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Joints (arthritis) Rheumatoid arthritis Inflammatory dz

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Joints (arthritis) Rheumatoid arthritis Inflammatory dz affecting synovial joints predominately Hyperplasia of synovial fibroblasts Severity is varied – PowerPoint PPT presentation

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Title: Joints (arthritis) Rheumatoid arthritis Inflammatory dz


1
Joints (arthritis) Rheumatoid arthritis
  • Inflammatory dz affecting synovial joints
    predominately
  • Hyperplasia of synovial fibroblasts
  • Severity is varied
  • Peak age is 30-50
  • About 1 of the population is affected with a
    2.5xs higher risk in women.
  • May be genetic as it tends to run in families
  • More common in Native Americans

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  • Insidious over several weeks usu.
  • Usu. Not symmetric at the beginning
  • Must have an inflammatory synovitis
  • If deformity is in a non-wt bearing jnt, you can
    assume its due to synovitis
  • 85 have serum RF
  • May start sero-(-) but become sero() w/
    progression
  • ESR is typically helpful to follow the
    inflammatory activity

3
  • Prolonged morning stiffness is universal
  • Active phase warm, swollen jnts Structural
    damage
  • Bone on bone crepitus
  • Try injected corticosteroids for
    anti-inflammation
  • C/s neck stiffness w/ possible loss of motion
  • C1 transverse lig tenosynovitis and possible
    z-jnt synovitis
  • Pain doesnt always accompany instability even in
    significant myelopathy

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  • Immobilization due to pain is the kiss of death
    to joint mobilizations. The result is
    contractures and deformity
  • You need to keep pts ROM esp. in non-wt bearing
    jnts like shoulder and hand
  • Once cartilage is completely gone, bones may fuse
    if immobilized10 remit usu in first two yrs of
    dz
  • 90 of jnts that are affected are involved during
    the 1st yr
  • Severe dz 10-15yr decr in life expectancy due to
    infection, pulmonary or renal dz,
    lymphoproliferative disorders, GI bleeds and
    cardiovascular

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  • RA criteria below
  • Morning stiffness
  • 3jnts
  • Arthritis of hand
  • Symmetric arthritis
  • Rheumatoid nodules
  • RF
  • X-ray changes
  • Need 4 of the 7
  • 1-4 must occur for at least 6 wks

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  • Stage I Early no destruction
  • Stage II Moderate no jnt deformity,
    osteoporosis w/ or w/out some bone and cartilage
    destruction
  • Stage III Severe cartilage and bone destruction
    with osteoporosis, jnt deformity
  • Stage IV Terminal fibrous or bony ankylosis

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  • Remission criteria
  • 5 of the following for 2 consecutive mos.
  • Morning stiffnesslt/15minutes
  • No fatigue
  • No jnt pain
  • No tenderness
  • No swelling
  • ESR

21
  • GOUT
  • Monosodium urate deposition - hyperuricemia
  • Tophi accumulation of crystal in articular,
    osseous, ST, and cartilage
  • Recurrent attacks of inflammation
  • Uric acid calculi in GU renal fxn impairment
    called gouty nephropathy
  • M/c 5th decade men African-Americans
  • Serum urate levels rise over time in men but
    dont in women until after menopause due to
    estrogen
  • Gout in women is often due to thiazide diuretic
    use and renal failure
  • Blacks due to more HTN, not genetic

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  • Crystals have decr solubility in low temps thats
    why it likes toes and ears
  • Likes areas of minor trauma like 1st MTP
  • Hemiplegia tophi wont form on paralyzed side
    -gt something to do w/ CT structure and turnover
  • Tophi is inflammatory cells around crystal w/
    erosion of surrounding cartilage and bone.
    Fibrous capsule around tophi
  • Crystals are needle-shaped and formed radially

23
  • Three stages asymptomatic hyperuricemia, acute
    intermittent gout, Chronic tophaceous gout.
  • Initially rubor, tubor, dolor and pain of jnt.
    Pain incr. Over hours. Pt. May not be able to
    walk. May get fever, chills, malaise. May last
    up to 2 weeks. Attacks become more frequent w/
    time
  • ½ involve 1st MTP as monoarticular site and 90
    of pts overall

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  • CHRONIC TOPHACEOUS GOUT
  • About 10yrs after initial dx usu.
  • No pain free period but not as severe as acute
  • Factors for tophi development early onset, long
    active phases, 4attacks/yr, UE or polyarticular
    episodes
  • Tophi can also be in heart valves and sclera
  • Supcutaneous gouty tophy are usu in fingers
    heberdens nodes

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  • Early onset gout
  • lt25yoa, 3-6 of gout pts, 80 have FHx
  • More severe and rapid course, 25 have
    nephrolithiasis
  • Transplant gout
  • 75-80 of heart transplants
  • Due to cycloporine tx to prevent rejection
  • Inhibits urate excretion

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  • 10 die of renal failure 25 have renal stones
  • 25-50 have HTN -gtdue to reduced renal blood flow
    from urate
  • Hyperlipidemia/obesity contraversial
  • Xray ST swelling -gt asymmetric in peripheral
    jnts erosions slightly removed from jnt (unique)
    (overhanging edge)
  • No osteopenia, and maintained jnt space until late

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Osteoarthritis
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  • OA
  • Garrod in 1907 differentiated RA from OA10 of OA
    patients had reduced work hours and 13.7 retired
    early.
  • Arthritis is the main reason for decr. Activities
    in the elderly
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