1. INFLAMMATORY AND DEGENERATIVE JOINT DISEASES Dr. Amro Al-Hibshi, MD, FRCSC, MEd

2. Painful joint

3. OBJECTIVES To identify the differences in etiology and pathophysiology To identify the differences in etiology and pathophysiology To identify the clinical, radiological and laboratory differences To identify the clinical, radiological and laboratory differences To identify the difference in treatment modalities To identify the difference in treatment modalities

4. DEGENERATIVE AND INFLAMMATORY ARTHRITIS Degenerative Osteoarthritis (OA) Osteoarthritis (OA) Post-traumatic arthritis Post-traumatic arthritis Arthritis following dysplasia Arthritis following dysplasia Osteonecrosis Osteonecrosis Osteochondritis dissecans Osteochondritis dissecans Inflammatory Rheumatoid arthritis (RA) SLE Ankylosing spondylitis Gout Pseudogout

5. DEGENERATIVE ARTHRITIS Arthritis Vs. Arthrosis !

6. OA – Etiology and pathophysiology Primary Vs. secondary Primary Vs. secondary Mechanical Mechanical Iatrogenic Iatrogenic Genetic predisposition Genetic predisposition Failed attempt to repair damaged cartilage Failed attempt to repair damaged cartilage Increased water content Increased water content Alterations in proteoglycans Alterations in proteoglycans Collagen abnormalities Collagen abnormalities Metalloproteinases Metalloproteinases Interleukin 1 Interleukin 1

7. RA – Etiology and Pathophysiology Cell-mediated autoimmune disease Cell-mediated autoimmune disease HLA-DR4 and/or –DW4 HLA-DR4 and/or –DW4 ? Genetic ? Genetic ? Infection ? Infection Synovium and soft tissues affected first Synovium and soft tissues affected first

8. Characteristics OA Localized Localized Asymmetric Asymmetric Large joints Large joints Older age Older age Aggravated by activities Aggravated by activities Varus knees Varus knees Labs -ve Labs -ve Symptomatic treatment Symptomatic treatment RA Systemic Symmetric Small joints Younger age Morning stiffness Valgus knees Labs +ve Specific treatment

9. OA – PHYSICAL EXAM Inspection Inspection Palpation Palpation ROM ROM Special tests Special tests Neurovascular exam Neurovascular exam

10. RA –Clinical Picture Insidous onset Insidous onset Morning stiffness Morning stiffness Polyarthritis Polyarthritis Most commonly in the hands Most commonly in the hands Subcutaneous nodules Subcutaneous nodules Labs Labs

11. Radiologic Findings OA Loss of joint space Loss of joint space Osteophytes Osteophytes Cyst formation Cyst formation Subchondral sclerosis Subchondral sclerosis RA Periarticular osteoporosis Loss of joint space Erosions Subluxations and deformities

18. Joint Aspiration OA Dry Dry WBC’s 200 WBC’s 200 PMN 25% PMN 25% Glucose and protein equal to serum Glucose and protein equal to serum RA Effusion WBC’s 2000-75000 PMN 50% Low glucose

19. OA - TREATMENT Activity modification Activity modification Physiotherapy Physiotherapy Supportive devices Supportive devices NSAIDs and analgesics NSAIDs and analgesics Intraarticular injections Intraarticular injections Joint debridement Joint debridement Joint realignment procedure Joint realignment procedure Arthrodesis Arthrodesis Joint replacement Joint replacement

20. RA - TREATMENT Medical ! Medical ! Surgical Surgical - Synovectomy - Synovectomy - Arthrodesis - Arthrodesis - Joint replacement - Joint replacement * Preoperative preparation * Risk of infection