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INFLAMMATORY AND DEGENERATIVE JOINT DISEASES

INFLAMMATORY AND DEGENERATIVE JOINT DISEASES. Dr. Amro Al-Hibshi, MD, FRCSC, MEd. Painful joint. OBJECTIVES. To identify the differences in etiology and pathophysiology To identify the clinical, radiological and laboratory differences To identify the difference in treatment modalities.

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INFLAMMATORY AND DEGENERATIVE JOINT DISEASES

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  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 clinical, radiological and laboratory differences • To identify the difference in treatment modalities

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

  5. DEGENERATIVE ARTHRITIS Arthritis Vs. Arthrosis !

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

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

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

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

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

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

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

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

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

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