DISEASE OF BONES AND JOINxhdfjcncnfmfTS.pptx

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1. By Haripriya Sajikumar DISEASE OF BONES AND JOINTS

2. These are those disease which are related to bones and joints. Osteology is the study of bones and teeth. Joints are the junction between two or more bones or cartilages, or between a bone and a cartilage, where movement may or may not occur.” Three main disease: 1. Rheumatoid arthritis 2. Osteoporosis 3. Gout INTRODUCTION

3. Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that primarily affects synovial joints , leading to progressive joint destruction, deformity, and disability. RHEUMATOID ARTHRITIS (RA) Weak, swollen and painful joints. Here the immune system attacks the synovium . The synovium becomes inflamed and thickened. It ultimately destroys the cartilage and bone within joints.

4. Joint pain (especially in hands, wrists, feet) Morning stiffness lasting more than 1 hour Swelling and warmth in joints Symmetrical involvement (both sides of body) Tiredness / fatigue Fever (low-grade) sometimes Joint deformities (in long-standing cases) SIGNS AND SYMPTOMS

5. RA is multifactorial : Genetic – genes connected to immune responses (HLA-A, HLA-B, HLA-C, HLA-D proteins). Immunological – Autoantibodies (rheumatoid factor, anti-CCP). Environmental – Smoking, obesity, infections, gut microbiome changes. Hormonal – More common in women (estrogen influence). ETIOLOGY

6. Genetic + Environmental trigger ↓ Abnormal immune activation → activation of CD4+ T cells, B cells, macrophages ↓ Autoantibody formation → Rheumatoid factor ( IgM against IgG Fc), Anti-CCP antibodies ↓ Immune complexes deposition in synovium ↓ Cytokine release (TNF- α, IL-1, IL-6) ↓ Synovial inflammation & proliferation → pannus formation (granulation tissue) ↓ Erosion of cartilage & bone → joint deformity, ankylosis PATHOPHYSIOLOGY

7. General measures Rest during flare, physiotherapy for mobility Lifestyle: stop smoking, balanced diet Pharmacological treatment NSAIDs – symptom relief (not disease modifying) Corticosteroids – short-term control of inflammation DMARDs (Disease-Modifying Anti-Rheumatic Drugs) Eg. Methotrexate (first-line) Surgical Synovectomy , joint replacement in severe deformity TREATMENT

8. Osteoporosis is a condition where the bones become weak, thin, and fragile, making them break easily. It is caused due to imbalance between new bone formation and bone resorption. SIGNS AND SYMPTOMS Often asymptomatic until fracture occurs Back pain due to fractured or collapsed vertebra Easy bone fractures Loss of height over time Stooped posture Fragility fractures (wrist, hip, vertebrae common) OSTEOPOROSIS

9. Primary osteoporosis Postmenopausal (estrogen deficiency) A ge-related bone loss Secondary osteoporosis (due to other causes) Endocrine: hyperthyroidism, Cushing’s syndrome, hyperparathyroidism Drugs: corticosteroids, anticonvulsants, heparin Diseases: rheumatoid arthritis, malabsorption, chronic kidney disease Lifestyle: smoking, alcohol, physical inactivity ETIOLOGY

10. Imbalance in bone remodeling ↓ ↑ Bone resorption (osteoclast activity) or ↓ Bone formation (osteoblast activity) ↓ Loss of bone mass & trabecular thinning ↓ Weak, porous bones ↓ Increased fragility & fracture risk PATHOPHYSIOLOGY

11. RISK FACTORS Non-modifiable: Age > 50, female sex, menopause, family history, small/thin body build Modifiable: Smoking, alcohol, low calcium & vitamin D intake, sedentary lifestyle, long-term steroid use TREATMENT General measures Adequate calcium & vitamin D intake Weight-bearing exercise Fall prevention (home safety, balance training) Avoid smoking & alcohol

12. Pharmacological management Bisphosphonates (Alendronate, Risedronate – first line) Selective Estrogen Receptor Modulators (SERMs) – Raloxifene Denosumab (RANKL inhibitor)

13. Gout is a joint disease caused by too much uric acid in the blood, which forms crystals in the joints and leads to sudden, painful swelling. ETIOLOGY High uric acid ( hyperuricemia ) due to: Overproduction (genetic, high purine diet, alcohol) Underexcretion (kidney disease, dehydration, drugs like diuretics, aspirin) GOUT

14. SIGNS AND SYMPTOMS Acute attack: Sudden severe pain in one joint, redness, warmth, and swelling. Pain often starts at night Chronic gout: Repeated attacks, t ophi (hard uric acid lumps under skin, e.g., ear, elbow, fingers), joint deformity and kidney stones (urate stones) RISK FACTORS Male sex, age > 40 Family history Obesity Alcohol intake (beer, spirits) High purine foods (red meat, seafood, organ meats) Kidney disease or long-term diuretic use

15. ↑ Uric acid in blood ( hyperuricemia ) ↓ Deposition of monosodium urate crystals in joints & tissues ↓ Crystals trigger inflammation (neutrophil activation, cytokines) ↓ Acute joint pain, swelling, redness ↓ Repeated attacks → chronic gout, joint damage, tophi PATHOPHYSIOLOGY

16. Male sex, age > 40 Family history Obesity Alcohol intake (beer, spirits) High purine foods (red meat, seafood, organ meats) Kidney disease or long-term diuretic use RISK FACTORS

17. Acute attack NSAIDs (Indomethacin, Naproxen) Corticosteroids (if NSAIDs not tolerated) Long-term management Urate-lowering therapy: Allopurinol (↓ uric acid production) Probenecid (↑ uric acid excretion) Lifestyle: Avoid alcohol & high-purine foods Drink plenty of water Weight reduction TREATMENT

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