Arthritis

Synovial fluid in joints if decreases, can give rise to such crackling noise from knees. Synovial fluid maintains lubrication
Patella mal-tracking syndrome is a possibility. Weakness of cartilage can give similar symptoms.
Noise may be more when you walk downstairs

Arthritis related deformities

Rheumatoid Arthritis can lead to deformities and become a crippling disease.

Uses and side effects Steroids

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Uses and side effects Steroids

Arthritis- Causes & treatment

Joint pain is a very common condition. It can be due to

Rheumatoid arthritis

Osteoarthritis

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Many old people get affected especially LADIES after 40 years of age. Arthritis is a chronic and disabling condition and it limits the patient’s activities. So this can become a “Crippling disease’

Rheumatoid arthritis –

Rheumatoid arthritis is a systemic autoimmune disease which causes inflammation and tissue damage in
joints (arthritis), cartilages, synovitis and tendon sheaths,
An association exists between RA and Human Herpes Virus (HHV6 )
Epstein-Barr virus (EBV) infection
It’s a polyarthritis affecting women 3 times more commonly than men
Joints involved-
Small joints of hand, feet and cervical spine are affected
Larger joints - shoulder and knee
Morning stiffness of joints creates a lot of discomfort and problems.

Systemic manifestations of RA

Anemia.
Inflammation in the
Sclera of the eye
Pericardium,
Pleura, and
Lungs,

Skin –
The most characteristic sign - subcutaneous rheumatoid nodule
• Erythema nodosum
• Pyoderma gangrenosum, a necrotizing dermatosis

Heart
Pericarditis,
Endocarditis
Cardiac failure

Kidneys
Vasculitis causes glomerululopathy.
Amyloidosis due to chronic inflammation.

Lungs
Pleural effusions
Lung fibrosis

Vasculitis

Eye
. Scleritis-
Its a very painful eye condition. Eye becomes red, congested. Necrotising scleritis can occur
. Episcleritis
. Keratoconjunctivitis sicca leads to dry eye, dry mouth. This is called as Sjogren's syndrome
. Seronegative arthritis can be associated with many eye problems like conjunctivitis, uveitis, etc.



Hematological ( changes in blood)
Anemia
Neutropenia.


Constitutional symptoms
Low grade fever, weight loss, malaise, morning stiffness, loss of appetite and
Fatigue,

Investigations -

. Rheumatoid factor (RA) – This is an autoantibody
. Full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein
. Liver enzymes, renal function,
and other immunological tests (e.g. antinuclear antibody/ANA)


American College of Rheumatology Diagnostic criteria
• 1, 2, 3, 4 for at least 6 wks
• 1. Morning stiffness of >1 hour most mornings
• 2. Arthritis and soft-tissue swelling of >3 of 14 joints joint groups
• 3. Symmetric arthritis
• 4. Arthritis of hand joints
• 5. Subcutaneous nodules in specific places
• 6. Rheumatoid factor - level above the 95th percentile
• 7. Radiological changes of joint erosion

Management -
It is not a curable disease. Rx is aimed at reducing symptoms.

Orthopedic & immunological consultation is necessary.


Rheumatoid arthritis is a systemic disease . Joints involved- Small joints of hand
Morning stiffness of joints creates a lot of problems.

Finger deformities occur in longstanding cases

Boutonniere fingers

The finger is painful and swollen around the PIP ( proximal interphalangeal joint) joint in early stages.
Orthpedician will advise X-ray to rule out any avulsion fracture.
Other conditions that can cause the boutonniere deformity are - burns and prolonged inflammation of proximal interphalangeal joint


Swan-neck deformity


Joints involved- Small joints of hand

Finger deformities occur in longstanding cases


Boutonniere fingers
Swan-neck deformity

Seronegative arthritis can be associated with many eye problems like conjunctivitis, uveitis, etc.

Osteoarthritis-

It occurs due to calcium deficiency which leads to bone weakness. Bones get fractured easily. Old people should be careful to avoid falls in bathroom ( which is very common), etc as they develop fracture femur easily. This again limits activity




Nonsteroidal anti-inflammatory analgesic drugs offer symptomatic relief but they don’t cure the disease.
Disease modifying anti-rheumatoid drugs like
Chloroquine, hydroxychloroquine, D-penicillamine are used.

Hydroxychloroquine is preferred over chloroquine as it has less eye related side effects.


Corticosteroids

– Act as immunosuppressants & try to reduce tissue damage

Recent advances in management

Joint replacement surgery –
Done for hip and knee joints.
People who have these types of problems can join online support groups and discuss their problems
Physiotherapy has an important role in management.



Immunomodulators

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Joint Pain

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Arthritis can become a chronic problem.
For help - contact drsrb1@gmail.com