Arthritis

ARTHRITIS
Def:
Inflammation of the Joint’s is Called Arthritis.
Types of Arthritis:
1. Mono arthritis

2. Poly arthritis
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1. Acute Mono Arthritis:
 Pyogenic arthritis
 Gonococcal arthritis
 Reactive arthritis
 Juvenile chronic arthritis
 Gout (or) other crystal deposition diseases
 Trauma, internal derangement
 Palindromic arthritis
 Haemarthosis

2. Chronic Monoarthritis:
 Degenerative joint disease
 Tuberculosis (or) fungal infection
 Incompletely treated pyogenic arthritis
 Reactive arthritis
 Rheumatoid Arthritis.

3. Acute Polyarthritis.
 Rheumatic fever
 Rheumatoid arthritis
 Reactive arthritis
 SLE
 Syphilitic arthritis
 Poncet’s

4. Chronic Poly Arthritis
 Rheumatoid arthritis
 Psoriatic arthritis
 Ankylosing spondylitis
 S.L.E
 Degenerative arthritis
 Hypertrophy osteoarthropathy

MONO ARTHRITIS

Four main common diagnoses need to be considered in patients who present with a single hot, painful, tender, and swollen Jt.


D/D for Mono Arthritis:
Infection
Bacterial, Viral, Fungal, Spirochaetal,

Crystal Arthropathy
Gout, Pseudo gout

Inflammatory
- Rheumatoid arthritis
- Juvenile idiopathic arthritis
- Reactive arthritis
- Psoriatic
- Inflammatory bowel disease
- Erythema Nodosum
- Plaindromic
- Plant thorn synovitis
- Paraneoplastic

Traumatic:
• Haemarthrosis
• Internal derangement
• Loose body
• Fracture



* Degenerative
• Primary osteoarthritis
• Secondary osteoarthritis

* Bone disease
• Osteomyelitis
• Osteonecrosis

* Blood disorders:
• Leukemia
• Hemophilia
• Anticoagulants

* Other:
• Villonodular synovitis
• Tumors
POLYATHRITIS
Inflammation occurs in more than one joint’s

Causes and pattern of poly arthritis
 Symmetrical inflammatory
• Viral arthritis
• Rheumatoid arthritis
• Juvenile idiopathic arthritis
• SLE

 A Symmetrical Panciarticular
• Psoriatic arthritis
• Reiter’s syndrome
• Enteropathic arthritis
• Ankylosing spondylitis
• Behcet’s disease
• Bacterial endocarditis
• Sarcoidosis
• Septic arthritis

 Additive
• Gonococcal arthritis

 Flitting
• Rheumatic fever
• Septicemia

 Metabolic
• Polyarticular gout
• Pyrophosphate arthropathy
• Acromegalic arthritis
• Haemochromatosis
• Hyperlipidaemia

 Osteoarthritis
Nodal osteoarthritis
Non- nodal generalized osteoarthritis

DIFFERENTIAL DIAGNOSIS OF ARTHRITIS
RHEUMATOID ARTHRITIS
Def:
A chronic inflammatory joint disease with symmetrical destructive and deforming polyarthritis, affecting small and large Jt’s with presence of circulating anti Globin antibodies

Aetiology:
The cause remain obscure, but an increasing evidence that the disease is triggered by Th1 Lymphocytes.

Predisposing factors
Genetically individuals with HLA DR4
Temperate climate
Hereditary may play a part in 5% to 10% of cases
It is commonly seen in subjects with asthenic built
In many cases H/O trauma is present.


Pathology
Swelling and congestion of synovial membrane

Infiltration of Lymphocytes, plasma cell and macrophage

Effusion of synovial fluid into the Jt space

Hypertrophy of synovial membrane

Inflammatory granulation tissue (pannus)

Spreads over the under the articular cartilage

Articular cartilage progressively eroded and destroyed

Fibrous (or) bony ankylosis may occur

Muscles adjacent to inflamed jt’s atrophy and there may be focal infiltration with lymphocytes.

C/F:
- Onset is usually gradual, sometimes acute
- Common in adults and middle aged.
- Joint pain, stiffness and symmetrical swelling of and number of peripheral joints are being swollen.
- Pain usually only on morning, but later on pain at rest and early morning stiffness are characteristic.
- Small joint’s of the fingers usually the proximal interphalangeal joint’s are involved giving a spindle appearance
- Rheumatoid nodules present in subcutaneous over bony prominences,
- In the toes usually the metatarsal phalangeal joint’s leading to broadening of the toes.
- Initially the small joint’s such as interphalangeal joint’s and metatarsophalangeal joint’s are involved, but later on the wrist, elbow, shoulder, ankle, knee, hip, temparomandibula and acromion clavicular jont’s are involved.

Hand Deformities:
- Swan neck deformities present.
- Boutonnier’s (or) buttonhole deformity present.
- Z deformity of thumb present.

