<p> JOINT DISORDERS/ ARTHRITIS</p><p>LEARNING OBJECTIVES</p><p>At the end of lecture the student should be able to know about:</p><p>• Joint disorders • Definition of arthritis • history ,examination aspect of arthritis • Different types of arthritis • Investigations required for diagnosing different types of arthritis</p><p>JOINT DISORDERS/ ARTHRITIS</p><p>1. SURGICAL CONDITIONS . Dislocation . Fractures . Joint sprain</p><p>2. MEDICAL CONDITIONS . Arthritis . Enthesitis</p><p>RHEUMATOLOGY</p><p>Rheumatology is the sub-specialty of medicine that deals with clinical problems of joint, soft tissues and other connective tissues</p><p>ARTHRITIS AND ENTHESITIS</p><p>ARTHRITIS</p><p>Inflammation of joint is known as arthritis</p><p>Arthro means joint</p><p>Itis inflammation</p><p>ENTHESITIS</p><p>Enthesitis is an inflammation of the enthesis, the location where a bone has an insertion to a tendon or a ligament INFLAMATION</p><p>A protective neuro vascular response to any type of injury in tissue known as Inflammation characterized by</p><p>• Pain (Dolor) • Heat (Calor) • Redness (Rubor) • Tumor (Swelling) • Loss of function (functio laesea)</p><p>CAUSES OF ARTHRITIS</p><p>• Degenerative • Infections • Trauma • Crystal induced • Autoimmune</p><p>HISTORY</p><p>Ask few questions</p><p> How long the symptoms are there?  How many joints are involved?  Is there any history of stiffness?  Is there any history of systemic problem?  Ask about functional activity?</p><p>GENERAL SYMPTOMS</p><p>Related to joint</p><p>• Pain • Swelling • Difficulty in movement • Stiffness</p><p>Extra articular</p><p>• Fever • Loss of appetite • Weight loss • Involvement of other organs like Eye, lungs etc SCREENING EXAMINATION</p><p>GALS ( gait, arms, legs, spine)</p><p>• Gait • Arms • Legs • Spine</p><p>DEGENERATIVE ARTHRITIS (OSTEOARTHRITIS)</p><p>• Age related degenerative changes</p><p>• Involves weight bearing joints like knee & hip joint</p><p>• Pain in affected joint which get worse on walking</p><p>RHEUMATOID ARTHRITIS</p><p>• Autoimmune in nature</p><p>• Involves small joints of hands</p><p>• Morning stiffness</p><p>• Polyarticular</p><p>• Symmetrical in nature</p><p>• Often associated with deformities SEPTIC ARTHITIS</p><p> Infectious in origin</p><p> Usually involves single joint</p><p> Joint is markedly inflamed</p><p> Extremely painful</p><p>GOUT ( CRYSTAL INDUCED)</p><p> Starts with single joint (monoarticular)</p><p> Later becomes polyarticular</p><p> Crystallization of uric acid in joint</p><p> Acute attack is highly painful ( Inflammation)</p><p>WORKUP FOR ARTHRITIS</p><p>• BLOOD CP-ESR</p><p>• X-RAYS OF INVOLVED JOINTS</p><p>• CRP</p><p>• URIC ACID LEVELS</p><p>• SYNOVIAL FLUID ANALYSIS</p><p>• AUTOIMMUNE PROFILE</p><p>• MRI SYNOVIAL FLUID</p><p>• Fluid present in joint cavity • Secreted by synovial membrane • Making a thin layer of 50 millimicron • Composed on hyaluronic acid, glycosaminoglycans and lubricin • Provides lubrication ( weeping lubrication) • Provides nutrition to articulating</p><p>ROLE OF SYNOVIAL FLUID IN ARTHRITIS</p><p>There are many changes in synovial fluid in different types of arthritis which helps in making the diagnoses</p><p>Normal Group I Group II Group III Measure (Noninflammatory (Inflammatory) (Purulent) </p><p>Volume (ml) (knee) < 3.5 Often >3.5 Often >3.5 Often >3.5</p><p>Clarity Transparent Transparent Translucent to Opaque opaque Color Clear Yellow Yellow to Yellow to Opalescent Green WBC (per mcl) < 200 200 – 300 2000–75,000 >100,000</p><p>Polymorphonuclear < 25% < 25% 50% or more 75% or more leukocytes</p><p>Culture Negative Negative Negative Usually Positive</p><p>ARTHROSCOPY</p>