosynovitis – Carpal Tunnel Syndrome – Fibromyalgia Syndrome – Polymyalgia Rheumatica

18. CONTD 11.REGIONAL PAIN SYNDROMES: Backache, Shoulder pain syndrome,neck pain 12RHEUMATIC DISEASES ASSOCIATED WITH HIV/AIDS – Reiter’s Disease – Psoriatic arthropathies – Spondyloarthropathies – Rheumatoid Arthritis 13.Arthritis Associated with malignancies- Leukemia(ALL in children), multiple myeloma

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