3 OsteoarthritisArthritis is joint inflammation, usually accompanied by pain, swelling and changes in the structure.Arthritis can generally be divided into two major forms:Inflammatory arthritis, usually involving the synovium and mediated by inflammatory cells (e.g. rheumatoid arthritis)Non-inflammatory arthritis (e.g. primary osteoarthritis.
4 Primary osteoarthritis Primary osteoarthritis is:“slow progressive destruction of articular cartilage that affects weight-bearing joints and fingers of older persons or the joints of younger individuals subjected to trauma.”Before the age of 45: the disease mainly affects men.After age 55: osteoarthritis is more common in women.
5 Pathology:Joints commonly affected by osteoarthritis are the proximal and distal inter-phalangeal joints of the hands, knees and hips as well as the cervical and lumbar segments of the spine.
6 Osteoarthritis is characterized by: Radiologically:Osteoarthritis is characterized by:Narrowing of the joint spaceIncreased thickness of the subchondral boneSubchondral bone cystsLarge peripheral growths of bone and cartilage, called osteophytes.
9 Pathogenesis:Biomechanical: aging or wear and tear of articular cartilagesPredisposing factors includes obesity, previous joint injury, diabetes, trauma and haemarthrosis
10 Clinical Features:The involved joints may be enlarged, tender and may give crepitus sensation.There is deep achy joint pain that follows activity and is relieved by rest.
11 Discomfort is also caused by short periods of stiffness which is frequently experienced in the morning or after periods of minimal activity.Restricted joint motion indicates severe disease.Therapy includes exercise, weight loss and other supportive measures.Joint replacement may be necessary in disabling osteoarthritis.
13 Pathology: Weight bearing joints → knees, hips and spines Asymmetrical involvementDegeneration and loss of articular cartilageEburnation ( exposed bone becomes polished)Sub-chondral bone sclerosisSubchondral bone cystLoose bodies (joint mice) : free floating fragments of cartilages and boneOsteophytes (bone spurs): reactive boney outgrowths
15 Incidence: Etiology: Females>males Age: 20-40 years An autoimmune reaction in genetically susceptible individuals
16 Clinical features: Hand, wrist and ankle joints are the most involved Tends to have symmetrical involvementMorning stiffness that improves with activityFusiform swelling, redness and warmth of proximal inter-phalngeal joints
20 Pathology: Diffuse proliferative synovitis 2.Pannus formation: proliferation of the synovium and granulation tissue over the articular cartilage of the joint3.Fibrous and boney ankylosis (joint fusion)4.Joint deformities: Radial deviation of the wrist and ulnar deviation of fingers
22 Extra Articular Manifestations of RhA 1- Systemic symptoms: includes low grade fever, malaise, fatigue and weakness2- Rheumatoid nodules (25%)Subcutaneous skin nodulesUsually on extensor surfaces of the forearms or elbowComposed of central fibrinoid necrosis surrounded by epithelioid macrophages, lymphocytes and granulation tissueMay also be found in the heart valves, lungs, pleura, pericardium and spleen3-Generalized amyloidosis
24 Diagnosis of Rheumatoid Arthritis The clinical diagnosis of Rheumatoid Arthritis is based on a number of criteria such as the:Number and types of joints involved in the presence of Rheumatoid Arthritis nodulesPositivity for RF (Rheumatoid Factor)Radiographic features characteristic of the disease
26 Shared features include: Seronegativity for RFSacroiliac and vertebral involvementAsymmetric involvement of only few peripheral jointsSystemic involvement of other organs, especially the eye, heart and aortaOccur in young men
27 Ankylosing Spondylitis Ankylosing spondylitis is an inflammatory arthropathy of the vertebral column and sacroiliac joints.It may be accompanied by asymmetric, peripheral arthritis (30% of patients) and systemic manifestations.It is most common in young men, with a peak incidence at about age 20.
28 Pathology:Ankylosing spondylitis begins at the sacroiliac joints bilaterally then ascends the spinal column by involving the joints of the spine.The result is ultimate destruction of these joints after which the spine becomes fused.
