inflammatory arthritis
- Rheumatoid Arththritis
- properties
- chronic systemic autoimmune inflammatory disease
- undetermined etiology
- affects synovial membranes and articular structures of multiple joints
- female : Male 3:1
- 25-50yrs
- etiopathogenesis
- 3 components
- infectious triggers
- genetic predisposition
- twins
- HLA DR4 / 1
- autoimmune response
- CD4+ T cells, B cells, macrophages stimulate immune cascade
- result in synovial inflammation and joint destruction
- associtation with
- female sex
- psychological stress
- hormones?
- 3 components
- clinical features
- slow onset
- classical symptoms
- morning joint stiffness more than 1 hour
- arthritis more than 3 joints
- hand - PIP, MCP and wrist
- bilateral and symmetrical
- rheumatoid nodules
- others
- general malaise
- weakness
- fever
- weight loss
- myalgia
- examination
- spares DIP
- joint exam
- edema
- effusion
- warmth
- tenderness
- decreased ROM
- swan-neck deformities
- rheumatoid nodules
- diagnosis
- ACR and EULAR for early diagnosis
- criteria include...
- joint involvement
- Autoantibody status
- acute-phase responce
- symptom duration
- lab investigation
- Anemia
- lab criteria for 2010 ACR / EULAR
- positive serum RF
- Positive APCA (Anti citrullinated protein antibody)
- ESR+
- CRP+
- ANA+
- X-ray
- seen only in late stages
- bony erosions
- cysts
- osteopenia
- joint space swelling
- acute
- narrowed joint space
- chronic
- treatment
- traditional
- physiotherapy
- NSAIDs
- analgesia
- DMARDS
- current recommendations
- earlier use of DMARDs
- reduces swelling and pain
- decrease acute phase markers
- limit progressive joint damage
- improves function
- earlier use of DMARDs
- traditional
- extra-articular manifestations
- heart
- carditis
- pericarditis
- VHD
- conduction defects
- lungs
- pleuritis
- intrapulmonary nodules
- interstitial fibrosis
- pleural effusion
- liver
- hepatitis
- eye
- scleritis
- episcleritis
- dry eyes
- blood
- vasculitis
- skin
- subcutaneous nodules
- palmar etrythyma
- rashes
- CNS
- cervical myopathy
- peripheral myopathy
- heart
- properties
- juvenile RA
- types
- oligoarticular
- polyarticular
- systemic
- differences bet. RA
- F:M 2;1
- oligoarthritis more common
- large joints affected
- no rheumatic nodules
- before age 16yrs
- minimum 6wk duration
- good prognosis - 70-90% recover
- pathogenesis similar to RA
- types
- osteoarthritis (degenerative)
- properties
- most common articular disease
- 30% 45-65yrs
- 80% of people affected at 8th decade
- now classified as inflammatory
- due to the fact that there is a role of cytokines and metalloproteinases
- affect weight-bering joints
- knees
- hips
- cervical
- lumbosacral spine
- feet
- DIP
- PPP
- cartilage grossly affected
- types
- oligoarticular 95%
- monoarticular
- due to secondary cause
- previous trauma
- developmental abnormality
- systemic causes
- DM
- Ochronosis
- hemochromatosis
- obesity
- due to secondary cause
- clinical course
- deep aching pain
- main reason to seek medical attention
- more with activity, relieved with rest
crepitus in use
limited ROM
osteophytes
- may cause nerve entrapment
- deep aching pain
- morphology
- chondocyte at superficial articular cartilage
- proliferation
- enlargement
- disorganisation
- fibrillation and cracking matrix
- bone eburnation
- osteophytes formation
- pannus
- subchondral cyst
- chondocyte at superficial articular cartilage
- risk factors
- age
- obesity
- female
- trauma
- infection
- repetitive occupational trauma
- genetic factors
- history of inflammatory arthritis
- pathogenesis
-
- proteolytic breakdown of cartilage matrix
- increased production of metalloproteinases
- collagenase etc
- normal amount of tissue inhibitors of TIMP1 / 2 are insufficient to counteract proteolytic effect
-
- more fibrillation and erosion of cartilage surface
