This presentation will let you know about arthritis, its type, etiology, signs and symptoms, and their management!

1. ARTHRITIS AND ITS TYPES
PRESENTED BY: GHAZIA IJAZ (DPT)

2. CONTENT
 Define Arthritis
 Common signs and symptoms of Arthritis
 Different kinds of arthritis
 Etiology and possible treatment

3. WHAT IS ARTHRITIS
 Arth means “Joint” and Tis means “Inflammation”
 Arthritis is a chronic condition inflammation of the joint
 It covers a group of more than 100 diseases that involve
inflammation of joint

4. SIGNS AND SYMPTOMS
 According to the US National
Arthritis foundation there are four
major signs of arthritis:
 Persistent pain and stiffness on arising
 Pain, tenderness and swelling in one or
more joint
 Recurrence of these symptoms ,
especially when they involve more than
one joint
 Recurrent or persistent pain and stiffness
in the neck, lower back, knees and other
joints

5. DIAGNOSIS
 Follow these steps to diagnose arthritis in
suspected person:
1. Complete health history
2. Physical examination to look for swelling and loss
of motion
3. Blood tests (this analysis will help to pinpoint the
type of arthritis)
4. X-rays(It shows cartilage loss, bone damage and
bone spurs)

6. TREATMENT
 Treatment focuses on relieving symptoms and
improving joint function
 Medications such as
 Painkillers help to reduce pain, but have no effect on inflammation
 Nonsteroidal anti-inflammatory drugs (NSAIDs): reduce both pain and inflammation
 Corticosteroids: this class of drugs, which includes prednisone and cortisone, reduces
inflammation and suppresses the immune system.

7. PHYSICAL THERAPY
 Physical therapy can be helpful for some types of arthritis.
 Exercises can improve range of motion and strengthen the muscles
surrounding joints.
 In some cases, splints or braces may be warranted.

8. SURGERY
 If conservative measures don't help, doctors go for:
 Joint repair: Joint surfaces can be smoothed or realigned to reduce pain and improve
function.
These types of procedures can often be performed arthroscopically — through small incisions
over the joint.

9.  Joint replacement:
This procedure removes your damaged joint and replaces it with an artificial
one.
Joints most commonly replaced are hips and knees.

10.  Joint fusion:
This procedure is more often used for smaller joints, such as those in
the wrist, ankle and fingers.
It removes the ends of the two bones in the joint and then locks
ends together until they heal into one rigid unit.

11. KINDS OF ARTHRITIS
 Osteoarthritis
 Rheumatoid arthritis
 Psoriatic arthritis
 Gout
 Systemic lupus Erythromatosus

12. 1. OSTEOARTHRITIS
 The wear and tear disease
 It's the "wear and tear" that happens when your joints are overused
 It happens with age, but it can also come from joint injuries or obesity, which puts extra stress
on your joints
 Joints that bear weight -- like your knees, hips, feet, and spine -- are the most common places
it affects

13. SYMPTOMS
 Pain
 Stiffness
 Tenderness
 Loss of flexibility
 Bone spurs
 Swelling

15. CAUSE
 Osteoarthritis occurs when the cartilage that cushions the ends of bones in
your joints gradually deteriorates
 Besides the breakdown of cartilage, osteoarthritis affects the entire joint. It
causes changes in the bone and deterioration of the connective tissues that
hold the joint together and attach muscle to bone

16. RISK FACTORS
 Older age: Risk of osteoarthritis increases with age
 Sex: Women are more likely to develop osteoarthritis
 Obesity
 Repeated stress on the joint
 Genetics
 Bone deformities

17. TREATMENT
 Osteoarthritis can't be reversed, but treatments can reduce pain and help you move better
Medications:
 Acetaminophen has been shown to help some people with osteoarthritis who have mild to
moderate pain
 NSAIDs typically relieve osteoarthritis pain
 Physical Therapy: Exercises to strengthen the muscles around your joint, increase joint
flexibility and reduce pain

