Musculoskeletal Involvement In

Systemic Diseases

• Duru Çelenoğlu
 •Injuries and conditions that affect the movement
of the human body or the musculoskeletal system
comprising of tendons, ligaments, muscles, discs,
What is a blood vessels, nerves, etc. are known as
Musculoskeletal Musculoskeletal Disorders – a term that is
disorder? collectively used to describe the issue.
What is a
Musculoskeletal
disorder ?

• Repetitive Motion Injury, Repetitive Stress Injury, 
Overuse Injury and much more, are other 
common terminologies for MSDs. While the titles 
might  varyry, Musculoskeletal Disorder by itself  
points to one singularcause for damage that is 
 repetition and stress.
 What causes
MSDs ?
Your risk of developing MSDs is affected by:
• Age
• Occupation
• Activity level
• Lifestyle
• Family history
Certain activities can cause wear and tear on your musculoskeletal
system, leading to MSDs. These include:
• Sitting in the same position at a computer every day
• Engaging in repetitive motions
• Lifting heavy weights
• Maintaining poor posture at work
 • Forceful or repetitive tasks can lead to tissue injury, tissue
reorganization, or central nervous system (CNS)
reorganization. Any of these pathways can lead to chronic
disability if causal factors are perpetuated or if appropriate
Pathophysiolog interventions are not implemented. 

y of • Repeated microtrauma to previously injured tissues

prevents normal healing and reconstitution of structure
Musculoskeletal and physiology.  

Disorders • There is an exposure-response relationship between

ergonomic factors(e.g., force and repetition) and the
severity of musculoskeletal disorders , with higher levels of
exposure leading to greater pathology. 
Pathophysiology of
Musculoskeletal Disorders
• Tissue injury or reorganization can occur in multiple
tissues, including            muscle, tendon, loose
connective tissue, peripheral nerve, and bone.
• Tissue injury elicits an inflammatory response, which
may be acute or chronic (or both) or systemic.
Systemic inflammation can cause widespread
symptoms. 
• Tissue reorganization is typically pathophysiologic
(e.g., degenerative changes, fibrosis) in animal
models and human studies of MSD. Compromised
tissues have reduced tolerance for exposure to
repetitive or forceful tasks and are more vulnerable
to reinjury, thus perpetuating a cycle of injury, pain,
and disability. 
Symptoms

• Some of the most common symptoms of

MSDs are:
• Stiffness, weakness and pain – all of them
often persistent.
• Decreased range of motion – limiting
mobility, dexterity and functional abilities. 
• Noises in the joints – where early diagnosis
and treatment are not available, joint
deformity may be visualised.
Symptoms
• Inflammation
-along with pain and impaired function, there is
 redness, swelling and warmth in the overlying  
skin area.
• On a broader perspective, there could be 
associated impacts on mental well-
being due to the individual’s inability to actively
 participate in social activities.
 How are MSDs
diagnosed?

•If you’re experiencing symptoms of an MSD,

make an appointment with your doctor. To
diagnose your condition, they’ll likely perform
a physical exam. They will check for:
• pain
• redness
• swelling
• muscle weakness
• muscle atrophy
How are MSDs
diagnosed?
• They may also test your reflexes. 
Unusual reflexes may indicate 
 nerve damage.
• Your doctor may also order 
 imaging tests, such as
xrays or MRI scans. These tests 
can help them examine your bone
s and soft tissues. They may also 
order blood tests to check for 
rheumatic diseases, such as RA
Impacts of MSD

•MSD can affect the following:

• Joints – osteoarthritis, psoriatic arthritis, gout, rheumatoid arthritis,
ankylosing spondylitis 
• Spine – back and neck pain
• Muscles – sarcopenia 
• Bones – osteoporosis, fragility fractures, traumatic fractures
• Multiple systems in the body – connective tissue diseases and
vasculitishave musculoskeletal manifestations (example: systemic lupus
erythematosus)
Rheumatoid Arthritis
Where rheumatoid arthritis comes
from?
Rhematism =musculoskeletal illness
joints
inflammation

• Rheumatoid arthritis is a chronic, progressive, and

disabling autoimmune disease. It causes inflammation,
swelling, and pain in and around the joints and can
affect other body organs.
• Which can affect mostly joints,but can also effect the
other organ system,skin and lungs.
 • To tell what rheumatoid arthritis is ,the comparison of the healthy
joint and affected joint by such disease can say it all.
• How does a normal joint work?
• For example, the knee is the largest joint in the body and one of the
most complicated. It must be strong enough to take our weight and
must lock into position, so we can stand upright.