- release of proteoglycan and collagen fragments into synovial fluid
-
- chronic inflammatory responce initiation
- synovial macrophages produce cytokines,
- IL1
- TNF-a
- more destruction of cartilage
- compensatory bone overgrowth to stabilize joint
- change in joint architecture
-
- DD
- need to differentiate between RA
- secondary OA
- Joint trauma
- metabolic bone diseases
- hyperactive joints
- investigations
- rule out other causes by
- ESR
- Synovial fluid analysis
- X-ray
- osteophytes
- assymetric joint-space narrowing
- subchondral sclerosis
- subchondral cyst formation
- rule out other causes by
- management
- non-pharmacological
- patient education
- weight loss
- exercise
- physical therapy
- reduce joint stress
- proper posture
- weight bearing and muscle strenghtening
- pharmacological
- paracetamol / acetaminophen for pain
- NSAIDs
- COX2 inhibitors
- Misoprostol / H pump inhibitors
- Analgesic tramadol
- Narcotics for severe pain
- intra-articular glucocorticoids
- surgical care
- joint lavage
- artheroscopy
- osteotomy
- arthroplasty
- relieves pain
- improve function
- give approx 8-15yr pain-free time
- non-pharmacological
- properties
- Seronegative Spondyoartheropaties
- key features
- inflammation of axial joints
- peripheral aethritis
- enthesitis (contrasting to RA)
- HLA B27+ (similar to RA)
- general properties
- No rheumatologic factors
- genetic predisposition
- intitiated by environmental factors
- immune-mediated T-cell responce
- Psoritic
- 5-10% of psoritic ptn
- Characteristic radiological appearance
- pencil in cup deformity
- pencil in cup deformity
- nail changes prominent
- pitting
- discolouration
- dystrophy
- onycholysis
- course
- 30% have chronic destructive aethritis
- patterns of joint involvement
- asymmetric oligoartheritis
- symmetric polyarthritis 40% - similar to RA
- DIP joint involvement 15%
- Spondylitis / sacroiliitis 20-40%
- evaluation
- rheumatoid negative
- hypoproliferative anemia
- hyperuricemia sometimes present
- HIV suspected in severe disease
- Enteropathic
- 5-20% ptn with IBD
- rist increase with extent of colonic involvement
- extraintestinal manifestation
- dermatologic
- rheumatologic
- ocular
- hepatobiliary
- urologic
- reactive arthritis
- classical triads
- arthritis
- conjuctivitis
- urethritis / vaginitis
- clinical presentation
- 1-3 wk after infective event
- usually assymetrical aethritis, oligoarticular
- balanitis in male ptn
- can be chronic and intermittant
- constitutional
- fatigue
- malaise
- fever
- weight loss
- infective triggers
- chlamydia
- ureaplasma urealyticum
- enteric infections
- shigella
- salmonella
- typhoid
- campylobacter
- complications
- acute anteirior uveities
- carditis
- keratoderma blenorrhagica
- radiological appearance
- bony spurs in high-impact bones
- bony spurs in high-impact bones
- classical triads
- ankylosing spondyoartheropathy
- classical triads
- morning stiffness
- inflammatory Low Back Pain
- immobilization of back
- complications
- spinal fusion
- aortic valve insufficiency
- extraspinal symptoms
- enthesitis
- uveitis
- blur vision
- red eye
- painful eye
- excess lacrimation
- morphology
- "?" shaped kyphosis
- lumber lordosis obliteration
- bamboo-like spine X-ray
- joint-line of SacroIliac Joint
- "?" shaped kyphosis
- physical examination findings
- tenderness over involved joints
- diminished chest expansion
- diminished anterior flextion of lumber spine (shober test)
- classical triads
- key features
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the map is not clear. could you please upload a better one
ReplyDeleteHi. thanks for your input. yeah I do agree I can't see anything here. I'm not sure how to increase the size of the pic... but I have uploaded a PDF format here -
ReplyDeletehttp://www.mediafire.com/?1nsff0r8b252rdy
hope it helps.