Arthritis All answers are TRUE for the T/F questions

Arthritis is the leading cause of disability in the US T or F Arthritis is the leading cause of disability in the US

There are over 100 different types of arthritis T or F There are over 100 different types of arthritis

Arthritis is more common in women T or F Arthritis is more common in women

Arthritis can affect children T or F Arthritis can affect children

Affects more than 50 million adults and 300,000 children Arthritis Very common More common in women and the elderly Affects more than 50 million adults and 300,000 children Not just a “single” disease

Degenerative or Non-inflammatory TYPES OF ARTHRITIS Degenerative or Non-inflammatory Inflammatory Infectious Hemorrhagic Classified to four basic groups based on their common characterastics.

Inflammation Body’s way of reacting to harmful stimuli Pathogens, irritants etc Purpose Eliminate the cause, clear / clean, repair Signs Pain, heat, redness, swelling, loss of function Different from an “infection” i.e. bacteria, virus etc

Degenerative Arthritis Most common type OSTEOARTHRITIS Cartilage wears away Bone rubs against bone Joints become weaker

Osteoarthritis Leads to functional limitation Reduced quality of life Pain gets worse as the day progresses Reduced quality of life Hips Knees Spine Small hand joints DIP and PIP

Osteoarthritis Pain Swelling Stiffness Deformity Decreased range of motion Instability Loss of function SYMPTOMS Osteoarthritis

Repetitive stress load Risk Factors Age Women Obesity Joint injuries Repetitive stress load Sports, work etc

How to protect yourself? Protection of affected joints Weight loss Exercise of supporting muscles. Pain relief medications Injections. Glucosamine & chondroitin  Surgical treatment TREATMENT

Example of a knee replacement

Another type of Degenerative Arthritis Charcot Joint Usually due to diabetes Loss of sensation leads to - repetitive trauma that is unnoticed Diabetes can cause arthritis Loss of sensation in the foot  worsening cut / injury  ulcers  injury reaches the bone  bone destruction and increased risk of infection  can lead to amputations

INFLAMMATORY ARTHRITIS Rheumatoid Arthritis SLE JRA Spondyloartropathies Crystal deposition disease Relapsing polychondritis

Typically starts ages 40-60 RHEUMATOID ARTHRITIS Common Affects 3% population Female > male (3:1) Typically starts ages 40-60

Combination of genetics and environmental factors What causes RA? Unclear Combination of genetics and environmental factors Your body attacks itself AUTOIMMUNE DISEASE

RHEUM. ARTHRITIS – Signs & Symptoms Morning stiffness Affects 3 or more joint areas Affects hand joints Symmetric arthritis Morning stiffness Morning stiffness in and around the joints, lasting at least 1 hour before maximal improvement. Arthritis of 3 or more joint areas At least 3 joint areas simultaneously have had soft tissue swelling or fluid (not bony overgrowth alone) observed by a physician; the 14 possible joint areas are right or left proximal interphalangeal (PIP) joints, metacarpophalangeal (MCP) joints, wrist, elbow, knee, ankle, and metatarsophalangeal (MTP) joints. Arthritis of hand joints At least 1 area swollen (as defined above) in a wrist, MCP or PIP joint. Symmetric arthritis Simultaneous involvement of the same joint areas (see 2 above) on both sides of the body (bilateral involvement of PIPs, MCPs, or MTPs is acceptable without absolute symmetry). Rheumatoid nodules Subcutaneous nodules, over bony prominences, or extensor surfaces, or in juxta-articular regions, observed by a physician. Serum rheumatoid factor Demonstration of abnormal amounts of serum rheumatoid factor by any method for which the result has been positive in <5% of normal control subjects. Radiographic changes Radiographic changes typical of RA on posteroanterior hand and wrist radiographs, which must include erosions or unequivocal bony decalcification localized to or most marked adjacent to the involved joints (osteoarthritis changes alone do not qualify)

Muscle pain, fatigue, weight loss Joint pain Signs & Symptoms EARLY FEATURES Muscle pain, fatigue, weight loss Joint pain Wrists, feet, knees, shoulders Start up pain Joint pain (MCP / PIP) Tendon crepitus

RHEUM. ARTHRITIS

RA can affect any part of your body!

RHEUM. ARTHRITIS - TREATMENT Stop the inflammation Rest Weight loss, smoking cessation Medicines Prevent Deformity and Rehab Stop the Synovitis Rest Drugs - Pyramid Approach = NSAIDs - antimalarials - disease modifying agents (MTX, sulphasalazine, gold, penicillamine) - steroids - cytotoxic drugs - experimental drugs. Synovectomy - chemical, irradiation, surgical Prevent Deformity Splintage Physiotherapy Tendon repairs & joint stabilisation Reconstruct Arthroplasty Arthrodesis Osteotomy Rehabilitate Occupational therapists - aids, support

Rheumatoid Osteoarthritis Age of onset Any age Usually later Speed of onset Wks to months Over many years Distribution Symmetrical Usually one sided Joints affected Small joints Weight bearing Stiffness Morning End of the day Systemic symptoms Fatigue, fever, night sweats, etc -