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Arthritis
- Rayuma
- Inflammation of the joints. - Over 200 forms of arthritis. - About 30% of adults have arthritis. Major symptom = joints
PAIN
in or around
Arthritis
COMMON:
- Osteoarthritis - Rheumatoid Arthritis - Gouty Arthritis
Osteoarthritis
Most common Degenerative or aging bone disease Universal aged 65 and older Primarily affects weight-bearing joints such as the knees, hips, and lumbrosacral spine
Osteoarthritis
Classification: PRIMARY: Degenerative wear and tear process at 5th and 6th decade with no apparent predisposing abnormalities
Osteoarthritis
Classification: SECONDARY: Degeneration caused by congenital
abnormality in joint structures eg: hypermobility abnormally shaped joint surfaces trauma, obesity, crystal deposits
Osteoarthritis
Osteoarthritis
Osteoarthritis treatment
Pain medications
Osteoarthritis treatment
Osteoarthritis treatment
Joint protection
Osteoarthritis treatment
Surgery
Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease in which the normal immune response is directed against an individual's own tissue, including the joints, tendons, and bones, resulting in inflammation and destruction of these tissues
The cause of rheumatoid arthritis is not known
Rheumatoid Arthritis
Rheumatoid Arthritis
Initial stages of each joint involvement, warmth, pain, and redness, with corresponding decrease of range of motion of the affected joint Reducible and later fixed deformities
Rheumatoid Arthritis
Medications
NSAIDS - only one should be given at a time. - titrated every two weeks until max dosage or response is obtained. - least 2 to 3 wk before assuming inefficacy. Disease-modifying drug - eg, gold, hydroxychloroquine, sulfasalazine, penicillamine - 2 to 4 mo of disease despite treatment with aspirin or other NSAIDs,) - Methotrexate, an immunosuppressive drug - second-line potentially disease-modifying drugs
Rheumatoid Arthritis
Corticosteroids - most effective short-term relief as an antiinflammatory drugs - recent report may slow erosions. - Severe rebound follows the withdrawal of corticosteroids in active disease. Immunosuppressive drugs - eg, methotrexate, azathioprine, cyclosporine) - severe, active RA. They can - suppress inflammation and may allow reduction of corticosteroid doses..
Rheumatoid Arthritis
Surgery:
Removal of inflamed synovium Arthroplasty
Physical therapy
Gout
Deposition of uric acid salts and crystals in and around joints and soft tissues
Major route of disposal is renal excretion Humans lack the enzyme uricase to break down uric acid into more soluble form.
Gout
Genetic disorders: Derangements in mechanisms that regulate purine neucleotide synthesis. Accounts for >90% of hyperuricemia Diminished tubular secretory rate, increased tubular reabsorption, diminished uric acid filtration
Gout
Stages of Classic Gout
Asymptomatic hyperuricemia
Gout
Intercritical Gout
Symptom free period interval between attacks. May have hyperuricemia and MSU crystals in synovial fluid
Refers to stage of deposition of urate, inlammatory cells and foreign body giant cells in the tissues. Deposits may be in tendons or ligaments. 10 or more years of acute intermittent gout.
Gout
Presenting Symptoms
Musculoskeletal: - Acute onset of monoarticular joint pain. - First MTP/Big toe: most common. 90% of patients with gout. - Other joints knees, foot and ankles. - Less common in upper extremities Postulated that decreased solubility of MSU at lower temperatures of peripheral structures such as toe and ear
Skin: warmth, erythema and tenseness of skin overlying joint. May have pruritus and desquamation GU: Renal colic with renal calculi formation in patients with hyperuricemia
Gout
Gout
Corticosteriods
One or two large joints affected Good option for elderly patient with renal disease
Gout
Non- Pharmacologic Treatments
Consumption can increase serum urate levels by increasing uric acid production. When used in excess it can be converted to lactic acid which inhibits uric acid excretion in the kidney
Gout
Non- Pharmacologic Treatments
Dietary modification
Low carbohydrates Decrease in dietary purine-meat and seafood. Dairy and vegetables do not seem to affect uric acid
Bing cherries and Vitamin C
Gout
Non- Pharmacologic Treatments
Serious types of arthritis Lupus (systemic lupus erythematosus) Rheumatoid arthritis Scleroderma Sjogrens syndome Lyme disease Ankylosing spondylitis Psoriatic arthritis Infectious arthritis
When to see a doctor for arthritis Joint is red, hot or very painful. Other symptoms such as fever, tiredness,
weight loss, rash, skin thickening, hair loss, ulcers in the nose or mouth or on the fingers, cold sensitivity in the hands, swollen fingers or toes, muscle weakness, numbness or tingling. Pain persists despite over the counter medication.