Disease of Joints and Musculoskeletal Disorders OSTEOARTHRITIS and GOUT

Disease of Joints and Musculoskeletal Disorders

OSTEOARIRITIS

  • 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.

Lab findings

  • · In X-ray joint-space narrowing is seen
  • · Osteophytes.

OSTEOARIRITIS Treatment

  • 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
  • AnalgesicsNaproxen. Read more ... »
  • Paracetamol Cox-2 inhibitors Ibuprofen Naproxen
  • Intraarticular injection of hyaluronidase Steroids –
    • intraarticular should not be given Opioids
    • Tramadol
  • 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
  • Chondroplasty.

GOUT

Disease of Joints and Musculoskeletal Disorders OSTEOARTHRITIS and GOUT


GOUT

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.

GOUT Treatment

  • For acuteInterstitial Lung Diseases Clinical Features examination Treatment. Read more ... » attack Colchicine is given – 0.6 mg every hour till relief. Colchicine is stopped if there is diarrhoea
  • NSAIDs
  • Steroids
  • Indomethacin
  • Ibuprofen
  • ACTH – 40 – SO IU every 12 hours for 2 days. Uricosuric agents – probenecid, allopurinol given to increase excretion of uric acid.
  • They prevent acuteInterstitial Lung Diseases Clinical Features examination Treatment. Read more ... » 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.

INFECTIVE ARTHRITIS

  • 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.

REACTIVE ARTHRITIS

  • 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.

Pathology

  • 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

Lab tests

  • · 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 –
  • Indomethacin,
  • Cox-2 inhibitors
  • Sulphasalazine
  • Azathioprine – 1 mg/kg/day
  • Methotrexate – 15 mg/kg/week
  • Glucocorticoids.