Rheumatoid Arthritis Vs Osteoarthritis - Welcome to the ：类风湿性关节炎和骨关节炎-欢迎来到.ppt

Management Management !THINK! Function- function-function Conservative- muscle strengthening exercises + aerobic exercise Drugs- Paracetamol + NSAIDS (top/oral) Intrarticular steroid injections as adjunct therapy Surgery- indicated when PAIN/stiffness have a substantial impact on QOL MDT- Physio, OT, GP Osteoarthritis- !THINK! Function Case 2 67 F presents with pain in the joints of her hands, mainly the thumbs. Pain worse after gardening Slight swelling present Pain eased by paracetamol Hypertension (Amlodipine 5mg), retired secretary, never smoked and non-drinker Case 2 On examination Not grossly defomed Squaring of the thumb joint Tender over PIPs and DIPs Do her buttons and write her name with slight discomfort Case 2 Investigations ? Bloods FBC, UEs, LFTs, ESR, CRP Imaging Subchondrial sclerosis Osteophytes Narrowing of joint space Subchondrial cysts Management References Nice guidelines- Rheumatoid Arthritis (2009) .uk/nicemedia/live/12131/43326/43326.pdf Nice guidelines- Osteoarthritis (2008) .uk/nicemedia/live/11926/39557/39557.pdf THANK YOU! ANY QUESTIONS?? Hand Changes in RA Hand Changes in OA Square thumb * A multisystem autoimmune inflammatory conditions typically affecting the small joints of the hands and feet http://www.google.co.uk/imgres?imgurl=/fullsize/migrated/546/105/ga546105.fig2.gifimgrefurl=/viewarticle/546105_2usg=__r_ObvW5qoJo6t8q_l7rGkQ2CwfY=h=622w=500sz=71hl=enstart=3zoom=1tbnid=jNxgsGTc6LthCM:tbnh=136tbnw=109ei=c6GNUu-ZNubD7Ab7iYGYAQprev=/search%3Fq%3Drheumatoid%2Barthritis%2Bdistribution%26safe%3Dactive%26rls%3Dcom.microsoft:*:IE-SearchBox%26rlz%3D1I7ADFA_enGB494%26tbm%3Dischitbs=1sa=Xved=0CC4QrQMwAg * The pathogenesis of RA is not completely understood. An external trigger (eg, cigarette smoking, infection, or trauma) that triggers an autoimmune reaction, leading to synovial hypertrophy and chronic joint inflammation along with the potential for extra-articular manifestations, is theorized to occur in genetically