RHEUMATOLOGY

ARTHRITIS

Do not confuse arthritis and osteoarthritis.

Arthritis is an inflammatory joint disorder. The affected joint is painful, swollen, and hot, at least when the condition is superficial. The pain has a particular rhythm: it is mainly present in the morning and sometimes wakes the patient in the second half of the night. The sedimentation rate is accelerated. Arthritis is relieved by anti-inflammatory drugs.

arthritis is said to be acute, when the inflammation is sharp and short-lived. It is said to be chronic, when it lasts more than three months and the inflammation is generally of moderate intensity.

Arthritis is mono-articular or poly-articular, depending on whether it affects one or more joints.

It is said to be infectious or septic when it is due to the presence of a bacteria or a virus in the joint.

Arthritis is said to be post-infectious or infectious rheumatism; when, although of infectious origin, it is aseptic. The affected joint does not contain the germ involved, as for example in rheumatic fever.

Arthritis is micro-crystalline when the inflammation is due to the presence of micro-crystals in the joint, in cases of gout and articular chondrocalcinosis.

Finally, in a large number of rheumatisms such as rheumatoid arthritis, rheumatic palvispondylitis; the pathophysiology of arthritis remains poorly understood.

Copyright photo : pixabay taokenisis

Bibliography : Biologics for the Treatment of Rheumatoid Arthritisby Ronald van Vollenhoven

ARTHROSIS

Osteoarthritis is the most common disease of the musculoskeletal system. this condition, the frequency of which increases with age, is not only linked to aging.

The causes of Osteoarthritis are indeed multiple:

– mechanical causes, due to joint overload (excess weight) or anatomical abnormality (joint incongruence or static imbalance);

– In other cases, the joint is anatomically normal, but the cartilage is damaged. These cartilaginous lesions can be caused by trauma (post-traumatic Arthrosis), by metabolic phenomena (chondrocalcinosis) or by other conditions (such as hyperostosis or Paget’s disease).

Osteoarthritis affects preferably the large and most stressed joints (knee, hip), but does not spare the small (polyosteoarthritisof the fingers). It manifests itself by pain and impotence of the joint.

The clinical examination finds a limitation, most often painful, to joint mobility. The biological examination confirms the absence of inflammatory syndrome; the sedimentation rate is normal and the analysis of the joint effusion fluid reported by joint puncture is mechanical. Joint pinching, excessive bone production or osteophytosis (parrot beak for example), osteosclerosis (bone appears denser) are the radiological signs of arthrosis. There is no correlation between the clinic and radiology; many people have but do not have radiological osteoarthritis lesions.

Is osteoarthritis transmissible?

There is a family incidence in osteoarthritis of the fingers in women. for other arthritis, the genetic character is difficult to prove, because the factors intervening in osteoarthritis can be entangled.

The treatment of osteoarthritisis based on anti-inflammatories, infiltrations, physiotherapy and surgical interventions. There is no effectively recognized basic therapy for arthrosis, mainly due to the numerous pathophysiological unknowns.

Copyright photo : Par James Heilman, MD — personal work CC BY-SA 3.0,

Bibliography : How to get rid or Arthrosis and Rhumatism by Jacques Crousset

CHILD LAMPS AND / OR HIP PAIN

Any lameness in the child is abnormal and should lead to a consultation. It witnesses either pain or a decrease in mobility in the hip, in general.

After making sure that this lameness does not have an infectious origin, the doctor will look for other causes. A basin radio is always necessary. Two causes are common in children between the ages of five and nine.

Most often, it is a cold of the hip or acute arthritis benign or transient synovitis. The child limps, the mobility of the hip is reduced. The radio shows only a slight increase in the volume of his joint, the capsule in general. Simple rest may be sufficient, but it is sometimes necessary to put the child in traction for a few days, until he regains painless mobility of the hip. An x-ray of the pelvis is still necessary two months later, in order to formally rule out primary osteochondritis of the hip. This condition also called Legg-Perthes-Calvé disease is a necrosis of the femoral head. For some unknown reason, the blood supply to the femoral head is no longer made, leading to the death of the latter. But the natural evolution is towards the reconstruction of a new femoral head. The duration of this process is unfortunately long. The aim of the treatment which will be undertaken is to allow the reconstruction of a regular and well rounded head. Several techniques are used: traction to make the hip more flexible, wearing an appliance, or surgery; these techniques can be combined. In the absence of treatment, the evolution will be towards the reconstruction of a deformed head leading later to osteoarthritis.

If it is a teenager, and especially if it is a bit fat, the diagnosis of epiphyslolysis must be mentioned. The femoral head gradually slides over the neck of the femur causing serious changes in the architecture of the hip. It is the x-ray that will make the diagnosis. The treatment is imperatively surgical. If the sliding is not very important, one can avoid its aggravation by fixing the head to the femoral neck with screws. If the slip is too great, the result is more random. Your child should be monitored in particular, as this disease affects the other hip in 20% of cases. If the diagnosis is made early, the long-term prognosis is good.

Copyright photo : Public domain, Henry Gray (1918) Anatomie du corps humain 

Bibliography : Pediatric Orthopedic Deformities: Developmental Disorders of the Lower Extremity: Hip to Knee to Ankle and Foot by Frederic Shapiro 

INFECTIOUS ARTHRITIS

infectious arthritis

Infectious arthritis is caused by the presence of a microbial germ in a joint. It most often manifests suddenly, with fever and signs of joint inflammation. The joint is hot, painful, swollen, its mobilization limited.

You must consult your doctor quickly, the functional prognosis of the joint is at stake.

The diagnosis is facilitated by knowing the point of penetration of the germ into the body, such as a wound for example, or of a known infection at a distance, such as urinary tract infection or gonorrhea.

A bacteriological investigation is urgently required, on the blood, urine, joint puncture fluid. The direct examination, the culture, the antibiogram are systematically carried out.

Pending the results, the joint is immobilized by bivalve plaster, an antibiotic treatment instituted, then adapted according to the bacteriological result and the sensitivity of the germ. This antibiotic therapy is extended for several weeks.

Any infectious arthritis must be treated early, or risk further sequelae. Treated on time, complete and successful recovery.

Copyright photo : pixabay taokenisis

Bibliography : Biologics for the Treatment of Rheumatoid Arthritisby Ronald van Vollenhoven

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