Arthritis

                                            Arthritis

•       inflammation of the joints

•       Over 200 forms of arthritis.

•       About 30% of adults have arthritis.

•       Major symptom - pain in or around joints

•       often a constant and may be localized to the joint affected

Risk Factors for Arthritis

•       Age > 40 years

•       Women > men

•       Obesity

•       Previous joint injury

•       Ethnic background

Common types

•       Ankylosing spondylitis

•       Gout and pseudo-gout

•       Juvenile idiopathic arthritis

•       Osteoarthritis

•       Rheumatoid arthritis

•       Septic arthritis

•       Still's disease

Osteoarthritis

•       most common form of arthritis

•       can affect both larger and smaller joints of the body, including the hands, feet, back, hip or knee

•       acquired from daily wear and tear of the joint

•       begins in the cartilage and eventually causes the two opposing bones to erode into each other

•       starts with minor pain while walking

•       Later pain can be continuous and even occur at night

•       affects weight bearing joints such as back, spine, and pelvis

•       disease of the elderly

•       Risk factors: prior joint trauma, obesity, and a sedentary lifestyle

•       Common sites of osteoarthritis

•       hips

•       knees

•       hands, especially base of thumb

•       base of great toe

•       spine

Rheumatoid arthritis

•       disorder in which the body's own immune system starts to attack body tissues

•       not only directed at the joint but to many other parts of the body

•       most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones

•       often affects joints in the fingers, wrists, knees and elbows

•       disease is symmetrical (appears on both sides of the body) and can lead to severe deformity in a few years if not treated

Gout

• caused by deposition of uric acid crystals in the joint, causing inflammation
• Crystals of uric acid form inside a joint and cause inflammation, which makes the joint red, hot, swollen and painful
• runs in families
• more common in men, women after menopause
• Other risk factors include -
• obesity
• high blood pressure
• drinking too much alcohol
• kidney failure   
• uncommon form of gouty arthritis caused by the formation of rhomboid crystals of calcium pyrophosphate known aspseudogout                                                              

Serious types of arthritis

• Lupus (systemic lupus erythematosus)
• Rheumatoid arthritis
• Scleroderma
• Sjogren’s syndome
• Lyme disease
• Ankylosing spondylitis
• Psoriatic arthritis
• Infectious arthritis

Route of infection

•       dissemination of pathogens via the blood, from distant site…. (most common)

•       dissemination from an acute osteomylitic  focus

•       dissemination from adjacent soft tissue infection,

•       entry via penetrating trauma

•       entry via iatrogenic means

Pathology

•       acute synovitis with a purulent joint effusion

•       Synovial membrane becomes edematous, swollen and hyperemic, and produces increase amount of cloudy exudates contains leukocytes and bacteria

•       As infection spread through the joint, articular cartilage is destroyed by bacterial and cellular enzymes

•       cartilage may be completely destroyed

•       Pus may burst out of the joint to form abscesses and sinuses.

•       The joint may be become pathologically dislocated.

Clinical presentation

•       Typical features are acute pain and swelling in a single large joint ,commonly the hip in children and the knee in adults, however any joint can be affected.

•       The most commonly involved joint is the knee (50% of cases), followed by the hip (20%), shoulder (8%), ankle (7%), and wrists (7%). interphalangeal, sternoclavicular, and sacroiliac joints each make up 1-4% of cases.