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RHEUMATIC DISEASES: PATTERN
AND SCOPE
Dr. Femi Adelowo, FMCP, FWACP,FACR,FRCP Edin FRCP LondProfessor of Medicine and Consultant Rheumatologist, LASUTH. Ikeja
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INTRODUCTION
MISCONCEPTIONS
1. Arthritis is not one disease: more than 200 types or causes
2. Arthritis is not exclusive disease of elderly 3. Arthritis affects all age groups
4- Rheumatology is the specialty of Internal Medicine that
deals with diagnosis and management of all types of arthritis,as
well as systemic auto immune Connective Tissue Diseases
5. Arthritis affects hard tissue of joints and synovial membranewhile rheumatism(soft tissue,non articular) involves
capsule,tendon,ligaments,muscles.
Rheumatologist treats medically, Orthopaedic Surgeon treats
with surgery.They are both complimentary, as well as other
medical personnel-Physiotherapist,occupational
therapists,nutritionist,podiatrist etc
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CONTD
The word - Rheumatic derived from the
word Rheuma
In Broad usage - refers to diseases of the
joints
Arthritis and Rheumatism
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EXTENT OF ARTHRITIS
355 million people have different types ofarthritis world wide
By year 2025, degenerative joint diseaseswill be most common cause of physical
disability Socio economic impact of rheumatic
diseases on the rise
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CONTD
USA315 million physician visits per year
8 million hospital admissions per year
17 million people with activity limitation
Prevalence in a rural Nigeria community31%
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HEALTH IMPACT
. Decreased physical functioning
- Increased psychological distress
- Decreased social functioning
- Increased health care utilization
- Increased work disability
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CLASSIFICATION
1. DEGENERATIVE ARTHRITIS
Osteoarthritis Spondylosis- Cervical, Lumbar
2. CONNECTIVE TISSUE DISEASE(SYSTEMIC AUTO IMMUNE)
Systemic Lupus Erythematosus
Anti phospholipid syndromeScleroderma
Dermatomyositis/ Polymyositis (Inflammatory Myositis)
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CONTD
CHARACTERISTICS
1 Female preponderance
2. Overlap
3. Familiar clustering
4. Multisystemic
5. High acute phase proteinsESR, CRP
6. HLA typing
7. Serological Response to steroids and immunosuppressives
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CONTD
3. INFLAMMATORY ARTHRITIS
A. Rheumatoid Arthritis
Sjogrens Syndrome
B. SPONDYLO ARTHROPATHY
Ankylosing Spondylitis
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CONTD
Psoriatic arthropathy
Reiters disease
Inflammatory Bowel arthropathy
Undifferentiated
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CHARACTERISTICS
OF SPONDYLOARTHROPATHY
Male preponderance
Buttock pain - Sacroiliitis
Back pain associated with stiffness
Oligoarthropathylarge joints lower limbs
Association with urethritis and diarrhea
HLA B27 positive
Good response to NSAIDs
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CLASSIFICATION CONTD
JUVENILE CHRONIC(IDIOPATHIC
ARTHRITIS) Systemic
Pauciarticular
Polyarticular
Juvenile SLE
Juvenile Dermatomyositis
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CLASSIFICATION CONTD
4 INFECTIVE ARTHRITIS
All infective agents including TB.Staph,Strept,Gonococci
5. REACTIVE ARTHRITIS
Reiters Disease Rheumatic fever
Post streptococcal Arthritis
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CONTD
6.VASCULITIS(Pauci immune complexes)
Primary or Secondary
Systemic or Cutaneous Large vessel- Giant Cell arteritis, Takayasu
Medium vessel-Polyarteritis nodosa, BehcetsDisease, Kawasaki
Small vessel(AASV)- Wegeners Granulomatosis,Churg-Strauss, Microscopic Polyangiitis.
Secondary vasculitis- RA,SLE,HIV,HCV,HBVSyphilis,Drugs-(sulphonamides, ofloxacin),infectionsmeningococcus,Staph,
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CONTD
7.CRYSTAL
Gout Pseudogout
Cholesterol
8.BONE DISORDERS
Osteoporosis
Osteomalacia
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9.HYPERMOBILITY SYNDROME
Heritable EhlerDanlos Syndrome
Pseudoxanthoma Elasticum
Marfans Syndrome
Benign Hypermobility Syndrome
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CONTD
10. SOFT TISSUE RHEUMATISM
Bursitis Tendinitis
Enthesopathies
De Quervain tenosynovitis
Carpal Tunnel Syndrome Fibromyalgia Syndrome
Polymyalgia Rheumatica
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CONTD
11.REGIONAL PAIN SYNDROMES: Backache, Shoulderpain syndrome,neck pain
12 RHEUMATIC DISEASES ASSOCIATED WITH HIV/AIDS
Reiters Disease
Psoriatic arthropathies
Spondyloarthropathies
Rheumatoid Arthritis
13.Arthritis Associated with malignancies- Leukemia(ALL inchildren)
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THANK YOU