CLINICAL PRACTICE

GUIDELINES

ARTHRITIS
LIM, ANTHONY ROBERT PATRICK R.
POSTGRADUATE INTERN
DIVINE WORD HOSPITAL
OBJECTIVES
GENERAL OBJECTIVE SPECIFIC OBJECTIVES

Discuss clinical practice guidelines • Briefly define gout and osteoarthritis.

for gout and osteoarthritis.
• Discuss their epidemiology,
pathology, and clinical
manifestations.
• Identify their respective treatment in
accordance with relevant guidelines.
 CLINICAL PRACTICE
GUIDELINES
Project analysis slide 2 (2008)

PHILIPPINE
GOUTY ARTHRITIS RHEUMATOLOGY OSTEOARTHRITIS
ASSOCIATION
 GOUT

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How
What Who Where Clinical Features
Often affects middle- 1st episode – at night,
Deposition of aged to elderly men AFFECTS: MTP of the dramatic joint pain &
Monosodium Urate
1st toe, tarsal joint, swelling (mimics
crystals Postmenopausal Due to increased urate
ankles, knees cellulitis)
women with hyperuricemia
Episodic Acute Arthritis
Bouchard’s or Subsides within 3-10
or Chronic Arthritis Risk Factors: Estrogenic hormones are
Heberden’s nodes may days
Dyslipidemia uricosuric
be 1st manifestations
Obesity Confirm with Needle
Metabolic Syndrome Aspiration
CHF
Psoriasis SUA can be
Malignancies NORMAL/LOW during
acute attack

Jameson, J. L., & Loscalzo, J. (2015). Harrison's principles of internal medicine (20th edition.). New York: McGraw Hill Education
 UNCOMPLICATED GOUT
ALGORITHM
Project analysis slide 4

Philippine Rheumatology Association CPM 11 th ed,

 UNCOMPLICATED GOUT
ALGORITHM
Project analysis slide 4

Philippine Rheumatology Association CPM 11 th ed,

 UNCOMPLICATED GOUT
ALGORITHM
Project analysis slide 4

Philippine Rheumatology Association CPM 11 th ed,

 ACUTE GOUTY ARTHRITIS
ALGORITHM
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Philippine Rheumatology Association CPM 11 th ed,

 INTERCRITICAL & CHRONIC
GOUTY ARTHRITIS
Project analysis slide 4ALGORITHM

Philippine Rheumatology Association CPM 11 th ed,

 INTERCRITICAL & CHRONIC
GOUTY ARTHRITIS
Project analysis slide 4ALGORITHM

Philippine Rheumatology Association CPM 11 th ed,

RECOMMENDATIONS
 Phase 1: Asymptomatic Hyperuricemia

Philippine Rheumatology Association CPM 11 th ed,

 Phase 2: Acute Gout

Philippine Rheumatology Association CPM 11 th ed,

 Phase 2: Intercritical Gout and Chronic Tophaceous Gout

Philippine Rheumatology Association CPM 11 th ed,

 Phase 2: Intercritical Gout and Chronic Tophaceous Gout

Philippine Rheumatology Association CPM 11 th ed,

 Phase 2: Intercritical Gout and Chronic Tophaceous Gout

Philippine Rheumatology Association CPM 11 th ed,

 OSTEOARTHRITIS

Project analysis slide 3

What Who Where
How
Leading cause of
disability in the AFFECTS: Hip, Knee,
Cartilage loss & elderly Degenerative joint
Osteophytes 1st MTP joint,
Cervical & disease
Age is the most Lumbosacral Spine
Sine Qua Non: potent risk factor Failure of
HYALINE protective joint
CARTILAGE LOSS SPARES: Wrist,
Hereditary – GDF5 Elbow, Ankle mechanisms:
gene polymorphism

Obesity

Repetitive use of
joint & exercise

Jameson, J. L., & Loscalzo, J. (2015). Harrison's principles of internal medicine (20th edition.). New York: McGraw Hill Education
 PROTECTIVE
JOINT MECHANISMS
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JOINT CAPSULE
SYNOVIAL FLUID
&
LIGAMENTS

JOINT STABILITY & LUBRICATION

MUSCLES
&
MECHANORECEPTORS TENDONS CARTILAGE

Jameson, J. L., & Loscalzo, J. (2015). Harrison's principles of internal medicine (20th edition.). New York: McGraw Hill Education
 OSTEOARTHRITIS

Project analysis slide 3

What Who Where
How Clinical Features
Leading cause of Early OA – pain is
disability in the Failure of activity-related
Cartilage loss & AFFECTS: Hip, Knee, protective joint
elderly 1st MTP joint,
Osteophytes mechanisms: Knee buckling
Cervical &
Age is the most Lumbosacral Spine
Sine Qua Non: potent risk factor 1. Joint capsule &
No blood tests
HYALINE ligaments
SPARES: Wrist, indicated
CARTILAGE LOSS Hereditary – GDF5 2. Synovial fluid
Elbow, Ankle 3. Mechanoreceptors
gene polymorphism Synovial fluid more
4. Muscles & tendons
helpful in diagnosis
Obesity 5. Cartilage
X-ray confirms
Repetitive use of diagnosis
joint & exercise

Jameson, J. L., & Loscalzo, J. (2015). Harrison's principles of internal medicine (20th edition.). New York: McGraw Hill Education
 OSTEOARTHRITIS

Project analysis slide 4

Philippine Orthopedic Association CPM 9th ed

Project analysis slide 4

Philippine Orthopedic Association CPM 9th ed

 OSTEOARTHRITIS

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Philippine Orthopedic Association CPM 9th ed

 OSTEOARTHRITIS

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Philippine Orthopedic Association CPM 9th ed

 OSTEOARTHRITIS

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Philippine Orthopedic Association CPM 9th ed

 OSTEOARTHRITIS

Project analysis slide 4

Philippine Orthopedic Association CPM 9th ed

TREATMENT
 IBUPROFEN
300mg PO q6-8 hours, not to exceed dose of
3200 mg/day. Side effect most notably,
Gastrointestinal bleeding.

DICLOFENAC GEL
For patients with symptomatic disease
limited to a few sites or with NSAID
contraindications
 PHYSICAL MODALITIES
Local application of heat, ultrasound, and
hydrotherapy offer temporary relief

SUPPORTIVE AIDS
Splints, braces, canes, walkers, crutches
decrease joint loading in
an osteoarthritic joint
 ARTHRITIS
and
PUBLIC HEALTH
www.arthritis.ca
TAISO EXERCISE/ RADIO CALISTHENICS
Thank You