I T I S

T HR
: A R
CP G
C ai lao
r i a T .
V ic to ic i ne
Ma r ia M ed
n i ty
o m mu a y n ila
te r n ,C d ng M
nior In u n g so d i c in e
Ju a n n gL o f M e
an tas o l l e ge
Pa m C
What
is Arthr
i tis ?
 • Char
acter
quali i ze t h
ty, lo e join
joints catio t pain

TES
), pal n (spec :
facto liativ ify
rs e/trig
O • (+/-) gerin
g
pares
• (+/-) thesia
MA N
stiffn
• (+/-) ess
defor
• Emph mitie
s
U

a
medi sis on pre
RHE

catio v i
predn n s (i.e ous
isone . met
) hotre
xate,
SYN
O VI AL
JOIN
TS
 d
us an
Fibro s
Joint
inous
lag
Carti
  Osteoarthritis
OF  Rheumatoid arthritis
IS
HRIT  Gouty arthritis
S
 CPPD arthritis (Pseudo-
TYPE

gout)
 Septic arthritis
ART

 Reactive arthritis
 Psoriatic arthritis
 Lupus arthritis
 2 MO
T Y PE ST C
S OF OMM
ART ON
HR I T
IS
OA v
ersus
RA
 Osteoarthritis Rheumatoid arthritis
Location • Hands, hips, knees • Hands (PIP and MCP),
• Chronic monoarthritis shoulders, feet, sometimes
• Asymmetric oligo/polyarthritis knees
• Symmetric polyarthritis
Onset Gradual, over years Rapid, over weeks and months
Epidemiology • >60 y/o • 30-50 y/o
• Most common type • M:F = 1:3
• Female predilection • HLA-DR4
• Overweight
• Trauma
Joint Sx Joints ache and may be tender but have Joints are painful, swollen, and
little or no swelling. stiff.
Duration of • <1 hour >1 hour
morning • Stiffness returns at the end of the day
stiffness or after periods of activity.
PE findings Squaring of the hand Subluxation
Heberden’s nodes Swan neck deformity
Bouchard’s nodes Boutonniere deformity
Rheumatoid nodules
Squa
ri n g of
h a nd
Hebe
rden’
s no d e
s
Bouc
h ard’s
n od e
s
(Part S u b lu x
ial di ation
sloca
tio n )
 Flexion of distal interphalangeal joint

Neck
rmity
Swan
Defo

Extension of proximal interphalangeal joint

Bo u t
o n n ie
defor r e
mity
Rh e u
mato
i d No
dules
 Gouty Arthritis Pseudogout
Location • Hands, feet (1st MTP - podagra) • Knee, hands, elbows,
• Monoarthritis shoulder, tarsal joints
• Monoarthritis
Onset Begin abruptly and typically reach Resemble acute gout or a more
maximum intensity within 8-12 hours insidious onset that occurs over
several days

Epidemiology • Increases with age • Increases with age

• M:F = 10:1 • Often accompanies OA

PE findings • Acute: Hot, red, tender, swollen joint • Acute: Hot, red, tender,
• Chronic: Gouty tophi swollen joint
• Chronic: Resemble RA or OA

Joint aspirate • Needle-shaped negatively • Rhomboid positively

birefringent MSU crystals birefringent CPPD crystals
Ne e d
le-sh
ape d
cryst
als
Rh o m
boi d
cryst
als
Dia g
n o s is
 ACR Criteria:
Knee Osteoarthritis
 ACR Criteria:
Hip Osteoarthritis
 ACR Criteria:
Hand Osteoarthritis
 Osteoarthritis
 Clinical features: Joint pain on motion, relieved by rest,
stiffness after inactivity lasting less than 30 mins.
 X-ray of the involved joint:
 Narrow joint space
 Osteophyte – bone spurs/parrot beak
 Bone cysts
 CBC
 ESR – normal
 Synovial fluid analysis
 Joint fluid is straw-colored with good viscosity
 Fluid WBCs <1000/μL
Rheumatoid arthritis
Rheumatoid arthritis
 Rheumatoid arthritis
 CBC
 Rheumatoid factor
 ANA test – screening test
 Anti-CCP antibodies
 ESR, CRP - increased
 Synovial fluid analysis (inflammatory arthritis)
 X-ray
 Gouty arthritis
 CBC
 BUN, Creatinine, Uric acid
 ESR, FBS, SGPT
 Urinalysis
 24-hr urine collection for urinary uric acid and
creatinine clearance
 Synovial fluid exam
 X-ray
 Treat
O m e n t
Pharm st e o a :
acolo
gi c a n r thriti
d No
n-pha
rma
s
c
Mana ologic
geme
nt
OSTE
OAR H AND
T HR
ITIS
OSTE
OAR K NE E
T HR
ITIS
OSTE
OAR K NE E
T HR
ITIS
KNEE OSTEOARTHRITIS
OSTE
OAR HIP
T HR
ITIS
OSTE
OAR HIP
T HR
ITIS
 HIP
OSTEOARTHRITIS
Rheu Treat
m a t o m e n t
Pharm i d A :
acolo
gi c a n r thriti
d No
n-pha
rma
s
c
Mana ologic
geme
nt
 <6 months

• Functional limitation
• Extraarticular disease
• (+) Rheumatoid factor/anti-
cyclic citrullinated peptide Ab
• Bony erosions
>6 months
 Treat
ment
: G ou
Pharm
acolo Arthr t y
gic an
d No
n-pha
itis
rma
c
Mana ologic
g em e
nt
Go u t
y Art
h r iti s
Go u t
y Art
h r iti s