What is • It also has to act as a hinge, so we can walk, and needs to twist and
turn when we run or play sports.
rheumatoid • The end of each bone is covered with cartilage that has a
arthritis? very smooth, slippery surface. The cartilage allows the ends of the
bones to move against each other, almost without rubbing.
The joint is held in place by the synovium, which contains thick
fluid to protect the bones and joint.
The synovium has a tough outer layer that holds the joint in place and
stops the bones moving too far.
Strong cords called tendons anchor the muscles to the bones.
 • If you have rheumatoid arthritis, your
immune system can cause inflammation
inside a joint or a number of joints.
Inflammation is normally an important part
How does the affected of how your immune system works. It allows
joints work? the body to send extra fluid and blood to a
part of the body under attack from an
infection. For example, if you have a cut that
gets infected, the skin around it can become
swollen and a different color.
Comparison by pictures

Symptoms
• Rheumatoid arthritis can affect any joint in
the body, although it is often felt in the small
joints in the hands and feet first. Both sides of
the body are usually affected at the same
time, in the same way, but this doesn’t always
happen.
• A few people develop fleshy lumps called
rheumatoid nodules, which form under the
skin around affected joints. They can
sometimes be painful, but usually are not.
•  main symptoms of rheumatoid arthritis are:
• joint pain
• joint swelling, warmth and redness
• stiffness, especially first thing in the morning
or after sitting still for a long time.
• Other symptoms can include:
• tiredness and lack of energy – this can be
known as fatigue
• a poor appetite (not feeling hungry)
• weight loss
• a high temperature, or a fever
• sweating
• dry eyes – as a result of inflammation
• chest pain – as a result of inflammation.
Why exposing in cigarette fumes can induce
to develop the RA?

• Action of smoking is in the development of RA, that

remains to be determined. However, smoking is
associated with increased periodontal disease and
lung disease, so it may be that this factor drives
inflammation and autoimmunity at these sites, and
this will be discussed further below. In addition,
there are systemic effects of smoking and it may be
that these lead to changes within joints that drive
RA. In this regard, in a study of FDRs of patients
with RA, joint tenderness and swelling was
associated with smoking even in the absence of RA-
related autoantibodies, raising the possibility that
smoking may have early direct joint effects that
could be related to the future development of
inflammatory arthritis.
Risk factors
it is combination of
running in family and
environmental issues.
 • A diagnosis of rheumatoid arthritis is based on your
symptoms, a physical examination and the results of x-rays,
scans and blood tests.
• It can be difficult to diagnose because there isn't a test that
can prove you definitely have it. There are also quite a few
conditions that have the same symptoms.
Diagnosis • Your doctor will ask about your symptoms and do a physical
examination. They will look for swollen joints and check how
well your joints move. Rheumatoid arthritis can affect different
parts of your body at once, so it's important to tell your doctor
about all the symptoms you've had, even if they don't seem to
be related.
• If they think you have rheumatoid arthritis, they will refer you
to a rheumatologist and may arrange blood tests to help
confirm a diagnosis.
Specific diagnosis
Blood tests
• Erythrocyte sedimentation rate
(ESR)
• Rheumatoid factor and anti-CCP
antibodies
• C-reactive protein (CRP)
Scans
• x-rays – these will show any
changes in your joints
• ultrasound scans – a picture of
your joints is created using high-
frequency sound waves
• magnetic resonance imaging
(MRI) scans – pictures of your
joints are produced using strong
magnetic fields and radio
waves.
Treatments

