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2. ARTHRITIS
By HOORISH BALOACH BALOACH

3. CONTENTS
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Arthritis
•
Types of Arthritis
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Osteoarthritis
•
Rheumatoid arthritis
•
Gouty arthritis

4. ARTHRITIS
•
from Greek arthro means joint and itis, inflammation; plural: arthritides
•
Arthritis is inflammation of the joints (the points where bones meet) in one or more areas
of the body
•
Some forms of arthritis are caused by a reduction in the normal amount of this cartilage
tissue
•
The major complaint by individuals who have arthritis is joint pain. Pain is often a constant
and may be localized to the joint affected. The pain from arthritis is due to inflammation
that occurs around the join

5. TYPES OF ARTHRITIS
Following are some common types of Arthritis
•
Osteoarthritis
•
Rheumatoid arthritis
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Gouty-arthritis
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Ankylosing spondylitis
•
Suppurative arthritis
•
Tuberculous arthritis

6. OSTEOARTHRITIS
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It is the most common type of arthritis
•
It is not usually and inflammation
•
Its is a degenerative disease of joints which occurs due to wear and tear and cartilage on
the ends of the bones wears down over time
•
This causes the bones to rub against each other, causing stiffness, pain and loss of joint
movement
•
It gradually worsens with time
•
Commonly affected sites are hip and knee

7. SYMPTOMS
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Pain
•
Joint stiffness
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Restricted range of motion
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Loss of flexibility
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Bone spurs or osteophytes formation

8. RISK FACTORS
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Older age.
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Sex : Women are more likely to develop osteoarthritis, though it isn't clear why.
•
Bone deformities : Some people are born with malformed joints or defective
cartilage, which can increase the risk of osteoarthritis.
•
Joint injuries. Injuries, such as those that occurs from an accident, may increase the risk
of osteoarthritis.
•
Obesity: more body weight puts added stress on your weight-bearing joints, such as your
knees.
•
Certain occupations: Job that includes tasks that place repetitive stress on a particular
joint, that joint may eventually develop osteoarthritis.
•
Other diseases: Having diabetes, gout or Paget's disease of bone can increase your risk
of developing osteoarthritis.

9. COMPLICATIONS
Osteoarthritis is a degenerative disease that worsens over time. Joint pain and stiffness may
become severe enough to make daily tasks difficult. Some people are no longer able to work.
When joint pain is this severe, doctors may suggest joint replacement surgery

10. DIAGNOSIS
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Physical examination
•
Imaging tests

11. PHYSICAL EXAMINATION
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Joint movement may cause a cracking sound, called crepitation
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Joint swelling (bones around the joints may feel larger than normal)
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Limited range of motion
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Tenderness when the joint is pressed
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Normal movement is often painful

12. IMAGING TESTS
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X-rays
Shows reduction in the joint space and presence of Osteophytes
•
Magnetic resonance imaging (MRI)
Determining what exactly is causing pain and how much area is involved

13. TREATMENT
•
MEDICATIONS
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Physical therapy and exercise
•
Orthotic intervention
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SURGERY

14. MEDICATION
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Pain relief medications: Analgesics relieve pain
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Non steroidal anti-inflammatory drugs (NSAIDS)
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Corticosteroids injected right into the joint to reduce swelling and pain
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Artificial joint fluid

15. PHYSICAL THERAPY AND EXERCISES
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Improve flexibility
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strengthen the muscles surrounding the joints
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Endurance exercises
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Stretching
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Heat and cold therapies

16. ORTHOTIC INTERVENTION
Knee Brace
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Stabilize knee and ultimately provide relief
•
Provide greater support
•
The arthritis knee brace is designed to maximize stability while minimally effecting
function and range of motion
•
The arthritis knee brace bears the mechanical stresses of knee motion and reduce the
pressure felt by anatomical knee.

17. ORTHOTIC INTERVENTION
Magnetic Knee Braces
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Unique and non surgical
•
Encouraging bone growth and alleviating pain, while simultaneously structurally
supporting the knee
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Reinforces bone growth while existing bone is under stress

19. ORTHOTIC INTERVENTION
Unloader Knee Brace
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Absorbs some of the pressure, and some of the pressure is transferred to the opposite
side of the knee
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Unload the weight pressure on an arthritic knee joint
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This unloading will provide knee pain relief
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Provide protection and stability to an arthritic knee joint

21. ORTHOTIC INTERVENTION
Patella stabilizing articulated osteoarthritis knee orthosis (OA)
•
•
Relief for the medial compartment of the knee and is able to make the knee stable
It takes pressure due to weight away from the area of the knee that is normally
affected, but it still allows the muscle to be used

23. SURGERY
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Realignment
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Fusion
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Joint replacement
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Cartilage grafting
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Knee replacement surgery

26. RHEUMATOID ARTHRITIS
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Rheumatoid arthritis is
autoimmune disorder in which Immune system identifies the synovial membrane as
"foreign" and begins attacking
•
Disease process often leads to the destruction of articular cartilage
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Women two to three times as often as men
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Onset is most frequent during middle age, but people of any age can be affected
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Rheumatoid arthritis may also affect the skin, eyes, lungs, heart, blood, or nerves

27. SYMPTOMS
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Joint pain
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Swelling
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Stiffness
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Fatigue
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Joints are swollen red and tender
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Stiffness can persist for more than one hour

28. CAUSES
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The cause of rheumatoid arthritis is unknown. Even though infectious agents such as
viruses, bacteria, and fungi have long been suspected as well as smoking, but none has
been proven as the cause.
•
It is believed that the tendency to develop rheumatoid arthritis may be genetically
inherited.

