INFLAMMATORY INFLAMMATORY AND AND

DEGENERATIVE DEGENERATIVE JOINT DISEASESJOINT DISEASES

Dr. Amro Al-Hibshi, MD, Dr. Amro Al-Hibshi, MD, FRCSC, MEdFRCSC, MEd

Painful jointPainful joint

OBJECTIVESOBJECTIVES

To identify the differences in To identify the differences in etiology and pathophysiologyetiology and pathophysiology

To identify the clinical, radiological To identify the clinical, radiological and laboratory differencesand laboratory differences

To identify the difference in To identify the difference in treatment modalities treatment modalities

DEGENERATIVE AND DEGENERATIVE AND INFLAMMATORY INFLAMMATORY

ARTHRITISARTHRITISDegenerativeDegenerative Osteoarthritis (OA)Osteoarthritis (OA) Post-traumatic Post-traumatic

arthritisarthritis Arthritis following Arthritis following

dysplasiadysplasia OsteonecrosisOsteonecrosis Osteochondritis Osteochondritis

dissecansdissecans

InflammatoryInflammatory Rheumatoid Rheumatoid

arthritis (RA)arthritis (RA) SLESLE Ankylosing Ankylosing

spondylitisspondylitis GoutGout PseudogoutPseudogout

DEGENERATIVE DEGENERATIVE ARTHRITISARTHRITIS

Arthritis Vs. Arthrosis !Arthritis Vs. Arthrosis !

OA – Etiology and OA – Etiology and pathophysiologypathophysiology

Primary Vs. secondaryPrimary Vs. secondary MechanicalMechanical IatrogenicIatrogenic Genetic predispositionGenetic predisposition Failed attempt to repair damaged Failed attempt to repair damaged

cartilagecartilage Increased water contentIncreased water content Alterations in proteoglycansAlterations in proteoglycans Collagen abnormalitiesCollagen abnormalities MetalloproteinasesMetalloproteinases Interleukin 1Interleukin 1

RA – Etiology and RA – Etiology and PathophysiologyPathophysiology

Cell-mediated autoimmune diseaseCell-mediated autoimmune disease HLA-DR4 and/or –DW4HLA-DR4 and/or –DW4 ? Genetic? Genetic ? Infection? Infection Synovium and soft tissues affected Synovium and soft tissues affected

firstfirst

CharacteristicsCharacteristics

OAOA LocalizedLocalized AsymmetricAsymmetric Large jointsLarge joints Older ageOlder age Aggravated by Aggravated by

activitiesactivities Varus kneesVarus knees Labs -veLabs -ve Symptomatic Symptomatic

treatmenttreatment

RARA SystemicSystemic SymmetricSymmetric Small jointsSmall joints Younger ageYounger age Morning stiffnessMorning stiffness Valgus kneesValgus knees Labs +veLabs +ve Specific treatmentSpecific treatment

OA – PHYSICAL EXAMOA – PHYSICAL EXAM

InspectionInspection PalpationPalpation ROMROM Special testsSpecial tests Neurovascular examNeurovascular exam

RA –Clinical PictureRA –Clinical Picture

Insidous onsetInsidous onset Morning stiffnessMorning stiffness PolyarthritisPolyarthritis Most commonly in the handsMost commonly in the hands Subcutaneous nodulesSubcutaneous nodules LabsLabs

Radiologic FindingsRadiologic Findings

OAOA Loss of joint spaceLoss of joint space OsteophytesOsteophytes Cyst formationCyst formation Subchondral Subchondral

sclerosissclerosis

RARA Periarticular Periarticular

osteoporosisosteoporosis Loss of joint spaceLoss of joint space ErosionsErosions Subluxations and Subluxations and

deformitiesdeformities

Joint AspirationJoint Aspiration

OAOA DryDry WBC’s 200WBC’s 200 PMN 25%PMN 25% Glucose and Glucose and

protein equal to protein equal to serumserum

RARA EffusionEffusion WBC’s 2000-75000WBC’s 2000-75000 PMN 50%PMN 50% Low glucoseLow glucose

OA - TREATMENTOA - TREATMENT Activity modificationActivity modification PhysiotherapyPhysiotherapy Supportive devicesSupportive devices NSAIDs and analgesicsNSAIDs and analgesics Intraarticular injectionsIntraarticular injections Joint debridementJoint debridement Joint realignment procedureJoint realignment procedure ArthrodesisArthrodesis Joint replacementJoint replacement

RA - TREATMENTRA - TREATMENT Medical !Medical ! Medical !Medical ! Medical !Medical ! SurgicalSurgical - Synovectomy- Synovectomy - Arthrodesis- Arthrodesis - Joint replacement- Joint replacement* Preoperative preparation* Preoperative preparation* Risk of infection* Risk of infection