INTRODUCTION

1. INTRODUCTION The Almighty gave us legs to walk on gave us mobility; to carry us from place to place and gave us hands to be creative, to perform the daily chores of life and to carry the burden of mankind. Primitive hunting man used to walk miles to hunt food for himself and his family. He had to have strong legs to do this day in and day out. Since there was never any certainty where he would go and what he would find, his limbs were tuned to work that extra mile or two if the need arose. In those days, limbs or rather the joints served man faithfully for really long number of years and most mortals were mobile till death.

2. But then came the Industrial Evolution and Man had to develop different faculties. The joints were used less and less till life became almost sedentary : From Home  elevator  car  Office  elevator. The only exercise people indulged in is climbing walls and jumping to conclusions! The joints now had to be prescribed exercise by doctors, as a must for maintaining mobility and good health. As a result of disuse – joints stiffened, synovial fluid dried up, joints started degenerating earlier. Every which way you looked at it, the joint refused to cooperate. What more can you call spondylitis in early 30s and sever OA knee in mid 40s?

3. JOINTS Definition : It is a junction between two o more bones or cartilage. It is a device to permit movements. There are more joints in the child than in an adult.

4. Classification of Joints Functional 1) Synapthrosis - Immovable It. 2) Amphiarthosis - Slights movable 3) Diarthrosis - Freely movable • Structural Classification • Fibrous Joint • 2,Cartilaginous Joints • * Synchonorosis or Hyaline Cartilage Joints. • It B/w Epiphysis and diphysis of a growing long bone. • Example : • Spheno – Occipital Bone. • Costochondral and Coststernal Joint. • * Symphysis or fibro cartilaginous Joints. • Example: Symphysis pubis • Manabrio sternal joint

5. 3. Synovial Joints or Diarthrodial Joints • Also k/s Freely movable joints • The ends of tow bones are held together by joint capsule, with ligaments and tendons inserted at the outer surface of capsule. • A synovial joint has a fluid filled cavity. The fluid is known as synovial fluid (produced) • Synovial fluid acts as lubricant. • Most of the disease of Joints affected Diarthrodial or Synovial Joints.

6. Types of Synovial Joints & their movements • 1 .Plane or Gliding movement • Example- Intercarnel Joints • Inter tarsal joints • Joints b/w bertebras • Movements – Gliding movements.

7. Hinge Joints • Uniaxial Joints • Movements are limited in one plane. • Example - elbow joint • Ankle joint • Interphalangeal joints • movements - Flexion & extension

8. Pivoto Joints • Uniaxial Joints • Example - superior and inferior radio ulnar. • Median Atlanto axial joints • Movement - Rotation only • Condoyle Joints • Joints permit movements mainly in one plane around • transverse axial but partly in another plane around vertical axis. • Movement possible – Flexion & extension & limited • rotation. • Example - Knee joint • right & left Saw joints 260

9. Ellipsoid Joints • Biaxial Joints • Free movement are permitted around both the axis. • Movements Possible –Flexion, Extension • abduction, adduction and circumduction. • Example - wrist Joints • Metacarpophalengeal joints. • Saddle Joint (Seller) • Multiaxial Joints • Move possible-- Flexion, Extension, adduction, abduction • and conduct rotation. • Example Sternoclavicular joint • Calcaneocuboid joint

10. Ball and socket Joint (Spherodial) • Multiaxial joint • Movements occurs around and • indefinite number of axes which have • common centre. • Movements-Flexion, extension, • abduction, adduction, • medial rotation, • Lateral rotation and • circumduction. • Example - Shoulder joint • Hip joint • Talocalcaneonavicular joint

11. Factor maintaining stability of joint • Muscles • Ligaments • Bones

12. Aging & Joints • With aging, a decrease in synovial fluid, thinning articular cartilage and decrease flexibility ligament occur. • Most individual experience some degeneration is the knees, elbows, hips and shoulder due to aging presses.