18. RHEUMATOID ARTHRITIS
 An autoimmune disorder in which immune system attacks its own body
tissues especially joints
 It leads to the joint inflammation that severely damages the joint.
 Most typical features
a) Symmetrical polyarthritis
b) Morning stiffness
c) Elevation of erythrocyte sedimentation rate ESR
d) Appearance of autoantibodies that target immunoglobins in the serum

19. EPIDEMIOLOGY
 Peak prevalence between the ages of
30 and 50 years
 Women are affected 3 or 4 times
more commonly than men

20. CAUSES
 Factors in the development of RA are
1. Genetic susceptibility
2. Autoimmune reactions
3. Inflammatory response in joints and synovial sheaths
4. Appearance of rheumatoid factor in the blood and synovium
5. Articular cartilage destruction

23. RISK FACTORS
 Risk factors are almost same for
every kind of arthritis.
 Sex
 Age
 Family history
 Smoking
 Environmental exposures
 Obesity

25. CLINICAL FEATURES
 Early feature (synovitis)
 Most commonly affect MCPJ and PIPJ, wrist, tendon sheaths around the
joint(wrist----knee----shoulder)
 Bilateral symmetrical polysynovitis
 Pain, fusiform swelling, stiffness, loss of mobility

26.  Deformity
 Increased pain, deformity, instability, decreased ROM
 Joint deformity---- Movement restricted and painful
 Z deformity in Thumb
 Swan neck deformity/ boutonniere's deformities, ulnar deviation in Fingers
 Radial and volar displacement in Wrist
 Limited extension in Elbow
 Limited abduction in Shoulder
 Swollen, flexion an valgus in Knees
 Clawed Toes

28. MEDICATION
 NSAIDs
Such as Ibuprofen, Indomethacin, COX-2 inhibitors reduce pain and
inflammation
 Analgesics
Morphine and acetaminophen reduce pain
 Glucocorticoids
Prednisolone prescribed in a small dose

29.  Disease modifying antirheumatic drugs DMARD
Used with NSAIDs and/or prednisolone to slow down joint destruction caused
by RA over time. For example; Azathioprine, injectable gold, chloroquine
 Protein-A Immunoadsorption Therapy
A method to remove antibodies and immune complexes triggering the
inflammation

30. SURGERY
 Osteotomy
 Joint replacement therapy or Arthroplasty
Surgical reconstruction or replacement of joint
 Arthrodesis or fusion
A procedure that fuses two bones together to decrease pain and increase
stability of the joint although it limits movement at a joint

31. PSORIATIC ARTHRITIS
 A chronic disease characterized by inflammation of skin (psoriasis) and joints
(inflammatory arthritis)

32. SIGNS AND SYMPTOMS
 A chronic disease that get worse with the time. Signs and symptoms of psoriatic
arthritis often resemble those of rheumatoid arthritis
 Painful, swollen, red joints especially in knees, ankle and feet
 Sausage like swelling of fingers and toes
 Low back pain
 Pitted nails or nails separating from the nail bed
 Pain at the point f ligament and tendon attachment especially at the back of the heel and sole
of the foot

33. CAUSE
 Psoriatic arthritis develops because of the autoimmune reaction between the
antibody and body’s own tissue
 Immune complexes trigger the inflammatory mediators to attack and cause
inflammation in certain joint
 Researchers say that certain genes are responsible for causing PA

35. RISK FACTORS
 Psoriasis is the single greatest risk factor for developing psoriatic arthritis.
 Family history
 More often in adults between the age of 30-50 years
 Obesity
 Smoking
 Bacterial infection

36. TREATMENT
 NSAIDs
 Regular exercise
 Corticosteroids
 Antimalarial drugs are also prescribed
 Disease-modifying antirheumatic drugs (DMARDs)
 Immunosuppressants

37. SURGICAL AND OTHER PROCEDURE
 Steroid injections to reduce inflammation quickly
 Joint replacement surgery: Psoriatic arthritis can be replaced with artificial prostheses made
of metal and plastic