• There are a variety of treatments available for rheumatoid

arthritis. The earlier that intensive treatment is started, the
more likely it is to work.
• There are three main ways to treat rheumatoid arthritis:
• Drugs
• non-steroidal anti-inflammatory drugs (NSAIDs)
• disease-modifying anti-rheumatic drugs (DMARDs)
• steroids (also known as corticosteroids).
• painkiller
• physical therapies
• surgery
Physical therapy and assistive
devices
• 1.Transcutenous electric nerve stimulation
• It is non-invasive, fast acting, drug-free. Pads are placed on or near the
area of the arthritis pain. TENS sends soothing pulses via TENS electrodes
through the skin and along the nerve fibers.
• 2.Laser therapy
• Laser therapy uses a process called photobiomodulation. Photons enter
the tissue and interact with the cytochrome c complex within
mitochondria. This interaction triggers a biological cascade of events that
leads to an increase in cellular metabolism and a decrease in both pain
and inflammation. uses both red and infrared light to relieve pain,
decrease inflammation and to accelerate healing. The lights are
imbedded in pads that are placed on the joints so the photons penetrate
several centimeters into the joints.
 • Mobilizaing the tissue to create more synovial
fluid that can protect the joint.  massage can
improve healthy circulation throughout the
arthritic joints, reducing swelling and improving
Massage quality of life. Avoid massages on affected joints
during an RA flare up.
therapy • At the end it is very important to notice the
sleeping well can flush out the toxins which
accumulate during night , and avoiding some
food can alleviating the illness. some .
• Some foods like
berries,pineapple,avocado,omega-3,leafy greens,
broccoli these foods contain a lot of ani-
inflammatory features that can reduce the RA.
Axial Spondyloarthritis
Definition
• Axial Spondyloarthritis (axSpA) is a type of arthritis.
• It mostly causes pain and swelling in the spine and the joints that connect the bottom of the
spine to the pelvis (sacroiliac joint).
• It is a systemic disease, which means it may affect other body parts and organs. 
• The disease tends to run in families. 
There are two types of axSpA:
•Radiographic axSpA (also called ankylosing spondylitis or AS) includes damage to the
sacroiliac joints and spine that can be seen on X-rays.
•Nonradiographic axSpA (nr-axSpA) is clinically similar to axial ankylosing spondylitis but
without x-ray findings typical of sacroiliitis.
Causes
• The exact cause of axSpA is not clear.
• Research has shown more than 9 out of 10 people with axSpA carry a particular gene known as
human leukocyte antigen B27 (HLA-B27).
• Having this gene does not necessarily mean that patient will develop axSpA. It is estimated 8 in
every 100 people in the general population have the HLA-B27 gene, but most do not have axSpA.
• It is thought having this gene may make you more vulnerable to developing this disease.
• Testing for this gene may be carried out if axSpA is suspected. However, this test is not a very
reliable method of diagnosing the condition because some people can have the HLA-B27 gene
but not have axSpA.
Risk Factors
Gender: AS is more common in
Age: The disease can occur at any Genetic makeup: Variations in a
men than in women. However,
age, but typically begins between number of genes increase the risk
nr-axSpA may be just as common
ages 20 and 40. of developing axSpA.
in women as in men. 

Inflammatory Bowel Disease:

