Embed Size (px)
DESCRIPTION
pathophysiology
Citation preview
OsteoarthritisOsteoarthritis
ObjectivesObjectives
Compare & contrast the sequence of Compare & contrast the sequence of events leading to joint destruction in events leading to joint destruction in osteo-arthritis & rheumatoid arthritisosteo-arthritis & rheumatoid arthritis
Describe the clinical manifestations of Describe the clinical manifestations of OA and RAOA and RA
Compare & contrast the sequence of Compare & contrast the sequence of events leading to joint destruction in events leading to joint destruction in osteo-arthritis & rheumatoid arthritisosteo-arthritis & rheumatoid arthritis
Describe the clinical manifestations of Describe the clinical manifestations of OA and RAOA and RA
OsteoarthritisOsteoarthritis
Most common form of joint disease in Most common form of joint disease in NZNZ
Non-inflammatory disorder of the Non-inflammatory disorder of the synovial jointssynovial joints
Slowly progressive Slowly progressive More than 90% of adults are affected More than 90% of adults are affected
by age 40by age 40
Most common form of joint disease in Most common form of joint disease in NZNZ
Non-inflammatory disorder of the Non-inflammatory disorder of the synovial jointssynovial joints
Slowly progressive Slowly progressive More than 90% of adults are affected More than 90% of adults are affected
by age 40by age 40
OsteoarthritisOsteoarthritis
Before age 50, men are more often Before age 50, men are more often affected than womenaffected than women
Incidence of OA after 50 is twice as Incidence of OA after 50 is twice as great in womengreat in women
Before age 50, men are more often Before age 50, men are more often affected than womenaffected than women
Incidence of OA after 50 is twice as Incidence of OA after 50 is twice as great in womengreat in women
Etiology and PathophysiologyEtiology and Pathophysiology
Cause can be unknown or a known Cause can be unknown or a known event or condition that directly event or condition that directly damages cartilage or causes joint damages cartilage or causes joint instability e.g.. trauma, repetitive instability e.g.. trauma, repetitive physical activities, congenital physical activities, congenital dislocation of the hipdislocation of the hip
Cause can be unknown or a known Cause can be unknown or a known event or condition that directly event or condition that directly damages cartilage or causes joint damages cartilage or causes joint instability e.g.. trauma, repetitive instability e.g.. trauma, repetitive physical activities, congenital physical activities, congenital dislocation of the hipdislocation of the hip
Etiology and PathophysiologyEtiology and Pathophysiology
Estrogen reduction at menopauseEstrogen reduction at menopauseGenetic factorsGenetic factorsObesityObesityStrenuous exercise activitiesStrenuous exercise activities
Estrogen reduction at menopauseEstrogen reduction at menopauseGenetic factorsGenetic factorsObesityObesityStrenuous exercise activitiesStrenuous exercise activities
Etiology and PathophysiologyEtiology and Pathophysiology
Results from cartilage damageResults from cartilage damageCauses the normally smooth, white, Causes the normally smooth, white,
translucent articular cartilage to translucent articular cartilage to become dull, yellow & granularbecome dull, yellow & granular
Affected cartilage:Affected cartilage:– Dull, yellow, granular– Softer, less elastic– Less able to resist wear
Results from cartilage damageResults from cartilage damageCauses the normally smooth, white, Causes the normally smooth, white,
translucent articular cartilage to translucent articular cartilage to become dull, yellow & granularbecome dull, yellow & granular
Affected cartilage:Affected cartilage:– Dull, yellow, granular– Softer, less elastic– Less able to resist wear
Etiology and PathophysiologyEtiology and Pathophysiology
Body’s attempts at repair cannot keep Body’s attempts at repair cannot keep up with destructionup with destruction
