JOINT DISORDERS By Zahida Chaudhary MD

Ankylosing SpondylitisBack PainBehcet's syndromeCarpal tunnel syndromeDiffuse idiopathic skeletal hyperostosis (DISH)Ehlers-Danlos syndrome (EDS)FibromyalgiaGonococcal arthritisGoutJuvenile Rheumatoid Arthritis (JRA)

Systemic Lupus Erythematosus (SLE)Lyme DiseaseOsteoarthritisOsteomalaciaOsteoporosisPaget’s DiseasePolymyalgia Rheumatica (PMR)Psoriatic ArthritisRaynaud's phenomenonReactive arthritisRepetitive strain injuryRheumatoid arthritis

List of joint problems

The causes of arthritis depend on the form of arthritis.

Injury or aging, leading to osteoarthritis metabolic abnormalities such as gout and pseudo gout

Hereditary factors and infections

Auto immune such as rheumatoid arthritis and systemic lupus erythematosus.

systemic lupus erythematosusThe causes of arthritis

Basically, a joint is where one bone moves on another bone.

Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move.

Cartilage covers the bone surface to stop the two bones from rubbing directly against each other.

The covering of cartilage allows the joint to work smoothly and painlessly.

How a joint works

Broad Classification of Arthritis

Degenerative arthritis Osteoarthritis

Autoimmune arthritis Rheumatoid arthritis ANA positive diseases

Infectious arthritis Bacterial Viral

Metabolic / endocrine Hyperthyroidism Hyperparathyroidism

Crystalline arthritis Gout Pseudo gout

Neoplastic arthritis Primary Para neoplastic

Osteoarthritis “Degenerative joint

disease Primary sight of

pathology is cartilage and subchondral bone Primary vs Secondary Joints only (no systemic

features)

While osteoarthritis can damage any joint in our body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.

Symptoms

Pain Early in

disease, pain with use

End stage, pain at rest

May have little or no pain

Stiffness (gel phenomenon)

Physical Findings

Bony enlargement of involved joints Hands

DIP PIP

First CMC (carpometacarpal) Knees Hips Feet (Bunion joint) Spine

OA of Hands

• Hand Involvement“Bony” enlargementSparing of MCPsBouchard’s nodes (PIP)Heberden’s nodes (DIP)Little “synovitis”

OA of the spine

• Lumbar spine Xray in a • patient with scoliosis (curva-• ture of the spine). The • Scoliosis predisposed this• Patient to OA of the spinedisc space narrowing“bridging” osteophytessclerosis

Treating Osteoarthritis

Weight loss (knee OA)

Muscle strengthening (knee OA)

Physical therapy Assistive devices

Canes walkers

Acetaminophen (for mild disease)

NSAIDs Glucosamine/Chondroitin

Sulfate? Joint injections Steroids Viscos supplements

High molecular weight hyaluronic acid

Surgery Joint replacements

Findings from a newly released CDC report indicate that one third of U.S. adults with arthritis 45 years and older have either anxiety or depression.

As shown in the figure on the right, most people who had depression (85%) also had anxiety. However, only 50% of the people who had anxiety also had depression

Treating Osteoarthritis