Inflammation of the
Race: It is less common among
gastrointestinal tract is common
African Americans than people of
in ankylosing spondylitis. Having
other racial backgrounds.  
one disease raises the risk of
developing the other.
Symptoms
• Low back, buttocks and hip pain are usually the first
symptoms. Children, however, may have pain in the hips,
knees or heels before the back. 
Symptoms of axSpA include:
• Pain in the low back, buttocks and hips that develops slowly
over weeks or months.
• Pain, swelling, redness and warmth in the toes, heels, ankles,
knees, rib cage, upper spine, shoulders and neck. 
• Stiffness when first waking up or after long periods of rest.
• Back pain during the night or early morning. 
• Fatigue.
• Appetite loss. 
 • Joints. Over time, the joints and bones of the spine may
grow together (fuse). This usually happens at the base of
the spine first. This causes the back to become stiff and
hard to move. The rib cage may also fuse, making chest
expansion difficult. 
• Muscles. According to the National Ankylosing
Spondylitis Society (NASS), inflammation associated with
the condition can cause muscles and other soft tissues to
Health Effects become sore and hard to move. Muscles in the back may
also shorten or tighten, which can lead to a dull and
aching pain.
• Eyes. Chronic eye inflammation (uveitis) causes dryness,
pain, redness, sensitivity to light and vision problems.
The white part of the eye may also get inflamed and red
(called scleritis).
Health Effects
• Digestive Tract. Inflammation may
cause abdominal pain and diarrhea.
• Heart. Though uncommon,
inflammation may affect the largest
artery that leads to the heart (aorta).
People with axSpA also have an
increased risk for heart attack and
stroke.
• Lungs. Complications affecting the lungs
are rare. Inflammation may cause
shortness of breath and impaired lung
function.
Diagnosis
• A doctor that specializes in arthritis (a rheumatologist)
should be seen if axSpA is suspected. 
• There is no single test to diagnose axSpA. The doctor
will perform a physical exam and order a few tests to
rule out other causes of back and hip pain.  
 Medical history. The patient will be asked about
symptoms, when they started, if they come and go,
current medical conditions, medication use and whether
family members have arthritis.
 Physical examination. The patient will be checked for
signs of tenderness, swelling and pain in the spine,
pelvis and hips. 
 Blood tests. The HLA-B27 gene test may be requested
from the patient. Having this gene does not mean
patient have axSpA, but it can help with diagnosis. Other
tests will check for body-wide inflammation. 
 Imaging tests. X-rays, ultrasound, MRI or CT scans of the
pelvis and spine to look for damage.  
Treatment
• There is no cure for axSpA, but treatment aims to:
Relieve pain and stiffness in the back and affected
areas.
Keep the spine straight.
Prevent joint and organ damage.
Preserve joint function and mobility.
Improve quality of life.
• Early, aggressive treatment is the key to preventing
long-term complications and joint damage. A well-
rounded treatment plan includes medication, nondrug
therapies, healthy lifestyle habits and rarely, surgery. 
 • Nonsteroidal anti-inflammatory drugs. NSAIDs are
the most commonly used drugs to treat axSpA and
help relieve pain. They include over-the-counter
drugs, such as ibuprofen (Advil) and naproxen
(Aleve), as well as the prescription drugs
indomethacin, diclofenac or celecoxib.
Medications • Analgesics. In addition to NSAIDs, acetaminophen
(Tylenol) may recommend for pain relief.
• Disease-modifying antirheumatic drugs (DMARDs).
Conventional DMARDs are not usually used in
people with axSpA that effects just the back.
Sulfasalazine, however, may be used for joints other
than those in the back and pelvis.
Medications
• Biologics. A type of DMARD, biologics target
certain proteins and processes in the body to
control disease. Biologics are self-injected or given
by infusion at the clinic. The ones that work best
for axSpA are tumor necrosis factor (TNF)
inhibitors and interleukin (IL-17) inhibitors.
• Corticosteroids. These powerful drugs are not
often used for spinal disease in axSpA. However,
injecting steroids into a knee or shoulder can
provide quick relief.
Physical Therapy
and Assistive Devices
• Research evidence highlights that
physiotherapy is found to improve physical
functioning and reduce pain in axSpA. 
• This may include manual treatment, a specific
exercise program to perform at home, a gym-
based exercise program, hydrotherapy and
acupuncture.
• Also, physical therapist will educate the patient
about axSpA, how it may affect, how it may
affect their family, impact on work and
hobbies.  
Exercises
• Regular physical activity is a critical part of managing
axSpA. It helps prevent stiffness and preserves range of
motion in the neck and back. 
• Following exercises can help with flexibility and posture;
• Walking,
• Swimming, 
• Yoga,
• Tai chi.
Surgery
• Most people with axSpA will never need
surgery. But joint replacement can help people
with severe pain or joint damage. 
• Surgery may also help straighten a severely bent
forward spine. 
 • Eat a healthy diet. There’s no special diet for axSpA. But,
eating anti-inflammatory foods, like the ones found in
the Mediterranean diet may help. Eat plenty of fatty fish,
fruits, vegetables, whole grains and extra virgin olive oil.
Limit red meat, sugar, and processed foods.
• Avoid smoking. Smoking worsens overall health, and it can
speed up disease activity and joint damage. It can also
Self Care make it harder to breathe. 
• Practice good posture. Good posture can help ease pain
and stiffness. Adjust the height of the computer monitor or
desk so the screen is at eye level. Avoid staying in cramped
or bent positions. Alternate between standing and sitting
and use a pillow to support the back. 
• Stretch. Stretching exercises can help ease pain and relieve
stiffness.
OSTEOARTHRITIS
Definition
• Osteoarthritis is a degenerative joint disease caused by the destruction of joint cartilage
and bone underneath it. OA can affect any joint, but it occurs most often in knees, hips,
lower back and neck, small joints of the fingers and the bases of the thumb and big toe. 
• Osteoarthritis occurs when infection and joint damage cause cartilage tissue to break
down. The most common symptoms are joint pain and stiffness. Usually the symptoms
progress slowly over years.
• Other symptoms may include joint swelling, decreased range of motion, and, when the
back is affected, weakness or numbness of the arms and legs. 
• Risk factors for developing OA include age, female gender, obesity, anatomical factors,
muscle weakness, and joint injury. 
Osteoarthritis divides into two;
Primary Osteoarthritis: The disease is of idiopathic
origin and it usually affects several joints in a generally
elder people. 