29 Lateral lumbar spineX-ray demonstratingin ankylosing spondylitisThe ankylosis process
30 Reactive Arthritis (Reiter Syndrome) Reactive arthritis is a triad that includes:Polyarthritis,ConjunctivitisNon-specific UrethritisIt occurs almost exclusively in men and usually follows venereal infection or an episode of bacillary dysentery.More than half of the patients develop mucocutaneous lesions.In most patients, the disease remits within a year but progressive arthritis develops in 20% of cases.
33 Arthritis Associated with Inflammatory Bowel Disease (Enteropathic Arthritis) Ulcerative colitis and Crohn’s disease are accompanied by seronegative peripheral arthritis in 20% of cases and spondylitis in 10%.
35 Definition:Increase of serum uric acid and the deposition of sodium ureate crystals on the articular cartilage of joints, tendons and surrounding tissuesThis provokes an inflammatory reaction of these tissues
36 Types and causes of gout disease: Primary gout: a heterogeneous group with known and unknown enzymes defectsSome cases have a hereditary predispositionSecondary gout: due to excess nucleoprotein destruction as in cases of chronic myeloid leukemia
37 Pathogenesis:-Increased serum uric acid (hyperuricemia) above normal ( normal is 3-6 %)-Monosodium urate (MSU) crystals deposition leads to:a) Acute arthritis: in joints particularly the big toeb) Chronic tophaceous arthritis: i.e. repeated attacks of arthritis → excessive deposition of mono-sodium urate crystals → chronic inflammation → fibrosis → joint ankylosis
38 Tophus Definition: The tophus is the principle lesion in gout disease A tophus is small nodular lesion formed due to the deposit of crystallized monosodium ureate in people with longstanding hyperuricemia and usually associated with symptoms of gout.
40 Tophi appear in the following organs: Joint structures: synovium, tendons, ligaments and cartilagesCartilage of ear and nose: causing ulceration over itSubcutaneous; particularly the eye lids also with ulcerationCardiac valvesKidney forming uric acid kidney stones and leading to renal failure.
41 Signs and symptoms:Gout is a form of arthritis that affects mostly men between the ages of 40 and 50Gout is characterized by sudden unexpected burning pain as well as swelling, redness, warmth and stiffness in the affected joint
43 Tumors and Tumor-Like Lesions of Joints True neoplasms of the joints are rare.Pigmented villonodular synovitis (PVS):Benign but often locally aggressive neoplasm,Characterized by exuberant proliferation of synovial lining cells with extension into the subsynovial tissue.The most common site (80%) is the knee
45 Malignant lesions of the synovium are most commonly metastatic carcinomas particularly adenocarcinoma of the colon, breast and lung.Primary malignant bone tumors may invade the joint capsule
46 BursitisInflammation of the Bursa (fluid filled sac surrounding the joint).A bursa can become inflamed from injury, infection or due to an underlying rheumatic condition.Bursitis is typically identified by localized pain or swelling, tenderness and pain with movement of the tissues in the affected area.
50 Carpal Tunnel Syndrome Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve.Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index and the middle fingers, a condition known as "carpal tunnel syndrome."
53 ScoliosisScoliosis is an abnormal curvature of the spine. Scoliosis runs in families, but doctors often don't know the cause.Adult scoliosis may be a worsening of a condition that began in childhood, but wasn't diagnosed or treated.Also scoliosis may result from a degenerative joint condition in the spine.
56 Kyphosis It can affect children, adolescents and adults. With increased kyphosis the spine develops a hump.Kyphosis can occur as a result of:-developmental problems-degenerative diseases, such as arthritis of the spine-osteoporosis with compression fractures of the vertebrae-trauma to the spine.
60 Talipes Equinovarus- “Clubfoot” Clubfoot is a deformity of the whole foot that is present at birth. There are several types of clubfoot that are known as 'talipes' as the deformity is mostly in the talus (a bone in the ankle).The most common of the talipes is what is known as "talipes equino varus“ and is referred to as clubfoot.In talipes equino varus, the child is born with the foot pointing down and twisted inwards at the ankle.