38. GOUTY ARTHRITIS
 A chronic heterogenous disorder or urate metabolism
 Results in deposition of monosodium urate crystals in the joints and soft
tissues, with accompanying inflammation and degenerative consequences

39. PREDISPOSING FACTORS
 Purine rich food---Meat, kidney, liver, seafood
 Caffeine
 Drugs such as loop diuretics, NSAIDs, corticosteroids
 Trauma
 Infection
 Other disease such as diabetes mellitus, hypertension, vascular disease, renal disease or
thyroid disease

40. HALLMARKS OF GOUT
 Increased serum uric acid level
 Recurrent attacks of an acute inflammatory arthritis with monosodium urate
crystals demonstrated in synovial fluid leukocytes
 Bone and joint destruction in some cases
 Bone and joint destruction
 Tophus in bone leading to erosion in some cases
 Kidney disease and renal stones

41. STAGES
 Asymptomatic hyperuricemia
 Acute gout
 Intercritical gout
 Chronic tophaceous gout

42. INVESTIGATION
 Plain radiographs (may be normal)
 Serum Uric acid
 Synovial fluid analysis (shows uric acid crystals)
 BUN (blood urea nitrogen)
 Serum Creatinine
 Synovial biopsy
 Uric acid – urine

44. SYNOVIAL FLUID ANALYSIS
 The Gold standard
 Crystals intracellular during attacks
 Needle & rod shapes
 Strong negative birefringence

45. TREATMENT
 NSAIDs
Inhibits urate crystal phagocytosis by decreasing the migration of granulocytes into the inflammatory area
such as Indomethacin and Naproxen
 Colchicine
Inhibits the synthesis and release of leukotrienes
 Uricosuric agents
Such as Probenecid & Sulfinpyrazone. Increase the excretion of Uric acid.
 Allopurinol
Inhibits synthesis of uric acid by inhibiting xanthine oxidase enzyme

46. PREVENTION
 Avoid purine rich foods
 Reducing alcohol consumption
 Avoid Diuretic Drugs
 Maintain the concentration of Uric Acid level within the
normal range
 Drinking Plenty of Water
 Balance your weight with proper diet and exercise

47. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)
 Systemic lupus erythematosus is a chronic, multisystem, inflammatory, autoimmune disorder
characterized by formation of autoantibodies directed against self-antigens and immune-
complex formation resulting in damage to essentially any organ.

48. TYPES OF LUPUS
 Systemic Lupus Erythematosus (SLE)
 Discoid Lupus Erythematosus (DLE)
 Neonatal lupus

49. CLINICAL FEATURES
 Cardiac
Myocarditis
Endocarditis
Pericarditis
 Constitutional
Fatigue
Fever
Weight loss

50.  GIT
Abdominal pain
Nausea, vomiting
 Dermatological
Alopecia
Butterfly rash
Mucus membrane rash
Photosensitivity
Purpura
Urticaria
Vasculitis

51.  Hematological
Anemia
Leukopenia
Thrombocytopenia
 Musculoskeletal
Arthralgia
Arthritis
Thrombocytopenia

52.  Pulmonary
Pleurisy
Pulmonary hypertension
Pulmonary parenchyma
 Neuropsychiatric
Cranial neuropathies
Organic brain syndrome
Peripheral neuropathies
Psychosis
Seizures
Transverse myelitis

53.  Renal
Hematuria
Nephrotic syndrome
Proteinuria
 Reticuloendothelial
Hepatomegaly
Lymphadenopathy
Splenomegaly

55. ETIOLOGY
 Etiology is still unknown
 But environment factors such as Ultraviolet light (UVB), chemicals, drugs and
infections
 Beta cell activation results in increased autoantibody
 Development of and failure to remove immune complexes
 Impaired T-cell regulation of immune response

57. DRUGS
 NSAIDs----Acetaminophen
 Corticosteroids----Prednisone
 Antimalarial drugs----Hydroxychloroquine

58. TREATMENT GOALS
 Control disease manifestation
 Prevent adverse effect of drug
 Prevent flares
 Treat flares when they occur
 Minimize organ damage