Secondary Osteoarthritis: It usually develops as a

result of a defined disorder affecting the joint articular
surface (eg, trauma) or from abnormalities of joint. 
Hip Osteoarthritis
Definition Of Hip
Osteoarthritis
•Hip OA is the product of a variety of different disorders,
each identified with particular etiological variables and
alternative treatments that share a similar final pathway.
•Pain around the hip joint is the most frequent symptom
of hip OA.
•The pain progresses slowly most of the time and worsens
with time, or the pain can start suddenly.
• The articular cartilage is primarily
damaged by hip osteoarthritis, causing
changes in the subcondral bone,
synovium, ligaments and capsule. This
degeneration, which may theoretically
be symptomatic, leads to a lack of
joint space. 
What Causes Osteoarthritis of the
Hip Joint?
• The causes of hip osteoarthritis are
not known. Joint fracture, growing
age, and becoming overweight are
causes that could lead.
How Does Osteoarthritis Affect
the Hip Joint?
• Usually, people who have hip
osteoarthritis have difficulty to
walk. Initially, diagnosis can be
challenging because pain can be in
numerous areas, including the
groin, thigh, buttocks, or knee
 Abnormality of the hip joint
Joint trauma or injury
Increase in age

Risk Genetics

Factors Obesity
Congenital and developmental hip disease
Gender
Diet – low vitamin K, C and D levels
Sign &
Sypmtoms
•  Pain: Progressively increasing, eased with
continuous movement, constant pain (in end-
stage).
• Stiffness
• Limited movement in hip
• Decrease range of motion
• Crunching/popping sounds during
movement 
• Local inflammation
• Difficulty to walk
Diagnosis
• Hip osteoarthritis can be diagnosed by a
mixture of history and physical
examination findings. There is no single
examination, but the X-ray is frequently
diagnosed with characteristics such as
narrowing of the joint and spurring of the
joint margins.
• The doctor takes patient’s medical records
and start physical examination. This
examination will require a check on how
the hip functions, as it can lead to a loss of
motion.
Treatment of Hip
Osteoarthritis
• The main aim of the treatment of hip osteoarthritis is to
increase mobility and lifestyle of the individual. Part of this
aim is to strengthen the capabilities of the hip and to control
pain. Treatments are;
 Rest and joint care
 Using a cane to keep the weight off the hip impacted 
 Losing overweight 
 Exercise
 Medications, like acetaminophen , a nonsteroidal anti-
inflammatory medication such as ibuprofen or a generic
pain medicine 
 Complementary and alternative therapies
 Surgery
Physiotherapy
treatments inclued ;
•  manual techniques eg passive      movement to
increase joint flexibility.
• exercises,
• ice and heat,
• taping,
• stretching
• improve their stance and balance
• aid ability to peform ADL's.
Knee Osteoarthritis
Definition of Knee
Osteoarthritis
• Knee osteoarthritis is typically the
result of wear and tear and
progressive loss of articular cartilage. 
• Most commonly affecting age 45 and
greater. This condition occurs as the
cartilage in the knee wears away
eventually causing bone on bone
contact between joint surfaces. 
• Most common complaints include
joint swelling, joint stiffness and pain. 
 Obesity 

