1. Arthritis
All answers are TRUE for the T/F questions

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

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

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

5. Arthritis can affect children
T or F
Arthritis can affect children

6. 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

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

8. 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

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

11. 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

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

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

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

20. Example of a knee replacement

21. 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

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

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

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

26. 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)

27. 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

28. RHEUM. ARTHRITIS

32. RA can affect any part of your body!

33. 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

34. 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 -