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Arthritis

. . Aims. Types of arthritis Symptoms of arthritis Signs of arthritis Treatment of arthritis. . . Types of Arthritis. Rheumatoid arthritis (RA)Osteoarthritis (OA)Sero-negative arthritisAnkylosing spondylitisReiter's diseaseCrystal arthropathies. . . Rheumatoid Arthritis. affects 3% populationfemale> male (3:1)80% RF30% ANFHLA DR4 (chr 6).

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Arthritis

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    1. Arthritis Hip and Knee

    3. Types of Arthritis Rheumatoid arthritis (RA) Osteoarthritis (OA) Sero-negative arthritis Ankylosing spondylitis Reiter’s disease Crystal arthropathies

    4. Rheumatoid Arthritis affects 3% population female> male (3:1) 80% RF 30% ANF HLA DR4 (chr 6)

    5. Rheumatoid Arthritis Pathology Synovitis chronic infl, synovial hypertrophy, effusion Destruction proteolytic enzymes, pannus Deformity articular destruction, capsular stretching, tendon rupture

    6. Rheumatoid Arthritis extra-articular nodules tendon sheath vasculitis myopathy and neuropathy reticulo-endothelial system visceral - lungs, heart, kidneys, brain, GI

    7. Rheumatoid Arthritis early symptoms myopathy, tiredness, weight loss, malaise proximal finger joints wrists, feet, knees, shoulders start up pain tendon crepitus

    8. Rheumatoid Arthritis early joint changes

    9. Rheumatoid Arthritis late symptoms joint destruction pain deformity instability

    10. Rheumatoid Arthritis advanced joint changes

    11. Rheumatoid Arthritis X-ray findings joint space narrowing peri-articular osteopenia erosions

    12. stop synovitis prevent deformity reconstruct rehabilitate Rheumatoid Arthritis treatment

    13. Rheumatoid Arthritis prognosis 10% improve 60% intermittent, slowly worsening 20% severe joint erosion, multiple surgery 10% completely disabled

    14. Osteoarthritis A chronic joint disorder in which there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins (osteophytes) and capsular fibrosis

    15. Osteoarthritis classification Primary or idiopathic Secondary - infection - dysplasia - Perthes’ - SUFE - trauma - AVN

    16. Osteoarthritis aetiology Genetic metabolic hormonal mechanical ageing

    17. Osteoarthritis mechanism 1 Disparity between:- stress applied to articular cartilage and strength of articular cartilage

    18. Osteoarthritis mechanism 2 Increased stress (F/A) increased load eg BW or activity decreased area eg varus knee or dysplastic hip

    19. Osteoarthritis mechanism 3 Weak cartilage age stiff eg ochronosis soft eg inflammation abnormal bony support eg AVN

    20. Osteoarthritis X-ray changes joint space narrowing subchondral sclerosis osteophytes cysts

    21. Osteoarthritis X-ray changes

    22. Arthritis symptoms pain swelling stiffness deformity instability loss of function

    23. Arthritis non-surgical treatment analgesia disease modifying drugs (RA) altered activity walking aids physiotherapy

    24. Arthritis surgical treatment arthroscopy osteotomy arthrodesis excision arthroplasty replacement arthroplasty

    25. Arthritis knee arthroplasty

    26. Joint Replacement indications Disabling pain Functional limitations

    27. Joint Replacement history pain function medical expectations

    28. Joint Replacement history - pain Site radiation limiting activity disturbing sleep analgesics

    29. Joint Replacement history - function Walking distance walking aids low chairs foot care stairs

    30. Joint Replacement examination gait limb alignment range of movement stability peripheral circulation skin condition

    31. Joint Replacement investigation X-ray - alignment - deformity - previous fractures and implants - AVN - osteophytes - bone loss CT, MRI, bone scan - rarely

    32. Joint Replacement ideal painless joint full range of movement stable permanent

    33. Joint Replacement hip complications dislocation - 1% loosening >90% 10y survival DVT / PE infection - 1%

    34. Joint Replacement knee complications limited ROM patellar instability 3-5% loosening > 90% 10y survival DVT / PE infection - 2%

    35. Ankylosing Spondylitis 0.2% of population mainly affects spine and SI joints male > female HLA B27 in 90% synovitis enthesopathy

    36. Ankylosing Spondylitis hips and knees flexion deformities arthritis with large osteophytes ankylosis

    37. Ankylosing Spondylitis diagnosis Rome criteria A - bilateral SI B - stiff lumbar spine - stiff thoracic spine A+ 1xB - decreased chest or 4xB expansion (<7cm) - >3/12 LBP - iritis

    38. Ankylosing Spondylitis X-ray changes joint space narrowing large osteophytes heterotopic bone ankylosis

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