Arthritis

Dr.Hafiz Salman Saeed

Assistant Professor of Orthopaedic
Independent Medical College
Faisalabad.
ARTHRITIS
 In Britain 20 Million people are rheumatic
sufferers each year

☼ 5 Millions from Osteoarthritis

☼ 500,000 from Rheumatoid Arthritis

☼ 12,000 children with juvenile chronic arthritis

Rheumatic complaints account for more than

20% of all consultations

Davidson’s Principles & Practice of Medicine: 16th Ed, P.762, 1991

What is ARTHRITIS
Adegenerative disorder in which the
cartilage- the natural shock absorber
that cushions the insides of the joints
begins to break down
 A HOST OF CULPRITS
 CARTILAGE

 MUSCLES

 BONE

 TENDONS AND LIGAMENTS

 INFLAMMATION

 GENES
Anatomy of the break down!
NORMAL JOINT
WORN OUT CARTILAGE
 Classification
Rheumatic disorders

Articular Rheumatism Non-Articular Rheumatism

Bursitis, e.g.
Degenerative Inflammatory
Tennis Elbow

Rheumatoid Arthritis
Ankylosing Spondylitis
Osteo-Arthritis
Gout
Common types of arthritis
 Osteoarthritis equal in Males & Females
 After 50 years of age
 Rheumatoid arthritis more common in females
of mostly 2nd and 3rd decades
 RA is autoimmune systemic disease
 Juvenile rheumatoid arthritis in children less
then 14 years - an aggressive disease
 Ankylosing spondylitis 2nd and 3rd decades
 Gouty arthritis common in males & after
menopause in females too!
 Presentation
 The first sign is often a twinge in the Knee
or back or some stiffness at the base of the
thumb. Or maybe the patient was getting
out of the car and a sharp pain shoots
down his leg from hip to the calf. Nothing
serious,
 Your patient thinks, he is too young to
have arthritis, think again!
 Sign and symptoms other
than pain
 Swelling

 Difficulty in walking
 Inability to squat

 Decreasing ability to perform daily

activities
 Deformity
 Management of
Arthritis
☼ Rest

☼ Physiotherapy

☼ Drugs

☼ Surgery
 Management
 Depending upon the severity of the disease
 Osteoarthritis of Knee
 Early stage……. Conservative
 Cox2 inhibitors (latest)
 NSAIDs (G.I disturbances)

 Injections [steroidal| Hyaluronic acid??? ??]

 Surgical Management
 Arthroscopic lavage
 High tibial osteotomy

 Arthrodesis

 Joint replacement

 In hip joint you can do girdle stone

procedure
 X-Rays of Knee Osteoarthritis
 Early changes  Severe changes
 ARTHROSCOPY
 Examination of joint with Telescope & treating
the minor damage.
 It is diagnostic as well as therapeutic.
Arthroscopy
Post operative scars of arthroscopy
TREATMENT in Knee
UNICOMPARTMENTAL ARTHRITIS
High Tibial Osteotomy
 Different implants used for
High Tibial Osteotomy
 T PLATES
 STAPLES
 P.O.P CAST
 Total hip replacement
 Implants
Total Knee replacement
 Implants
Total Knee Replacement
 AFTER JOINT
REPLACEMENT
Non-invasive & Initial
Treatment !
 Drugs
 Towards New medications
Specific COX-2 Inhibitors
Conventional NSAIDs are believed to cause
gastro-duodenal damage by inhibiting the
COX-1 isoform & to have analgesic &
inflammatory effects by inhibiting the COX-2
isoform

Specific COX-2 inhibitors inhibit only COX-2

isoform, sparing COX-1 isoform, thus
associated with less GI side effects
 Physiological Inflammatory
Stimuli Stimuli

COX-1 (Constitutive) COX-2 (Inducible)

“Housekeeping”

Inflammatory
PGs
Urinary Tract

Inflammation
Platelets

G I Tract
 Celecoxib..
of the Cox-2 available only celecoxib
has survived and stood the test of
time!
FDA advisory committee has cleared
celecoxib of all the CV side effects
However, it is to be used with
caution in cardio-vascular patients.
Gouty Arthritis
 Epidemiology
In Men In Women

Mean age of 49 60
onset (years)

Incidence rate 2.8% 1.5%

 Pathophysiology
 Caused by disorder of purine metabolism
resulting in elevated level of uric acid
 >7mg/dl in men
 >6mg/dl in women
 Prolonged hyperuricemia

Formation of monosodium urate monohydrate

crystals
 Serum urate level
 Any sudden change in serum urate
concentration can provoke an acute gouty
attack
 Sudden increase favors formation of new
crystals
 Sudden decrease promote shedding of
previously formed crystals from the
synovial membrane
 Serum urate level
 During a gouty attack, serum urate levels
are normal in about 20% of cases
 Repeat blood test eventually detect
hyperuricemia
Manifestations of Hyperuricemia
 Subcutaneous tophaceous gout
 Urolithiasis
 Nephrolithiasis
 Renal disease involving the tubules,
interstitium or glomeruli
 Treatment
 NSAIDs
 Colchicine
 Allopurinol
 Steroids
 To prevent recurrent attack, serum urate
level should be kept <6mg/dl
 Differential Diagnosis
Pseudogout
 Gout
Negative birefringent needle shaped
intraleubocytic crystals
 Pseudogout
Rod or rhomboid shaped crystals with
opposite refractive properties
 Differential Diagnosis
Septic Arthritis
 Septic and gouty arthritis present with
many of the same signs & symptoms
fever & monoarthritis
 Beware: both septic and gouty arthritis
may present in the same joint
Thank You