Ortho

6/14/99

Arthritis—Ciba Book

Rheumatoid Arthritis

• Systemic ds that commonly affects the joints (and other connective tissues)
• Coarse is variable, progressive
• Changes that take place in joints (synovial villi)
• Inflammation of synovial membrane (synovitis)
• Cells begin to proliferate
• Lymphoid cells migrate to this area
• Synovial cells and lymphoid cells together create pannus

• Extremely destructive—erosive

• Periarticular osteoporosis
• Decrease in bone density
• Boutonniere dislocation--thumb
• Acute inflammatory stage—red, hot, swelling
• High risk for HVLA
• Final stage is bony ankolosis
• Not all pts make it to all stages
• Some oscillate b/w stages

Knee joint figure

Hands

• Swelling
• Proximal interphalangeal joints
• Metacarpal/phalangeal joints
• Uncommon for distal interphalangeal joints
• Woman in late 30's bilateral swelling of wrist and pain—classic presentation
• Rheumatoid nodule—fibrotic nodule w/lymphatic tissue, subcutaneous
• Advanced changes
• Ulnar deviation—weak radial side
• Dysfunctional hand—doesn't work
• Thickened wrist area
• Hyperflexion of distal interphalangeal and hyperextension of proximal interphalangeal joints—swan neck deformity
• Often seen w/rupture of tendons (can be just irritation)

• Upper cervical arthritis is most common part of the spine affected
• Also in psoriatic arthritis and Down's Syndrome (trisomy 21)
• Loss of stability of upper cervical spine
• C1-C2—odontoid to C1—transverse ligament—atlas can float freely

• Rheumatiod nodules can be seen in the lungs—biopsy
• Synovial cysts—baker's cyst in posterior knee—can limit ROM, not necessarily painful
• Ganglionic cyst—carpal cyst
• Cysts are not dx of rheumatoid arthritis but are commonly found

Treatment

• Acute inflammatory
• Modalities to treat inflammation—ice, electrical,
• Reduce inflammation, reduce tissue damage

• Mobilization
• After inflammation
• Adhesions tend to build up
• Be sure not in a state of instability

• Certain meds are helpful
• Remember to treat the whole pt
• Research on diet—limit animals products, artificial additives
• Anti-oxidant therapies may be helpful