13. ARTHRITIS • It is a form of Rheumatism in • which joints have become • inflamed and painful • Characterized by • Inflammation, Pain • and stiffness and moving • usability • Arthritis affects about 10 % • people of world Population. • Most common in older Aged • people due thinking of • particular cartilage and • decrease in • synovialfluid

15. Also due to injury, Truma, Allergy and infections disease spread such as • Tuberculosis. • Gonococcal • Syphilitic etc.

16. Important cause of Arthritis • Diffused connection tissue disease such as RA • Degenerative joint disease such as OA. • 3.Metabolic and endocrine Disease • such as Gouty Arthritis.

17. CLINICAL MANIFESTATION • Arthralgia - Pains in Joint • Chondritis - Inflammation of Cartilage • (3Synovitis - Inflation of a Synovial membrane. • in joint.

18. CLASIFICATION OF • ARTHRITIS • 1.Rheumatoid Arthritis – and its variants such as • Arthritis with psoriasis • Juvenile rheumatoid arthritis • Rheumatic spondylitis • Reiter’s syndrome • Arthritis due to rheumatic fever. • 3. Osteoarthritis.

19. 4.Arthritis associated with known infectious agents – e.g. Gonococcal, Tuberculoses – most common Involve – spine, hip join & Knee joints Tuberculosis of spine is termed as POTTS DISEASE Spondylitis. Syphilitic – Pneumococcal, etc.

20. Associated with metabolic or bio-chemical • or endocrine abnormalities - • Gout, hemoglobinopathies, onchronosis, • acromegaly, etc. • 6.Traumatic arthritis • 7.Neuropathic arthritis • 8.Allergy and drug reaction.

21. 9. Arthritis with blood disorders 10. Connective tissue disease – S.L.E. Polyarhteritis nodosa, Dermatomyositis. 11.Miscellaneous Disorders - Amyloidosis Erythema multiform, Ulcerative colitis, Sarcoidosis

22. OSTEOARTHRITIS (O.A)Also called as Osteorthrosis or • Degenerative Joint Disease • Result from a combination of aging, • irritation of joints, wear and abrasion. • Commonly known as wear and tear • arthritis and • leading cause of disability in older • individuals. • Most common form of chronic • disorder of synovial joints • particulars weight bearing joint

23. In Older Age. The Articular cartilage show Degenerative changes in CENTRE(Fibrillation of cartilage) And Proliferative change around the edges (Osteophytes ) It is characterized by : Degeneration of the cartilage with associated over growth of bone at the margin of joints And Changes in synovial membrane Affect up to 10% of world population

24. IT COMMONLY INVOLVES :

25. The distal IP joints of the fingers- to form • bony swelling – The Heber den nodes. • The proximal Interphalangeal finger • joints – to form bony swelling – • The Bouchard nodes

26. The lumbar spine – lumbar spondylitis

27. The cervical spine – • cervical spondylitis.

28. The large joints – • including Hips and Knees.

29. PRIIMARY– OESTEOARTHRITIES  • Occur more commonly in women than men . • Progress begin by end of 4th decade. • Pathogenesis • Wear and tear with repeated minor trauma, • heredity AND obesity.

30. Secondary Osteoarthritis  -May appear at any age. -Results from any previous injury, fracture inflammation and congenital dislocation of the hip. Clinical manifestaslation : Joint stiffness. Diminished mobility, pair etc. The symptom are prominent on walking up from the Bed in morning. .

31. The degenerative changes in the interphalenges joints lead to hard bony and pain less modules at the base of terminal. Its phalanx called as HEBERDEN”S NODES.

32. HEBERDEN”S NODES

33. Pathos Physiology of secondary osteoarthritis

34. Most marked in weight – bearing region. Initially Loss of cartilaginous matrix Resulting Progressive loss of normal metachron Focal loss of chondrocytes Causes Loosening, flaking and fissuring of Articular cartilage. Resulting Breaking off of pieces of cartilage. Developing of Osteophytes. Thicking of jointCauses swelling.

