Inflammatory and Rheumatic Disorders

 Inflamatory and Rheumatoid Disorders 


Rheumatoid Arthritis


Most common cause of chronic inflammatory joint disease 


1-3 % , 4th or 5th decdes


women affected 3 to 4 times more often than men.


Causes


1) Genetic susceptibility


2) Immunologic reaction


in joints and tendons


4) Rheumatoid Factors


5) perpetuation of inflammatory factors


 6) articular cortilage distruction.


Pathology 


1)Joints and Tendons 


      Preclinical inflammation - increased ESR and CRP


     Synovitis 


       Destruction

        De formity


2) Extra articular tissues


      1) Rheumatoid Nodules


       2) Lymphadenopathy


       3) Vasculitis


       4) Visceral disease

       5) Muscle weakness


Clinical features


Insidious onset


Early stage


soft tissue swelling 

 

 stiffness.


muscle pain


Tiredness, loss of weight,


Multiple joints pain 


Morning stiffness more than 30 minutes




Physical Exmaination 


Symmetrical distribution - Swelling


tenderness - MCP Jts


- Tevenosynovitis


-Limited movement


Later Stages 


joint deformity 

Tendon rupture 

Clawed toes

 Valgus Knee and Feet 

Pain & stiffness in spines


Extra-articular features


Nodules in back of elbows, viscera, eye


Muscles wasting , lymphadenopathy,


Skin atrophy or ulceration, Scleritis, Nerve Entrapment 


Peripheral Sensory Neuropathy 


Investigations 

X- Ray

USG/MRI


Normocytic Normochromic Anaemia

        Serological tests for rheumatoid focitor - 80% cases positive 


Synovial Biopsy - Needle Biopsy , or through Arthroscopy


Diagnosis 


   Explain as Bilateral Symmetrical Involvement 

   Involving Proximal Joints of hands and Feet Persisting for more than 6 weeks in my patient aged … , female gender …


 Likely be Rheumatoid Arthritis 







D/ D S

Seronegative Inflammation, Polyarthritis 


Ankylosing Spondylitis 

Pseudogout 

Peter's Disease  


       5) Polyarticular Gout


      6) کے Sarcoidosis

      

      7) Lyme Disease 

       8) Viral Arthritis 


9) Polymyaglia Rheumatica 


Treatment 


Corticosteroid Injection 

DMARD ± sulfasalazines , hydroxy chloroquine 


- Leflunamide


- Gold & Penicillamine / TNF Inhibitors 


B) Physiotherapy 


C) Surgical Management 


Synovectomy / tendon repair as replacement and jt. stabilization . 






Complications 


1)Fixed Deformities



2) Muscles weakness 


3) Joint Rupture 


4)Infection 


5) Spinal cord compression 


6) Systemic Vasculitis


7) Amyloidosis 


Comments

Post a Comment

Popular posts from this blog

Outline of Treatment of Spinal Tuberculosis

Image
 Tuberculosis     In general , Rest and Nutrition                                 Chemotherapy                                Surgery if needed .                                    Dorsal Spine - Approach to surgery     A bit ambiguous      Many prefer to do Anterior Transpleural. Some choose Anterolateral/posterolateral extrapleural                and posterolateral approaches      Posterolateral Approach(Martin 1970)      Dura exposed by Hemilaminectomy first and then operation extended laterally to remove posterior         ends of 2 to 4 ribs, corresponding tra...
Read more

COXA VARA

Image
Coxa Vara Painless limp, LLD gradually worsening ,  Unilateral or bilateral in 30-50 % cases Prominent trochanters Pelvic Tilt- LLD  Trendelenburg test or delaye trendelenburg test + ve B/L waddling  High Greater trochnater - supratrochanteric shortening,  Decreased abduction, (decrease in articular trochanteric distance ) and internal rotation (due to decreased anteversion) may have out toeing r/o cervical instability causing limping  Types of Coxa Vara  https://quizlet.com/au/304405013/coxa-vara-flash-cards/ Mangement      Depends on Hilgenreiner Angle (HEA ) https://www.orthobullets.com/pediatrics/4041/developmental-coxa-vara  > 60 degrees - wait and watch    45-60 degrees - wait and watch  Goals of surgery      Neck shaft angle  (more or equal ) to 140.              degrees     Correct version      Ossification and healing of inferomedia...
Read more

Paediatric Supracondylar Humerus Fracture

Image
Supracondylar Fracture  Patient Presentation         Age 6-10 years         MOI - Fall on outstretched hand with elbow on extension, breaks.   Olecranon serves as the fulcrum      and the stress concentrates in distal humerus. Anteriorly the perisoteum hinges.     Pain , swelling, deformity, bruising      Deformity (usually S shaped ) , skin puckering      Compartment syndrome         Blood vessels spasm/ contusion/ tear/ thrombosis     If capillary refill present , hand arm Dunlop traction done.      No role of Angiography , further delays the treatment.      Nerve Injuries, proximal fragment spike hits nerve.             3a Posteromedial displacement - Radial Nerve involvement             3b Posterolateral displacement - Median Nerve ...
Read more

Hind Foot amputation

Image
Boyd Amputation -Tibiocalcaneal arthodesis, heel pad preserved. ( https://www.semanticscholar.org/ ) ( Modifizierte Pirogoff-Amputation | SpringerLink ) Pirgoff Amputation  Amputation at ankle. part of calcanuem left in the stump , Calcaneum cut vertically.  Advantages  long lever arm , self suspension , good proprioception , end wt bearing.  Disadvantages  poor cosmesis , too long to use standard foot , no possibility of prosthetic foot fitting 
Read more

Timing and Outcome of Surgery in Hip Fractures

Hip Joint Ball and Socket joint. Hip fracture is any fracture involving Interochanteric region head, neck or acetabulum. 310,000 Hip fractures in the United State in 2003     1/3 rd - receive a hip replacement.     10.3 - 15.2 billion dollars / year Elderly – Vast Majority  Co-morbidities Femoral Neck Fracture Fracture Healing is delayed due to          - I ntracapusular neck- No Cambium layer          - Synovial fluid clears out haematoma and inhibits fracture union          - Haematoma causes pressure on head Mechanism of injury  • Directly on lateral hip • Twisting mechanism • Fatigue or insufficiency fracture, then fall • In younger - RTA /  fall from a height Risk Factors of Hip Fractures   • Osteoporosis and Falls   Lifetime risk -17.5 percent for women : 6 per...
Read more

Management of Nerve Injuries

Following points to be included in one's scheme . A. Detailed Clinical History                1.      Particular detatils of patient                             Hand dominance                              Profession             2.    C/C            3.   History of Present illness                   Regarding                  Site of Injury                   mechanism of injury -blast , crush , tractrion ,                                            ...
Read more