Joint hypermobility or instability

Malpositioning of the joint e.g. valgus/varus posture

Risk Previous injury to the joint

Factors Congenital defects

Immobilisation and loss of mobility

Family history

Metabolic causes e.g. rickets

Sign & Symptoms 
• Pain on movement
• Stiffness, particularly early morning stiffness
• Loss of range of movement
• Pain after prolonged sitting or lying
• Pain on joint line palpation
• Joint enlargement
Diagnosis 
• Knee osteoarthritis can be diagnosis via
radiographs indicating boney cysts,
narrowing joint space, and scelrosing of
the bone. 
• Diagnostic tests;
• Blood test
• X-ray
• Arthrocentesis
• Arthroscopy
• MRI
Treatment of Knee
Osteoarthritis 
• Initial treatment always begins with conservative modalities and
moves to surgical treatment once conservative management has
been exhausted.
•  There is a wide range of conservative modalities is available for
the treatment of knee OA. These interventions do not alter the
underlying disease process, but their goal is to reduce pain and
optimise function for as long as possible. 
• Conservative Treatments;
 Patient education
 Exercise therapy
 Activity modification
 Advice on weight loss
 Knee bracing
Role of Physiotherapy
•  Reduce knee pain and inflammation.
• Normalise knee joint range of motion.
• Strengthen lower kinetic chain
• Cardio-vascular exercise
• Improve proprioception, agility and balance.
• Improve function
• Use of walking aids as needed
 Hand Osteoarthritis 
Definition
•Hand osteoarthritis is inflammation
that causes pain and stiffness in
your joints. It usually happens in Definition
three places:

• The base of your thumb, where

it meets your wrist
• One of the joints closest to
your fingertips
• The middle joint of a finger
Risk factors for
hand
osteoarthritis 
Age (40-70 years old)

Female 

Repetitive occupational or recreational usage 

Prior injury 

Family history 

Obesity 
Symptoms of Hand Osteoarthritis​
Stiffness
Swelling
Pain
Limited range of motion
Bony nodules
Aching at the base of the thumb
Diagnosis of of • Presenting symptomatology 
•
Hand •
Joint distribution 
Assessment of risk factors 
Osteoarthritis • Assessment of treatment goals 
• Physical exam ( bony enlargment, extra-articular manifestation)
• Hand X-rays
Hand Osteoarthritis Treatment
• Painkiller pills. Acetaminophen and NSAIDs like ibuprofen can ease pain.
• Immobilizing devices. A splint, brace, or sleeve can hold your hand in a stable position to lessen
pain.
• Hand therapy. An expert called a hand therapist can show you exercises and ways to do
everyday tasks. For example, instead of carrying grocery bags with your fingers, you might carry
them over your forearm.
• Cortisone shots. An injection into the joint may help for weeks or months. Your doctor will offer
these only a certain number of times because they can have side effects like infection and
weakened ligaments.
• Surgery. If other treatments haven't worked or symptoms make it hard to use your hand, you
and your doctor may consider surgery. One option is joint fusion, in which the surgeon fuses
your bones together. You'll have less pain, but you won't be able to move your joint the way you
used to. Or you might have surgery that removes and replaces the joint.
Hand Osteoarthritis Prevention
There’s no one way to
prevent osteoarthritis. Some
lifestyle changes might lower
your odds:
Keep a healthy weight.
Try not to do activities that
involve the same motions
over and over again. And if
you can, skip the ones that
might work your joints too
much.
Exercise to make your joints
and muscles stronger.
 Wrist Osteoarthritis 
Definition
•Wrist osteoarthritis (OA) occurs when the cartilage
surrounding the ends of your wrist bones wears away
and eventually exposes the bone. As the disease
progresses, painful bone spurs called osteophytes can
form in the place of cartilage. 
 What Causes Wrist Osteoarthritis?

