“This topic is very important, so to understand this kind of good, first we need to know the knowledge of the synovial Joint.In this topic we first synovial joint. After that, read arthritis and its types like rheumatoid arthritis, gouty arthritis, osteoarthritis and degenerative”
Structure of Synovial joint
Structure of Synovial joint
The space between articulating bone called synovial(joint) cavity.
- The bones at synovial joint are covered by articular cartilage (hyaline cartilage)
- A sleevelike articular capsule surrounds a synovial joint.
- Articular capsule composed of two layers.
- Outer is fibrous capsule and an inner is synovial membrane.
- Fibrous capsule consist of dense iregular connective tissue that attach to periosteum of the articulating bone.
- These fiber bundles called ligament.
- Ligaments are hold bones together in a synovial joint.
- Inner layer of articular capsule called synovial membrane which secretes synovial fluid
- It reduces friction by lubricating joints, supplying nutrition and removing waste.
- Due to warming of joint the secretion of synovial fluid is increase.
- Fibrous connective tissue serving for the atchment of muscles to bones and other parts called tendon.
- Achilles tendon is the strongest tendons in the body. It is the tendon of insertion of the gastrocnemius and soleus muscles on the calcaneus.
- Injury to ligamentous structure surrounding a joint caused by a wrenching and twisting motion called sprain.
- Sprain characterized by pain and swelling.
- Sprain managed by RICE (rest, ice, compression bandage and elevation).
- An excessive stretching of a muscle, fascia or tendon called strain.
- Fascia or fascial sheath is a fibrous membranous covering, supporting and separating muscles (deep fascia) and the subcutaneous tissue that connects the skin to the muscles (superficial fascia).
- Strain managed by heat and cold application, exercise with activity limitation and muscle relaxants.
Joint inflamation, often accompanied by pain, swelling, stiffness and deformity called arthritis.
some diagnostic test for musculoskeletal disorders, like
- Renoval of synovial fuid by a nedle from a joint space.
- Use to dignostic infection and inflamation of joint and also to administer drugs like corticosteroid
- Radiography of a synovial joint after injection of a contrast medium.
- Direct joint visualization by means of an arthroscope (an endoscopic examination of joint)
- Study that record the electrical activity of selected skeletal muscle groups while at rest and during voluntary contraction.
- It is used to evaluate muscle weakness
Type of arthritis
- The most prevalent type of anthritis are osteoarthritis or degenerative arthritis (most common), rheumatoid arthritis and gouty arthritis.
Gout or Gouty Arthritis
- Gout is a metabolic disorder in which purine metabolism is altered, and the level of uric acid (by produet of purine metabolism) increase in body.
- Parent compound of nitrogenous bases adenine and guanine called purine.
- Uric acid form sodium urate crystal called tophi, which deposit in joints and other connective tissues like kidney,myocardium and synovial fluid.
Types of gout-
Primary gout – It is due to inherited defect of purine metabolism. It accounts 80% of all cases, of which 95% are male.
Secondary gout-It is acquired disorder due to increase cell turnover (leukemia, multiple myeloma) and renal disorder, which decrease excretion of uric acid.
- Stage I-Asympomatic hyperuricemia.
- Stage II- Acute attack with redness, swelling, tendemess and excruciating pain in one small joint especially great toe (gout of great toe called podagra).
- Stage III- Permanent change in multiple joints with restriction in movement of joint (an apparatus to measure joint movements and angles called goniometer).
- Tophi (Hard, iregular shape deposition under skin or joint).
- Pruritis & Renal calculi.
Blood uric acid level more than 8 mg/dl.
provide low purine diet(purine rich diet are organ meat, Sardine fish, wines, cheese etc.
Advise to take adequate (3 lit/day) fluid to prevent renal calculi.
Administer colchicin (decrease inflammation by reducing migration of WBC at synovial joint), allopurinol (to block uric acid production) and probenecid (to increased excretion of uric acid through l kidney).
Osteoarthritis (OA) or Degenerative joint disease (DJD)
OA is a joint disease characterized by a degeneration and loss of articular cartilage in synovial joints.
Primary or idiopathic–
- It is most common type and mainly occurs due to aging.
- Weight-bearing joints are the most commonly affected, like knee, toes & lower spine.
- Due to a condition that lead to damage to joint surface due to injury.
- Most com mmonly degeneration due to wearing or tearing of joints
- Pain and crepitation sound.
- Stiffness in larger weight bearing joints.
- Enlargement of joint.
- Heberden’s node (hard nodules or enlargements of the distal interphalangeal joints of the fingers).
- Bouchard’s node (bony enlargement of the proximal interphalangeal joints).
- Compression of spine.
- Difficulty in getting up afier prolonged sitting.
X-ray show less joint space.
- Administer NSAID and salicylate (aspirin) orally and corticosteroid injection in to joints.
- Apply cold application when the joint is acutely inflamed.
- Encourage for weight loss and for active exercise.
- Total joint replacement , most commonly hip and knee when all other measure fail.
- Total knee replacement is the implantation of a device to substitute the femoral condyles and tibial joint surface.
Rheumatoid Arthritis (RA)
- It is a chronic, systemic and progressive inflamatory connective tissue autoimmune disorder, in which immune complexes are deposited in synovial and other connective tissues like heart, kidney. joint etc.
- It mainly affects small peripheral joints in symmetrical distribution.
- female affected between 20 to 40 year is more common.
- Onset usually with physical or emotional stress.
- fibrous ankylosis (immobility of a joint due to the formation of fibrous bands within a joint) and then bony ankylosis (the abnormal union of the bones of a joint).
- Inflammations, red, warm, tenderness and stiffness in affected joint.
- Fatigue and weakness.
- Weight loss, low grade fever (rheunmatic fever).
- Ulnar drift (displacement of fingers to ulnar side).
- Pannus forms within joint (highly vascular granulation tissue).
- Guardedr movement.
- Joint deformity.
- X-ray show less space between joint cavities.
- Lab finding shows increased level of ESR, WBC, level of C-reactive protein (CRP) and presence of rheumatoid factor (RF) in serum above 80lu/ml (reactive).
- RF are proteins (IgM) produced by our immune system that can attack healthy tissue in our body.
- Administer acetylsalicylic acid (aspirin) and NSAID to control pain & inflammation.
- Administer gold salt and penicillamine to prevent progress of disease.
- Administer methotrexate (drug of first choice), azathioprine, cyclophosphamide etc. for immunosupression.
- Surgery to reshape, reconstruct or replace a diseased or damaged joint, which called arthroplasty.
- Provide range of motion exercise to keep the joint functional.
- Never massage acute inflamed joint.
- Intra-articular injection of corticosteroid to temporarily relieve pain and inflammation.
- Hot and cold application to relieve pain, stiffness and muscular spasm.