29. COMPLICATIONS
Formation of deformities like:
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Swan neck deformities
•
Boutonniere deformities
•
Z deformity of thumb
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Bow string sign
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The tendons on the back of the hand may become very prominent and tight, called the
bow string sign.

30. DIAGNOSIS
X-ray findings
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Reduction of joint space
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bony erosions
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subluxation

31. DIAGNOSIS
Laboratory tests findings
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Rheumatoid Factor
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Elevated ESR
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Anemia
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Thrombocytosis
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Antinuclear antibodies
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Synovial fluid: WBC >2000/mm3
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Rheumatoid Factor
Antibody IgM against the Fc fragment of IgG

33. TREATMENT
•
Medications
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Conservative treatment
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Surgical Intervention

34. MEDICATIONS
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Non steroidal anti inflammatory drugs (NSAIDs)
•
Disease-Modifying Anti rheumatic Drugs or DMARDs
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Immunosuppressive Medicines
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Corticosteroids

35. CONSERVATIVE TREATMENT
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Physiotherapy and exercises
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Orthotic intervention for deformities develop due to RA

36. SURGERY
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In early phases of the disease, an arthroscopic or open synovectomy may be performed.
It consists of the removal of the inflamed synovia and prevents a quick destruction of the
affected joints

37. GOUTY ARTHRITIS
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Gouty arthritis is caused by the deposition of crystals of uric acid in a joint.
•
Chronic gout is repeated episodes of pain and inflammation. More than one joint may be
affected
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When uric acid crystals accumulate, it causes inflammation in a joint
•
An elevated uric acid level in the bloodstream leads to uric acid accumulation in the
tissues of a joint
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Uric acid is normally found in the body and is a normal byproduct of the way the body
breaks down certain proteins called purines

38. SYMPTOMS
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Severe attacks of joint pain with
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Redness
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Warmth
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Swelling in the affected area
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The pain starts suddenly, often during the night. Pain is often described as
throbbing, crushing, or excruciating
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The most typical location for gout to occur is the big toe
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Another sign of gout is the presence of tophi. A tophus is a hard nodule of uric acid that
deposits under the skin
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Kidney stones may be a sign of gout as uric acid crystals can deposit in the kidney and
cause kidney stones.

39. CAUSES
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Certain high-protein foods can make the body produce too much uric acid, triggering gout
•
High levels of uric acid in the blood (hyperuricemia) is the underlying cause of gout
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Kidney disease
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Obesity
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Sickle cell anemia and other anemia's
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Leukemia and other blood cancers
•
People who take certain medicines, such as hydrochlorothiazide and other water
pills, may have higher levels of uric acid in the blood.

40. JOINTS MOSTLY INVOLVED
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Ankle
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Heel
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Knee
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Wrist
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Fingers
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Elbow

41. DIAGNOSIS
Synovial fluid
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Definitive diagnosis of gout is based upon the identification of monosodium urate
crystals in synovial fluid
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Under polarized light microscopy, they have a needle-like morphology
Blood tests
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Hyperuricemia is a classic feature of gout
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Plasma urate level greater than 420 μmol/l (7.0 mg/dl) in males and 360 μmol/l (6.0 mg/dl)
in females
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ESR may be elevated due to gout in the absence of infection

42. PREVENTION
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Both lifestyle changes and medications can decrease uric acid levels
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Reducing intake of food such as meat and seafood, consuming adequate vitamin C
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A low-calorie diet in obese men decreased uric acid levels by 100 µmol/l (1.7 mg/dl)
•
Choose of healthy foods such as dairy products, vegetables, nuts, legumes, fruits (less
sugary ones), and whole grains
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Decrease alcohol, especially beer

43. TREATMENT
Medication
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Medications to reduce pain
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Steroids
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Anti-inflammatory painkillers

44. CONSERVATIVE TREATMENT
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Changing to better-fitting footwear; avoiding high heels and tight shoes
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Stretching exercises for toes and toe joints
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Shoe inserts

45. ORTHOTIC TREATMENT
Shock-absorbing toe pads
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Silicone toe crest should help to minimize rubbing on the top of the toe
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Can help to reduce discomfort
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Reduces pain

47. ORTHOTIC TREATMENT
Turf Toe T-Strap
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limits motion of the big toe joint
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reducing big toe joint pain
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Reducing inflammation
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Turf toe is a term used in athletic circles to describe a jamming or impact injury of the big
toe joint

49. ORTHOTIC TREATMENT
Hallux Trainer Insoles
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built into a fully padded insole
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The trainer limits the range of motion in the great toe joint relieving pain in the big toe joint
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The Morton's extension is made with a firm polypropylene that is extra durable and thicker
at the arch
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They're recommended for metatarsal fractures and mid foot gouty arthritis

51. SUMMARY
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Canes, crutches, walkers, or splints may help relieve the stress and strain on arthritic
joints
•
Learning methods of performing daily activities that are the less stressful to painful joints
also may be helpful
•
Certain exercises and physical therapy may be used to decrease stiffness and to
strengthen the weakened muscles around the joint.
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The availability of Orthotic braces and foot orthotics means that more people can afford
these treatments and is much more effective
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Orthotic treatment slow the progression of the disease but not fully finally cure it

52. REFERENCES
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http://en.wikipedia.org/wiki/Arthritis
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Medical Author:
William C. Shiel Jr., MD, FACP, FACR
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Catherine Burt Driver, MD
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Arthritis New Zealand (2010) Osteoarthritis. Pamphlet. Arthritis New Zealand. Wellington
•
Kenneth C Kalunian, MD
Professor of Medicine
University of California, San Diego School of Medicine