Gender – women are

Increasing age, Family history of
more likely to get Being overweight
especially over 65 osteoarthritis
osteoarthritis

Long-term, repetitive A history of Kienböck’s

strain on your wrists, Genetic defects in the disease, which is a
Previous wrist injuries
whether occupational cartilage or wrist breakdown of one of
or recreational the carpal bones
What are the Signs and Symptoms of Wrist
Osteoarthritis?
• Swelling or tenderness of the wrist joint
• Stiffness in the wrist, especially first thing in the morning or after periods of inactivity
• A crunching, clicking, or snapping sound (known as crepitus) when moving your wrist
• Weakness of the wrist and difficulty gripping objects
• Decreased range of motion and pain while doing routine activities such as opening jars,
turning a key or doorknob, writing, or gripping the steering wheel of a car
• Pain during or after strenuous activity
How is Wrist Osteoarthritis Treated?
• Medications, including:
•     Over-the-counter painkillers such as ibuprofen and
acetaminophen
•     Topical medications such as creams, sprays, gels or patches
• Non-steroidal anti-inflammatory drugs (NSAIDs), though
these drugs can have serious side effects
• Corticosteroid injections, though these cannot be
continued for a long period of time
• Surgery – if surgery is necessary after other less invasive
treatments have not helped, physiotherapy is an important
part of rehabilitation
 Physiotherapy for Wrist Osteoarthritis

• Stretching, strengthening, and range of motion

Physiotherapy is a drug-free and non-surgical exercises​
treatment that has been proven to reduce
osteoarthritis pain. • Activity modification and functional retraining​
• Splinting, bracing, or compression gloves​
• Patient education so you can feel in control of
The goal of physiotherapy for wrist your condition​
osteoarthritis is to prevent the progression of • Cross-disciplinary pain-relieving therapies such
the disease, reduce pain, regain strength, and as:​
increase joint mobility, function, and quality of • Interferential current therapy (IFC) or TENS
life.
therapy​
• Therapeutic ultrasound​
Depending on your individual needs,
• Hand therapy​
physiotherapy for wrist osteoarthritis can • Heat and cold therapy​
include: • Acupuncture​
• Occupational therapy​
Can You Prevent Wrist Osteoarthritis?

1 2 3
Exercising regularly, Eating a non- Maintaining a healthy
including stretching inflammatory diet weight
exercises such as yoga (avoiding processed
or tai chi (at least 30 and refined foods and
minutes every day) sugar)
Systemic Sclerosis
Definition
A-Multisystem disorder
B-Unknown etiology
C-İmmune system activation
D-Collagen accumulation
E-Autoimmunity
 Symptoms and Signs
Joint pain

Hair loss

A dry cough

Diarrhea

Constipation

Small, dilated blood vessels under the skin's surface.

What does
systemic sclerosis look
like?

• Scleroderma's signs and symptoms vary,

depending on which parts of your body are
affected:Skin.Nearly everyone who has
scleroderma experiences a hardening and
tightening of patches of skin. These patches
may be shaped like ovals or straight lines, or
cover wide areas of the trunk and limbs.
Cause of systemic
sclerosis
• SS occurs when your body
begins to overproduce collagen
and it accumulates in your
tissues. Collagen is the main
structural protein that makes up
all of your tissues.Doctors aren’t
sure what causes the body to
produce too much collagen. The
exact cause of SS is unknown
Risk Factors for
Systemic Sclerosis

1.Being Native american

2.Being African-American
3.Being female
4.Using certain chemotherapy drugs such as
Bleomycin
5.Being exposed to sicila dust and organic
solvents
Diagnosis of Systemic sclerosis 

