Clinical Medicine &
Applied pathology
Musculoskeletal disorders
Rheumatoid Arthritis
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Rheumatoid arthritis is among the most
debilitating of all forms of arthritis, causing
joints to ache and throb and eventually become
deformed.
Sometimes these symptoms make even the
simplest activities — such as opening a jar or
taking a walk — difficult to manage.
Causes
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The cause of rheumatoid arthritis (RA) is unknown. It is
considered autoimmune disease. The body's immune system
normally fights off foreign substances, like viruses. But in an
autoimmune disease, the immune system confuses healthy
tissue for foreign substances. As a result, the body attacks
itself.
RA can occur at any age. It usually occurs in people between
25 and 55. Women are affected more often than men. The
course and the severity of the illness can vary considerably.
Infection, genes, and hormones may contribute to the disease.
RA usually affects joints on both sides of the body equally.
Wrists, fingers, knees, feet, and ankles are the most commonly
affected.
Risks
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Getting older, because incidence of rheumatoid
arthritis increases with age. However, incidence
begins to decline in women over the age of 80.
Being female.
Being exposed to an infection, possibly a virus or
bacterium, that may trigger rheumatoid arthritis in
those with an inherited susceptibility.
Inheriting specific genes that may make one more
susceptible to rheumatoid arthritis.
Smoking cigarettes over a long period of time.
Symptoms
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Pain and swelling in your joints, especially in the smaller joints of your
hands and feet
Generalized aching or stiffness of the joints and muscles, especially after
sleep or after periods of rest
Loss of motion of the affected joints
Loss of strength in muscles attached to the affected joints
Fatigue, which can be severe during a flare-up
Low-grade fever
Deformity of your joints over time
General sense of not feeling well (malaise)
Skin redness or inflammation
Paleness
Swollen glands
Eye burning, itching, and discharge
Numbness or tingling
Anemia may occur due to failure of the bone marrow to produce enough
new red cells.
Rheumatoid nodules
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Small lumps, called rheumatoid nodules, may form
under the skin at pressure points and can occur at
elbows, hands, feet and Achilles tendons. Rheumatoid
nodules may also occur elsewhere, including the back
of scalp, over knees or even in lungs. These nodules
can range in size — from as small as a pea to as large
as a walnut. Usually these lumps aren't painful.
In contrast to osteoarthritis, which affects only bones
and joints, rheumatoid arthritis can cause
inflammation of tear glands, salivary glands, the
linings of heart and lungs, lungs themselves and, in
rare cases, blood vessels.
Tests
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Blood tests – ESR and RA factor tests can
confirm diagnosis
Imaging – X-Rays and MRI scans can also
show progression of disease
C-reactive protein
Synovial fluid analysis
Complications
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A life-threatening joint complication can occur when the
cervical spine becomes unstable as a result of RA.
Rheumatoid vasculitis (inflammation of the blood vessels) is a
serious , potentially life-threatening complication of RA. It can
lead to skin ulcerations and infections, bleeding stomach
ulcers, and nerve problems that cause pain, numbness, or
tingling. Vasculitis may also affect the brain, nerves, and heart,
which can cause stroke, heart attack, or heart failure.
RA may cause the the outer lining of the heart to swell
(pericarditis) and cause heart complications. Inflammation of
heart muscle, called myocarditis, can also develop. Both of
these conditions can lead to congestive heart failure.
The treatments for RA can also cause serious side effects.
Osteoarthritis
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Osteoarthritis is the most common joint
disorder. The chronic disease causes the
cushioning (cartilage) between the bone joints
to wear away, leading to pain and stiffness. It
can also cause new pieces of bone, called bone
spurs, to grow around the joints.
Its also known as Hypertrophic osteoarthritis;
Osteoarthrosis; Degenerative joint disease;
OA;
Causes & Risk
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Most of the time, the cause of osteoarthritis (OA) is unknown.
It is primarily related to aging. However, metabolic, genetic,
chemical, and mechanical factors can play a role in its
development.
The symptoms of osteoarthritis usually appear in middle age
and are present in almost everyone by the age of 70. Before the
age of 55, the condition occurs equally in both sexes.
However, after 55 it is more common in women.
The cartilage of the affected joint becomes rough and wears
down (degenerates). As the disease gets worse, the cartilage
disappears and the bone rubs on bone. Bony spurs usually
develop around the joint.
OA is classified as primary or secondary. Primary OA occurs
without any type of injury or identifiable cause. Secondary OA
is osteoarthritis due to another disease or underlying condition.
The most common causes of secondary OA are metabolic
conditions, such as acromegaly, problems with anatomy (for
example, being bow-legged), injury, or inflammatory disorders
like septic arthritis.
