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INFLAMMATORY AND DEGENERATIVE JOINT DISEASES

Painful joint. OBJECTIVES. To identify the differences in etiology and pathophysiologyTo identify the clinical, radiological and laboratory differencesTo identify the difference in treatment modalities . DEGENERATIVE AND INFLAMMATORY ARTHRITIS. DegenerativeOsteoarthritis (OA)Post-traumatic arthritisArthritis following dysplasiaOsteonecrosisOsteochondritis dissecans.

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INFLAMMATORY AND DEGENERATIVE JOINT DISEASES

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    1. INFLAMMATORY AND DEGENERATIVE JOINT DISEASES Dr. Amro Al-Hibshi, MD, FRCSC, MEd

    2. Painful joint

    3. OBJECTIVES To identify the differences in etiology and pathophysiology To identify the clinical, radiological and laboratory differences To identify the difference in treatment modalities

    4. DEGENERATIVE AND INFLAMMATORY ARTHRITIS Degenerative Osteoarthritis (OA) Post-traumatic arthritis Arthritis following dysplasia Osteonecrosis Osteochondritis dissecans Inflammatory Rheumatoid arthritis (RA) SLE Ankylosing spondylitis Gout Pseudogout

    5. DEGENERATIVE ARTHRITIS Arthritis Vs. Arthrosis !

    6. OA � Etiology and pathophysiology Primary Vs. secondary Mechanical Iatrogenic Genetic predisposition Failed attempt to repair damaged cartilage Increased water content Alterations in proteoglycans Collagen abnormalities Metalloproteinases Interleukin 1

    7. RA � Etiology and Pathophysiology Cell-mediated autoimmune disease HLA-DR4 and/or �DW4 ? Genetic ? Infection Synovium and soft tissues affected first

    8. Characteristics OA Localized Asymmetric Large joints Older age Aggravated by activities Varus knees Labs -ve Symptomatic treatment RA Systemic Symmetric Small joints Younger age Morning stiffness Valgus knees Labs +ve Specific treatment

    9. OA � PHYSICAL EXAM Inspection Palpation ROM Special tests Neurovascular exam

    10. RA �Clinical Picture Insidous onset Morning stiffness Polyarthritis Most commonly in the hands Subcutaneous nodules Labs

    11. Radiologic Findings OA Loss of joint space Osteophytes Cyst formation Subchondral sclerosis RA Periarticular osteoporosis Loss of joint space Erosions Subluxations and deformities

    18. Joint Aspiration OA Dry WBC�s 200 PMN 25% Glucose and protein equal to serum RA Effusion WBC�s 2000-75000 PMN 50% Low glucose

    19. OA - TREATMENT Activity modification Physiotherapy Supportive devices NSAIDs and analgesics Intraarticular injections Joint debridement Joint realignment procedure Arthrodesis Joint replacement

    20. RA - TREATMENT Medical ! Medical ! Medical ! Surgical - Synovectomy - Arthrodesis - Joint replacement * Preoperative preparation * Risk of infection

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