Transcript A seronegative(음성혈청반응), progressive inflammatory disease

Inflammatory Arthropathies
Ankylosing Spondylitis(AS)
Rheumatoid Arthritis(RA)
Kyung Dong University
Dept. of Occupational Therapy
Kim Chan Mun
Ankylosing Spondylitis
• Definition
“A seronegative(음성혈청반응),
progressive inflammatory disease
presenting with pain and stiffness of the
spine leading to bony ankylosis of the
sacroiliac and spinal joint
Aetiology
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Age : commonest between 15 and 49 years
Sex : men > women, 3:1
Incidence : 0.6% adult males
heredity : 30 times more commonly in relatives
of patients than in the general population
• Association condition : sacroiliitis(엉치엉덩관절염)
occurs in with ulcerative colitis(궤양결장염), crohn’s
disease(염증성 창자병) or Reiter’s syndrome
Pathology
• Start at the sacroiliac joints with synovitis
• Cellular infiltration of periosteum to ligament
or muscle junctions
• Continues the chronic inflammation leads to
fibrosis which gradually becomes calcified
and ossified
• Can progress to bony anklyosis of the
sacroiliac joint, symphysis pubis, joint of the
lumbar, thoracic and cervical
• Sometimes the shoulder and knee
Clinical features
• Onset : often with mild pain and
stiffness in the lower lumber spine,
acute with severe pain over the
sacroiliac joint and lumbar spine
• Morning stiffness : common in the
early stage
• Fatigue : also common
• Spinal feature : pain and stiffness in
the lumbar spine(sciatica, muscle
spasm, flattening of the lumbar
spine)
• Deformity : without
exercise the patients
can become fixed in
spinal flexion
• Iritis : painful
inflammation around
the iris(홍채)
• Skin : associated
psoriasis(건선)
• Colon : ulcerative
colitis
Treatment
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Relieve pain : heat and hot pack
Mobilize joints affected
Minimize deformity
hydrotherapy
Rheumatiod Arthritis(RA)
• NSAIDs(Nonsteroidal Antiflammatory Drugs) :
promote inflammation, pain, and fever
• Traditional DMARDs(disease-modifying
antirheumatic drugs)
• Immunosuppressants, including
MTX(Methotrexate)
• Tumor necrosis factor (TNF) inhibitors
• Newer biologics
Rheumatoid Arthritis
• non-suppurative(비화농성), progressive,
systemic inflammatory disease of
unknown cause characterized by
– Symmetric synovitis
– Joint erosions
– Multisystem extra-articular
Aetiology
• 1,5 million in the UK
• women > men, 3:1(Golding 1988,
Carson-Dick 1972)
• Age : 20~55 years
• Cause : unknow, disturbance of the auto
immune system
Pathology
Disorder of the connective tissue affecting
articular and extra-articular structures
Articular changes
• First joint structure affected is the synovial
membrane, inflamed and congested(충혈) with blood,
membrane proliferate(급격히 증가) and forms folds,
sometimes focal areas of necrosis
Synovial membrane
Synovitis, villous, gross
Finger joint, bony ankylosis
Pannus : 관절 내부
활막 세포의 염증성
산출물에 의한
증식에 의해
두꺼워지 것
Rheumatiod nodules
Erosions
2
4
1
3
5
Clinical feautres
Nature of Pain(Shipley 1995)
Localised or diffuse(방산통)
Unilateral or bilateral
Aching or sharp
Present only with use
Present constantly
Worse at night or at rest
Associated with sensory symptoms
Clinical feautres
Tenderness (Ritchie et al 1968)
Swelling ; MCP, PIP, wrist and MTP
Heat ; this is not always obvious
Erythema(홍반)
Loss of function
stiffness
Decreased range of movement
Clinical feautres
Commom deformity in RA
Shoulder girdle : protracted
Shoulder
: flexion, adduction, medial rotation
Elbow
: flexion, increased carry angle
Forearm
: pronation
Wrist
: volar subluxation, flexion,
radial deviation
MCP
: volar subluxation, flexion,
ulnar deviation
PIP,DIP
: botonniere, swan neck
Swan neck deformity
PIP hyperextension, DIP flexion
boutonniere deformity
PIP flexion, DIP extension
Volar subluxation of the
carpus on the radius as a
result erosive synovitis of
the radiocarpal joint
flexion contracture
Relationship between wrist
and metacarpophalangeal
joint deformity, radial
deviation
Influence of the long flexors in
metacarpophalangeal drift deformity
weakened ligaments cannot resist a pull toward
volar subluxation , during power pinch or grasp
Clinical feautres
Commom deformity in RA
hips : flexion, adduction, lateral rotation
Knee : flexion, valgus
Ankles : valgus
MTP : plantar subluxation, hyperextension
PIP, DIP : flexion
Hammer toes
volar subluxation of the MTP
combines with PIP flexion, DIP
hyperextension
Cock-up or claw toes
exhibit volar subluxation of
the metartarsal head with
flexion of the PIP and DIP
Diagnosis
Management
• To relieve pain and muscle spasm : drug,
heat, spint, exercise and relaxation
• To prevent deformity
• To maintain range of movement : pool, little
• To promote rest : little walking
• To maintain muscle strength
• To prevent circulatory and respiratory
complication : medication