Symptoms
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gradual and subtle onset of deep aching joint pain
worse after exercise or weight bearing
often relieved by rest
joint swelling
limited movement
morning stiffness
grating of the joint with motion
joint pain in rainy weather
Tests & Complications
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A physical exam can show
limited range of motion,
grating of a joint with
motion, joint swelling, and
tenderness.
An x-ray of affected joints
will show loss of the joint
space, and in advanced
cases, wearing down of the
ends of the bone and bone
spurs.
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Decreased ability to walk
Decreased ability to perform
activities of daily living,
such as personal hygiene,
house chores, or cooking
Adverse reactions to
drugs used for treatment
Lumbago
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Lumbago is defined as mild to severe pain or
discomfort in the area of the lower back. The
pain can be acute (sudden and severe) or
chronic if it has lasted more than three months.
Lumbago often occurs in younger people
whose work involves physical effort and is not
uncommon in people of retirement age.
Causes
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Small fractures to the spine from osteoporosis
Muscle spasm (very tense muscles that remain contracted)
Ruptured, slipped or herniated disk
Degeneration of the disks
Poor alignment of the vertebrae
Spinal stenosis (narrowing of the spinal canal)
Strain or tears to the muscles or ligaments supporting the back
Spine curvatures (like scoliosis or kyphosis) which may be
inherited and seen in children or teens
Other medical conditions like fibromyalgia
skeletal damage due to tumours or infection.
Risks
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Work in construction or another job requiring
heavy lifting, lots of bending and twisting, or
whole body vibration (like truck driving or using a
sandblaster)
Have bad posture
Are pregnant
Are over age 30
Smoke, don't exercise, or are overweight
Have arthritis or osteoporosis
Have a low pain threshold, Feel stressed or
depressed
Symptoms
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Pain across the lower part of the back that sometimes
radiates into the buttocks, the back of the thigh or to
the groin. The pain is usually worse on movement.
Limitation in movement of the spine - especially
bending forward and leaning back.
Tense spasm of the muscles surrounding the spine,
causing a stiff back.
With severe pain and spasm, the back may tilt to one
side causing a change in posture.
The pain is sometimes accompanied by a tingling
sensation or numbness in the back or buttocks or leg.
Referred pain & Tests
Referred pain from
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Bladder infection
Kidney stone
Endometriosis
Ovarian cancer, Ovarian
cysts
Testicular torsion
(twisted testicle)
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a myelogram (an X-ray
or CT scan of the spine
after dye has been
injected into the spinal
column),
X-ray
a CT of the lower spine
or
MRI of the lower spine.
Muscular Dystrophy
Soft tissue Rheumatism
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Soft tissue rheumatism is a collection of nonarticular
pain generators that result from pathology of
extraarticular and extra osseous periarticular
structures.
These soft tissue structures include bursae, tendons
and their synovial sheaths, muscles and fasciae.
The focal point to soft tissue rheumatism is that pain
is not due to pathology of structures within the true
joint (i.e., arthritis).
Soft tissue rheumatism may manifest itself as well
defined pathology of a single periarticular site or a
regional myofascial pain syndrome.
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Examples of single site periarticular pain generators
include bursitis, tendonitis or enthesopathy (e.g.,
plantar fasciitis).
Finding a few of these pain generators in the absence
of articular involvement suggests a chronic, lowgrade, repetitive trauma disorder or an acute
overexertion syndrome that one may find in
“weekend warrior” athletes.
Bursitis and tendinitis affect men and women of all
age groups whereas fibromyalgia affects more
women than men and most are between the ages of 20
and 40.
regional - bursitis and tendinitis
generalised – fibromyalgia
Cause & Risk
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The most common cause of bursitis and tendinitis is
overuse of affected area during daily activities.
Bursitis and tendinitis especially occur in people with
bad postures or those who use the affected area in a
strenuous positions.
Sometimes, the bursa or tendon sheath may become
infected. Tendinitis or bursitis may occasionally be
associated with diseases like gout and rheumatoid
arthritis.
As for fibromyalgia, the cause is unknown. Some
believe that fibromyalgia is related to disruptive sleep
patterns.
Factors that contribute to the development and
continuation of symptoms include stress and immune
disorders.
Symptoms
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When there is inflammation of the bursa and tendon, there is
pain and stiffness near the joints which may be mistaken for
arthritis.
The pain is more prominent at night and local swelling can
occur. Movements will worsen the symptoms.
The bursa and tendon most affected are located around the
shoulder, elbow, wrist, hip, knee, ankle and feet. The
inflammation is usually temporary but can recur again.
In fibromyalgia, the muscles become too tight and tense. These
leads to multiple painful areas like the back of the neck,
shoulder and the bony points of the elbows and hips.
Some people have symptoms of irritable bowel syndrome and
tension headaches accompanying fibromyalgia.
Major remedies
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Rhus tox
Ruta
Bryonia
Ledum pal
Arnica
Apis
Ars alb