35. MACHINICAL SYMPTOMS ARE CHARACTERRIZED BY: Pain: The pain is usually relieved by rest. Night pain may be a feature. Pain on weight- bearing, if the lower limb joints are involved. Stiffness after rest: usually lasting less than 5 minutes – with the patient loosening up quickly by moving the joints. Morning stiffness is not a prominent feature and short lived if present at all. Swelling is usually bony rather than soft tissue in character.

36. Risk factors: • Age • Obesity • Repetitive stress injury / trauma to joints. • Sex – Female are more frequently involved (10:1) • Genetics – this is a problem often seen within families. • Other diseases causing cartilage damage – resulting in • secondary osteoarthritis.

37. XRAY OF NORMAL KNEE JOINT

38. X RAY OF OSTEORITHRITIC KNEE

39. OSTEOARTHRITIS OF KNEE Most commonly affected joints found in clinical practice. Joint space narrowing with Osteophytes (new bone formation) and loose bodies are seen. The patellofemoral articulation is the most commonly affected with medical tibiofemoral compartment being second. In early disease, spiking of the tibial tubercles and marginal Osteophytes are seen.

40. OSTEORTHITIS OF THE HIP JOINT This is the second most affected joint in the body. Secondary osteoarthritis following: Congenital dysplasia. PERTH’S DISEASE congenital dislocation, slipped epiphysis, Aseptic necrosis etc is more common than primary osteoarthritis. Joint space reduction and marginal osieophyisis are seen. The femoral head migrates either superiorly or medially. A-P views of the hip usually provide adequate information. In certain cases, a CT scan show areas of subaiticular crescents as in aseptic necrosis or geode formation in advanced cases.

41. NORMAL X RAY OF THE HIP JOINT

42. OSTEORTHITIS OF THE HIP JOINT

43. OSTEOARTHRITIS OF THE HANDS In osteoarthritis, the distal interphalageal joints are most commonly affected with joint space narrowing and large peripheral osteophytes resulting in the clinically evident “Heber dens nodes “

44. X RAY OF ARTHITIS OF THE TOE JOINT

45. RHEUMATOID ARTHRITIS Definition– A systemic connective tissue disorder which affects predominantly the synovial joints, hence the term rheumatoid disease. Its systemic manifestation include hematological, pulmonary, neurological & CVS abnormalities

46. Etiology : • Age – any age, majority Between 20-40. • Sex– more in females than males = 5:1 • Climate– in temperature climate. • Familial tendency. • Genetic factors. • Sex hormones – more in female than in • males. • 7.Psychological factor – Physical • 8.Exposure to cold & wet. • 9.Trauma: • Arthritis may start in a joint which • has been the seat of trauma and • other joints subsequent get involved. • 10.Environmental triggers.

47. EITIOPATHOGENISIS OF REHEVMATOID ARTHERITIS • IMMUNOLOGIC FACTORS • (II) GENETIC FACTOR

48. Genetic susceptibility ( MHC – Class – II ) Antigenic stimulation ( By infections agent ) CD4 + T –Cells Cytokines ( TNF – α, INF – γ, IL -1) Activate Activate Activate B – Cells Endothelial Cell Macrophages Anti IgG – antibody Release of adhesion Cytokines (Rheumatoid factor) molecule Protease Formation of immune complex, Inflammatory Cells, Inflammatory damage to synovium, small vessel collagen Destruction of cartilage bone fibrosis, ankylosi joint Deformities

49. Types of Presentation:- 1.Classical – Pain, stiffness and swelling of small joints of head, wrists. 2.Palindromic – Pain, swelling and redness usually of a single joint, followed by rapid return to normal after several days. 3.Systemic - Weight loss, Pleurisy and pericarditis but minimal joint involvement. 4. Polycyclic - Plain and stiffness in shoulders and hips with subsequent synoptic. 5. Monoarthritic - Single joint involvement usually the knee. 6. Acute Onset - Sudden overnight onset with stiffness and pain. 7. With generalized lymphadenopthy.

50. Clinical Features:- • In early stage – • Joints are warm, swollen and tender. • Weakening of joints, capsule and tendon along • with ligament damage. • Instability, subluxation, dislocation. • Severe joint damage may lead to fibrous or body ankylosis