Disease of Joints and Musculoskeletal Disorders
- Also called degenerative joint disease.
- Hip osteoarthritis is more common in men and small joints and knee OA is more common in women.
- There is damage to cartilage, remodeling and hypertrophy of bone.
- There is bone and muscle wasting.
OSTEOARIRITIS Clinical Features
- · There is deep pain in the joint aggravated by joint movements and relieved by rest.
- · There is involvement of synovium, subchondral bone, ligament, capsule, muscle and formation of osteophytes.
- · Nocturnal pain, stiffness, synovitis.
- · There is bony crepitus over affected joints and synovial effusion.
- · There may be ‘bony deformities.
- · Fever, weight loss may occur.
- · In X-ray joint-space narrowing is seen
- · Osteophytes.
- Obese patient should lose weight
- Avoid prolonged standing, kneeling, squatting Medial taping of patella
- Wedged insoles in footwear
- Heat application – hot bath
- Walking, cycling, swimming reduces joint pain Walking with a cane during pain
- Proper footwear
- Paracetamol Cox-2 inhibitors Ibuprofen Naproxen
- Intraarticular injection of hyaluronidase Steroids –
- intraarticular should not be given Opioids
- Tidal irrigation of knee
- Topical therapy – Pain relievers – ointments, sprays, oils
- Glucosamine, chondroitin sulphate – it protects the cartilage and gives symptomatic improvement
- Surgery – Joint replacement, osteotomy, arthroplasty
- · It is a metabolic disease
- · Affects middle-aged and elderly men and women.
- · There is hyperuricemia ( increased levels of uric acid in blood)
- · There is acute or chronic arthritis with deposition of monosodium urate(MSU) crystals in connective tissue and kidneys
- · Usually only one joint is affected
- · The great toe (first toe) is involved
- · There are Heberden’s nodes or Bouchard’s nodes in the joints
- · Joints are warm, red, painful
- · It is precipitated by alcohol, steroids, MI, stroke
- · Renal insufficiency may occur.
GOUT Lab Diagnosis
- · MSU crystals can be demonstrated in the joint
- · Serum uric acid may be increased, normal or low
- · X-ray –bony erosions may be seen.
- For acute attack Colchicine is given – 0.6 mg every hour till relief. Colchicine is stopped if there is diarrhoea
- ACTH – 40 – SO IU every 12 hours for 2 days. Uricosuric agents – probenecid, allopurinol given to increase excretion of uric acid.
- They prevent acute attacks but are not started during an attack of painful gout because they can flare-up the attack.
- Allopurinol is given in a single dose 300 mg initially and increased upto SOO mg.
- Toxicity of allopurinol is skin rash, systemic vasculitis, hepatitis, bone-marrow suppression and renal failure.
- Hypourecemic therapy is given till the patient is normourecemic and without gouty attack for 3 months. Prophylactic colchicine may be continued.
- Usually caused by Staphylococcus aureus, Neisseria gonorrhoea.
- Also caused by Mycobacteria, spirochetes, fungi, viruses.
- One or more joints involved.
- Affects the knee, hip, shoulder, wrist, elbow joints. There is severe pain, effusion, limitation of movements. Fever is usually present.
- X-ray show,? swelling and increase of joint-space. MRI and CT’may be done.
- Synovial fluid is turbid or purulent.
- Gram’s staining shows neutrophils and staphylococci. Culture of synovial fluid is usually positive.
INFECTIVE ARTHRITIS Treatment
- Antibiotics oral or parenteral Drainage of joints
- Antibiotics – Cefotaxime, Ceftriaxone, Vancomycin instilled into joints
- Weight- bearing should be avoided till infection subsides.
- It is a non-purulent arthritis.
- It usually occurs after enteric or urogenital infections. It has a strong association with HLA B27 antigen. Age: commonly lS – 40 years.
- Sex: males and females are equally affected.
- There is synovial inflammation, infiltration of the soft tissues of joint, cartilages with inflammatory cells.
REACTIVE ARTHRITIS Etiology
- Any bacterial, viral or parasitic infection can lead to reactive arthritis.
- Shigella, Salmonella, Clostridium etc. cause reactive arthritis commonly.
- The disease is mediated by T cells-CD4+ and CDS+.
REACTIVE ARTHRITIS Clinical features
- Constitutional symptoms-fever, malaise, weight loss, fatigue.
- There is asymmetric arthritis from 1 – 2 weeks after an infection.
- Joints of lower extremities like knees, ankle, tarsal, and metatarsal joints are affected.
- Wrist and fingers are also affected.
- Dactylitis –
- Swollen fingers like a sausage called sausage-digit may be seen.
- Chronic pain in the heels. Pneumonia. Pleuropulmonary infiltrates. Prostatitis.
- Keratoderma blenorrhagica – Skin lesions with vesicles, crusting on palms and soles are seen.
- Nails turn yellowish, brittle. There is onicholysis (nails break up), hyperkeratosis of nails.
- Cardiac involvement – conduction defects, aortic regurgitation may occur.
- · ESR increased
- · Anaemia
- · HLA B-27 positive
- · X-ray
- – Osteoporosis especially juxta articular (close to the joints)
- – Sacroileitis
- – Periosteitis
- – Spinal fusion.
REACTIVE ARTHRITIS Treatment
- NSAIDs –
- Cox-2 inhibitors
- Azathioprine – 1 mg/kg/day
- Methotrexate – 15 mg/kg/week