BLOOD TEST ANTIBODY A CHEST X- A URINALSIS A CT SCAN OF SKIN BIOPSIES

TEST RAY THE LUNGS
 • Getting pain relief through nonsteroidal, anti-
inflammatory medications or corticosteroids
• Maintaining muscle strength through physical
therapy and exercise
Treating • Managing digestive tract function to optimize
scleroderma nutritional intake
• Controlling blood pressure and improving blood
flow with medication
• Treating specific symptoms such as heartburn and
Raynaud's phenomenon
• Getting pain relief through nonsteroidal, anti-
inflammatory medications or corticosteroids
Chronic Low Back Pain
 • Chronic back pain is the leading cause of years lived with
CHRONIC disability in the United States and accounts for more than 264
million lost work-days per year.
LOW BACK • In 2013 back pain was the most common reason for health
PAIN care visits among musculoskeletal disorders, with more than
57 million physician office visits.
 • Chronic low back pain is a clinical syndrome defined by
the persistence of pain in the lower back for at least 3
months.
Definition • In some persons, chronic low back pain may progress
over time to a complex condition “involving persistent
anatomical and functional changes in the central nervous
system, in addition to structural changes in the back.
• Chronic low back pain is sometimes associated with pain that radiates
to the lower extremity in a characteristic distribution (i.e., radicular
pain, sometimes called “sciatica”) or radiculopathy, meaning objective
neurologic abnormalities associated with spinal nerve root
involvement. 
• Lumbar spinal stenosis is a clinical syndrome most common in older
adults, in which characteristic pain in the buttocks or legs occurs with
walking.
Diagnosis
• Chronic low back pain is defined by its location and by a duration of at
least 3 months.
• It is often described as “nonspecific” because a specific cause is rarely
identified.
• Chronic low back pain involves diverse pathophysiologic, cognitive,
emotional, and social factors that contribute to its onset,
maintenance, and related impairment. 
• Numerous local pain generators are known to be present in the low back. 
•  Cognitive and behavioral factors such as catastrophizing and activity avoidance are
known to be involved in some individuals.
• More recently, alterations in the central nervous system structure and function related to
the processing of pain and emotion have been identified. 
• Unfortunately, there is little scientific consensus on the relative importance of those
factors or the extent to which they are causes rather than consequences of chronic back
pain
• Routine imaging and laboratory testing are not typically indicated in the initial evaluation
of chronic low back pain.
• As noted above, the diagnosis of chronic low back pain is a syndrome defined by
subjective pain experience in a defined anatomical region for a duration of time. 
• Imaging and laboratory testing are utilized to exclude high-risk sources of back pain in
some patients, but specific imaging or laboratory testing for the diagnosis of chronic low
back pain are not available. 
• Diagnostic testing is not indicated for the vast majority of low back pain patients;
however, spine X-rays or magnetic resonance imaging (MRI) may be indicated for back
pain that persists despite initial treatment 
Treatments for Chronic Low Back Pain

• Numerous treatments have demonstrated effectiveness for improving function in chronic

low back pain.
• These include exercise therapies, behavioral/psychological therapies, and manual
therapies.
• Multidisciplinary approaches, including intensive chronic pain rehabilitation programs
and less intensive primary-care-based collaborative care management interventions, also
have demonstrated benefits for function.
• Exercise therapies are the first-line treatments recommended in guidelines for routine
use in chronic low back pain.
• These guidelines are supported by a large body of evidence that is somewhat limited by
the methodology, size, and heterogeneity of published clinical trials.
• Studies have evaluated a wide range of exercise approaches in patients with low back
pain, including strength/resistance, motor control/stabilization, and aerobic exercise.
• In general, medications are less beneficial
for function than for pain in chronic low
back pain, with most of their benefits
demonstrated only in the short term. 
• A systematic review conducted for use in
developing the American College of
Physicians low back pain guideline found
evidence that NSAIDs, duloxetine,
tramadol, and opioids produced small
short-term improvements in functional
outcomes.
Resources
• https://www.ncbi.nlm.nih.gov/books/NBK559512/
• https://sbu.saglik.gov.tr/Ekutuphane/kitaplar/kas%20ve%20iskelet%20.pdf
• https://www.msdmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/autoimmune-rheumatic-disorders/systemic-sclerosis
• https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60802-3/fulltext
• https://physio-pedia.com/Knee_Osteoarthritis?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal
• https://www.physio-pedia.com/Hip_Osteoarthritis?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal
• https://creakyjoints.org/education/ankylosing-spondylitis-risk-factors/
• https://www.verywellhealth.com/wrist-osteoarthritis-what-you-need-to-know-2552322
• https://pubmed.ncbi.nlm.nih.gov/25596986/
• https://www.pthealth.ca/conditions/osteoarthritis/wrist-osteoarthritis/
• https://www.webmd.com/osteoarthritis/hand-osteoarthritis-degenerative-arthritis-of-the-hand
• https://www.healthline.com/health/osteoarthritis/osteoarthritis-hand
• https://www.verywellhealth.com/hand-osteoarthritis-eular-treatment-guidelines-190142