Foot Deformities:
- Painful sensation as if “walking on pebbles”
- Calcanen erosion
- Backer’s cyst (or) popliteal cyst

INVESTIGATIONS:
Test for Inflammation
- Increased ESR
- C reactive protein increased
- Thrombocytosis
- Norm chromic, normocytic anemia
- Hepatic alkaline phosphate increased
Immunological Test
- Rheumatoid factor - +ve
- ANF -+ve
X ray: Show deformities, nodules, (+)

OSTEOARTHRITIS
Def:
Osteoarthritis is not a single disease, rather it is the end result of a variety of patterns of Jt failure is characterized by both degeneration of articular cartilage and simultaneous proliferation of new bone, cartilage and connective tissue .mainly affected big wt bearing Jt of the body mainly in the aged individuals
Age groups - above 60 yrs

PATHOLOGY
Micro # of subchondral bones due to repetive loading

Healing of micro#

Relative loss of original shape of bone

Creates a stress to adjacent cartilage

Proliferate changes appear at margin
(That formation - osteophytes)

Articular cartilage is lost

Underlying bone becomes hard

Cyst may form

C/F
- The common joints affected are spinal cord, hip, knee Jt.
- Gradual onset of pain at 1st intermittent and dull aching pain,
- Pain rest
- As the disease progress movement of the joint restricted initially due to pain and later on due to formation of osteophytes and remodeling of bones.
- Nocturnal aching is common due to excessive blood supply

On Examination
- Crepitus may be felt (or) heard
- Muscular wasting near the involve Jt may be present.
- Heber den’s node present (Terminal inter phalangial Jt)
- Bouchard’s Node (proximal inter phalngial Jt)

Investigation
Blood picture : Normal
Synovial fluid : Viscus in nature with low cell count
X – Ray:
- Loss of Jt space
- Formation of marginal osteophytes
- Bone remodeling and cyst may be seen.

GOUT
Def:
A Disorders in which crystals of monosodium urate, monohydrate derived from hyperuraemic body fluids giving rise to inflammatory arthritis , Tendosynovitis, Bursitis, urolithiasis and renal disease
(Normal serum uric acid level
Male –3.0 to 7.6 mg/dl Female –2.6 to 6.8mg/dl)
Age: Post pubertal in male, women after menopause


Aetiology:
Increased excretion of uric acid (75%)
- Renal failure
- Lead poisoning
- Hyper parathyroidism
- Myxoedema
- Down syndrome
- Alcohol
- Toxaemia of pregnancy

Increased Production of Uric Acid (25%)
- Increased turn over
- Increased synthesis of uric acid
C/F
Acute:
- Initially the metatarsophalangeal Jt of the great toe is involved in 70% of individuals.
- As the disease progress the ankle and wrist are involved.
- The onset is insidious with heat, redness, swelling, shiny skin and dilatation of vein over the joint.
Chronic:
- Recurrent acute attacks lead to progressive cartilage and bony erosions.
- Deposition of sodium urate in the joint produced chronic foreign body inflammatory response of the joint, this is known as “Tophi”
- Severe functional impairment with deformities may be present.

Investigations:
- Serum urate level elevated.
- Joint radiograph shows soft tissues, swelling with deposition of crystals.
RHEUMATIC ARTHRITIS

- Here big joint’s are affected one after another (fleeting type arthritis)
- Evidences of carditis are present
- ASO titer increased

TUBERCULOUS ARTHRITIS
- Single joint is involved
- Wasting of muscles above and below the involved joint is common.
- Low grade fever present
- H/o tuberculosis present
- X ray of chest may reveal tuberculosis

TRAUMATIC ARTHRITIS
- H/o trauma will be present
- Usually single joint is affected

PYOGENIC ARTHRITIS
- It is monoarticular
- The skin is red, edematous, glossy and tender with local rise of temperature
- Blood shows leucocytosis with increased polymorphs

GONORRHOEAL ARTHRITIS
- H/o exposure and urethral discharge are present
- Complement fixation test is positive
PSORIATIC ARTHRITIS
- Terminal interphalangeal joints are involved
- Nails are cracked, pitted (or) thickened.
- Psoriatic skin lesions are present
- Rheumatoid factor is negative.
HAEMOPHILIC ARTHRITIS
- H/o hemophilia is present
- Males are affected,
- Knee joint is usually affected
- Coagulation time is prolonged
REITER’S SYNDROME
- The disease is common in males,
- There is polyarthritis, non gonorrheal, urethritis and conjunctivitis,
DYSENTERIC ARTHRITIS
- Usually 3-4 weeks after an attack of acute bacillary dysentery
- Knee, elbow, wrist and finger joints are commonly affected
ARTHRITIS IN BRUCELLOSIS
- This is monoarticular, usually involving knee, hip (or) sacroiliac joints.
- Low grade pyrexia is present.
- Agglutination test is positive
HOMOEOPATHIC MANAGEMENT
(Murphy repertory)
ARTHRITIS, Inflammation
Acon kalm sep
Apis kreos saras
Bell lac.ac sulph
Bry lyco
Led merc
Sil Nat.m
Ang
Arn Nat-s
Aur phyt
Calc psor
Caust puls
Guai Rhod
Kali-c Ruta
Kali-I Rhus.tox