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JOINT DISORDERS
By Zahida Chaudhary MD
List of joint problems
Ankylosing Spondylitis
Back Pain
Behcet's syndrome
Carpal tunnel syndrome
Diffuse idiopathic skeletal
hyperostosis (DISH)
Ehlers-Danlos syndrome (EDS)
Fibromyalgia
Gonococcal arthritis
Gout
Juvenile Rheumatoid Arthritis
(JRA)

Systemic Lupus Erythematosus
(SLE)
Lyme Disease
Osteoarthritis
Osteomalacia
Osteoporosis
Paget’s Disease
Polymyalgia Rheumatica (PMR)
Psoriatic Arthritis
Raynaud's phenomenon
Reactive arthritis
Repetitive strain injury
Rheumatoid arthritis
The causes of arthritis
The causes of arthritis depend on the
form of arthritis.
Injury or aging, leading to osteoarthritis
metabolic abnormalities such as gout and
pseudo gout
Hereditary factors and infections
Auto immune such as rheumatoid
arthritis and systemic lupus
erythematosus.

systemic lupus erythematosus
How a joint works
Basically, a joint is where one bone moves
on another bone.
Ligaments hold the two bones together.
The ligaments are like elastic bands, while
they keep the bones in place your muscles
relax or contract to make the joint move.
Cartilage covers the bone surface to stop
the two bones from rubbing directly against
each other.
The covering of cartilage allows the joint to
work smoothly and painlessly.
Broad Classification of Arthritis
n Degenerative arthritis
 Osteoarthritis

n Autoimmune arthritis
 Rheumatoid arthritis
 ANA positive diseases

n Infectious arthritis
 Bacterial
 Viral

n Metabolic / endocrine
 Hyperthyroidism
 Hyperparathyroidism

n Crystalline arthritis
 Gout
 Pseudo gout

n Neoplastic arthritis
 Primary
 Para neoplastic
Osteoarthritis
 “Degenerative joint
disease
 Primary sight of
pathology is cartilage and
 subchondral bone
 Primary vs Secondary
 Joints only (no systemic
features)

While osteoarthritis can damage any joint in our body, the disorder
most commonly affects joints in your hands, neck, lower back, knees
and hips.
Symptoms
 Pain
 Early in
disease, pain
with use
 End stage, pain
at rest
 May have little
or no pain

 Stiffness (gel
phenomenon)

Physical Findings
 Bony enlargement of
involved joints
 Hands
 DIP
 PIP







First CMC (carpometacarpal)
Knees
Hips
Feet (Bunion joint)
Spine
OA of Hands
• Hand Involvement
“Bony” enlargement
Sparing of MCPs
Bouchard’s nodes (PIP)
Heberden’s nodes (DIP)
Little “synovitis”
OA of the spine
•
•
•
•
•

Lumbar spine Xray in a
patient with scoliosis (curvature of the spine). The
Scoliosis predisposed this
Patient to OA of the spine

disc space narrowing
“bridging” osteophytes
sclerosis
Treating Osteoarthritis
 Weight loss (knee OA)
 Muscle strengthening
(knee OA)
 Physical therapy
 Assistive devices
 Canes
 walkers

 Acetaminophen (for mild
disease)
 NSAIDs
 Glucosamine/Chondroitin
Sulfate?
 Joint injections
 Steroids
 Viscos supplements
 High molecular weight
hyaluronic acid

 Surgery
 Joint replacements
Treating Osteoarthritis
Findings from a newly released
CDC report indicate that one third
of U.S. adults with arthritis 45
years and older have either
anxiety or depression.

As shown in the figure on the
right, most people who had
depression (85%) also had anxiety.
However, only 50% of the people
who had anxiety also had
depression
Educational Grand Rounds: Arthritis

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Educational Grand Rounds: Arthritis

  • 2. List of joint problems Ankylosing Spondylitis Back Pain Behcet's syndrome Carpal tunnel syndrome Diffuse idiopathic skeletal hyperostosis (DISH) Ehlers-Danlos syndrome (EDS) Fibromyalgia Gonococcal arthritis Gout Juvenile Rheumatoid Arthritis (JRA) Systemic Lupus Erythematosus (SLE) Lyme Disease Osteoarthritis Osteomalacia Osteoporosis Paget’s Disease Polymyalgia Rheumatica (PMR) Psoriatic Arthritis Raynaud's phenomenon Reactive arthritis Repetitive strain injury Rheumatoid arthritis
  • 3. The causes of arthritis The causes of arthritis depend on the form of arthritis. Injury or aging, leading to osteoarthritis metabolic abnormalities such as gout and pseudo gout Hereditary factors and infections Auto immune such as rheumatoid arthritis and systemic lupus erythematosus. systemic lupus erythematosus
  • 4. How a joint works Basically, a joint is where one bone moves on another bone. Ligaments hold the two bones together. The ligaments are like elastic bands, while they keep the bones in place your muscles relax or contract to make the joint move. Cartilage covers the bone surface to stop the two bones from rubbing directly against each other. The covering of cartilage allows the joint to work smoothly and painlessly.
  • 5. Broad Classification of Arthritis n Degenerative arthritis  Osteoarthritis n Autoimmune arthritis  Rheumatoid arthritis  ANA positive diseases n Infectious arthritis  Bacterial  Viral n Metabolic / endocrine  Hyperthyroidism  Hyperparathyroidism n Crystalline arthritis  Gout  Pseudo gout n Neoplastic arthritis  Primary  Para neoplastic
  • 6. Osteoarthritis  “Degenerative joint disease  Primary sight of pathology is cartilage and  subchondral bone  Primary vs Secondary  Joints only (no systemic features) While osteoarthritis can damage any joint in our body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips.
  • 7.
  • 8. Symptoms  Pain  Early in disease, pain with use  End stage, pain at rest  May have little or no pain  Stiffness (gel phenomenon) Physical Findings  Bony enlargement of involved joints  Hands  DIP  PIP      First CMC (carpometacarpal) Knees Hips Feet (Bunion joint) Spine
  • 9. OA of Hands • Hand Involvement “Bony” enlargement Sparing of MCPs Bouchard’s nodes (PIP) Heberden’s nodes (DIP) Little “synovitis”
  • 10. OA of the spine • • • • • Lumbar spine Xray in a patient with scoliosis (curvature of the spine). The Scoliosis predisposed this Patient to OA of the spine disc space narrowing “bridging” osteophytes sclerosis
  • 11.
  • 12. Treating Osteoarthritis  Weight loss (knee OA)  Muscle strengthening (knee OA)  Physical therapy  Assistive devices  Canes  walkers  Acetaminophen (for mild disease)  NSAIDs  Glucosamine/Chondroitin Sulfate?  Joint injections  Steroids  Viscos supplements  High molecular weight hyaluronic acid  Surgery  Joint replacements
  • 13. Treating Osteoarthritis Findings from a newly released CDC report indicate that one third of U.S. adults with arthritis 45 years and older have either anxiety or depression. As shown in the figure on the right, most people who had depression (85%) also had anxiety. However, only 50% of the people who had anxiety also had depression