RHEUMATIOD ARTHRITIS

- autoimmune disease that causes chronic inflammation of the joint

- chronic systemic inflammatory disease with bilateral involvement of
diarthrodial joints
- initial joint changes involve synovial cells lining the joint. Inflammatory
cells accumulate, and angiogenesis and formation of pannus, which proceed to cover the
articular cartilage.
- characterized by exacerbations and remissions of signs and symptoms

Clinical manifestations:
1. fatigue
2. anorexia
3. weight loss
4. generalized aching
5. stiffness
Criteria for Classification of Arthritis:
1. Morning stiffness for at least 1 hr and present for at least 6 wks.
2. Simultaneous swelling of 3 or more joints for at least 6 wks.
3. Swelling of wrist, metacarpophalangeal or pproximal interphalangeal joints for
more than 6 wks.
4. Symmetric joint swelling for 6 or more weeks.
5. Rheumatoid nodules.
6. Increased RF levels.
7. Radiographic changes.

***four or more of the ffg. must be present.

TREATMENT
Goals:
1. Reduce pain
2. Minimize stiffness and swelling
3. Maintain mobility

Treatment Plan:
1. Provide periods of rest
2. Therapeutic exercises
3. Relaxation techniques
4. Proper body mechanics
5. Use of assistive devices
6. Health information education
7. Pharmacologic therapy

MEDICATIONS

1. NSAIDs Non Steroidal Anti-inflammatory Drugs

N Naproxen (Flanax)
S (Salsalate) Disalcid
A Aspirin (Acetylsalicylic Acid)
I - Ibuprofen (Advil)
D (Diclofenac sodium) Voltaren
S SALICYLATES

Clelebrex (Celecoxib)
Mobic (Meloxicam
 2. DMARDs (Disease Modifying Antirheumatic Drugs)
- reduces the rate of damage to bone and cartilage

Examples: Hydroxychloroquine, Sulfasalazine, Methotrexate and Azathioprine

3. Corticosteriods interrupts inflammatory and immune cascades

- used in short term therapy in low doses
Example: Prednisone

Surgical Interventions:
Finger and hand surgeries, to correct joint problems in the hand.

Arthroscopy, which removes debris or inflamed tissue in a joint through a small

lighted instrument.

Synovectomy, to remove inflamed joint tissue.

Arthroplasty, to replace part or all of a joint in the hip or knee.

Resection of metatarsal heads, to remove deformed bone in the feet
 OSTEOARTHRITIS

- Degenerative joint disease

- Can occur as a primary idiopathic disorder or as a secondary disorder.

- Joint changes include a progressive loss of articular cartilage and synovitis,

resulting from the inflammation caused when cartilage attempts to repair itself,
creating ostephytes or spurs.

Causes of Osteoarthrtis

1. Postinflammatory disorders: RA and septic jont

2. Post-traumatic disorders: acute fracture, ligament injury, occupstional and
recreational trauma.
3. Anatomic disorders: hip displasia, avascular necrosis, Pagets disease
4. Metabolic disorders: Ca crystal deposition, acromegaly
5. Hereditary disorders of collagen
6. Idiopathic

Risk Factors:
a. Bone mass thinner subchondral bone provides greater shock-absorbing function
than denser bone
b. Obesity joint stress and metabolic effects
c. Occupation

Clinical Manifestations
- Pain
- Crepitus
- Limitations of joint motion
- Joint instability
- Joint enlargement

Diagnosis: History and Physiscal Examination, X-ray studies

TREATMENT

a. Physical Rehabilitative
1. balance of rest and exercise
2. use of splints
3. use of heat and cold to relieve pain
4. adjusting activities of daily living
5. weight reduction
6. use of cains or walkers

b. Pharmacologic Measures
- NSAIDs
- Corticosteroids
- Hyaluronate (injected to joint)

c. Surgical Measures
- Arthroscopic lavage and debridement

- Total hip replacements

- Total knee replacements

- Joint replacement

- arthrodesis

GOUTY ARTHRITIS

- Accumulation of uric acid crystals in the joints

- Manifested by pain that is typically abrupt with redness and swelling

Sources of Uric Acid

sweetbreads, anchovies, sardines, liver, beef kidneys, brains, meat extracts,
herring, mackerel, scallops, and gravy.
Diagnosis:
- Synovial fluid analysis
- Measurement of serum uric acid levels
- Determination of urate excretion in the urine

TREATMENTS

Pharmacologic:
1. NSAIDs Indomethacin and Ibuprofen
2. Colchicine produces ant inflammatory effects by inhibition of leukocyte
migration
3. Allopurinol inhibits conversion of xanthine to uric acids
4. Uricosuric drugs (probenecid or sulfinpyrazone) prevents tubular resorption
of urate and increase its excretion in the urine.

Health Teachings:

- Lifestyle changes: maintenance of ideal weight, moderation in alcohol consumption and

avoidance of purine rich foods.