Continued changes in collagen Continued changes in collagen structure structure fissuring and erosion fissuring and erosion
Body’s attempts at repair cannot keep Body’s attempts at repair cannot keep up with destructionup with destruction
Continued changes in collagen Continued changes in collagen structure structure fissuring and erosion fissuring and erosion
Etiology and PathophysiologyEtiology and Pathophysiology
Central cartilage becomes thinnerCentral cartilage becomes thinnerCartilage and bony growth Cartilage and bony growth
(osteophytes) increase at the joint (osteophytes) increase at the joint marginsmargins
Secondary synovitisSecondary synovitis
– Inflammatory changes early pain and stiffness
Central cartilage becomes thinnerCentral cartilage becomes thinnerCartilage and bony growth Cartilage and bony growth
(osteophytes) increase at the joint (osteophytes) increase at the joint marginsmargins
Secondary synovitisSecondary synovitis
– Inflammatory changes early pain and stiffness
Pathophysiology of osteoarthritisPathophysiology of osteoarthritis
Clinical ManifestationsClinical Manifestations
No systemic manifestationsNo systemic manifestationsJoint painJoint pain
– Predominant symptom
– Relieved by rest in early stages
No systemic manifestationsNo systemic manifestationsJoint painJoint pain
– Predominant symptom
– Relieved by rest in early stages
Clinical ManifestationsClinical Manifestations
Joint painJoint pain
– Generally worsens with joint use
– May become worse as barometric pressures fall before inclement weather
Joint painJoint pain
– Generally worsens with joint use
– May become worse as barometric pressures fall before inclement weather
Clinical ManifestationsClinical Manifestations
Joint painJoint pain
– May be referred to:
• Groin
• Buttock
• Medial side of thigh or knee
Joint painJoint pain
– May be referred to:
• Groin
• Buttock
• Medial side of thigh or knee
Clinical ManifestationsClinical Manifestations
Joint painJoint pain
– Crepitation
• Grating sensation caused by loose particles of cartilage in the joint cavity
Joint painJoint pain
– Crepitation
• Grating sensation caused by loose particles of cartilage in the joint cavity
Clinical ManifestationsClinical Manifestations
Joint pain
– Affects joints asymmetrically
– Early morning stiffness
• Resolves within 30 minutes
Joint pain
– Affects joints asymmetrically
– Early morning stiffness
• Resolves within 30 minutes
Clinical ManifestationsClinical Manifestations
Most commonly involved joints:Most commonly involved joints:– Distal interphalangeal (DIP)– Proximal interphalangeal (PIP)– Carpometacarpal joint of the thumb– Weight-bearing joints (hips, knees)– Metatarsophalangeal (MTP)– Cervical and lower lumbar vertebrae
Most commonly involved joints:Most commonly involved joints:– Distal interphalangeal (DIP)– Proximal interphalangeal (PIP)– Carpometacarpal joint of the thumb– Weight-bearing joints (hips, knees)– Metatarsophalangeal (MTP)– Cervical and lower lumbar vertebrae
Joints Involved in OsteoarthritisJoints Involved in OsteoarthritisJoints Involved in OsteoarthritisJoints Involved in Osteoarthritis
Fig. 63-2
Clinical Manifestations - DeformityClinical Manifestations - Deformity
Specific to involved jointSpecific to involved joint– Heberden’s & Bouchard’s nodes
• Indication of osteophyte formation & loss of joint space
• Appear from age 40 & tend to be seen in families
• Often red, swollen & tender• Do not cause significant loss of
function
Specific to involved jointSpecific to involved joint– Heberden’s & Bouchard’s nodes
• Indication of osteophyte formation & loss of joint space
• Appear from age 40 & tend to be seen in families
• Often red, swollen & tender• Do not cause significant loss of
function
Hand Deformormities - NodesHand Deformormities - Nodes
Osteoarthritis HandsOsteoarthritis Hands
Clinical ManifestationsClinical Manifestations
DeformityDeformity
– Bouchard’s nodes
• PIP joints
– Nodes often red, swollen, tender
DeformityDeformity
– Bouchard’s nodes
• PIP joints
– Nodes often red, swollen, tender
