Rheumatic Disorders Overview

Prevalence: Most common disabling musculoskeletal disorder in the U.S. with about 46 million affected.
Demographics: Increasing age is a major factor; nearly 2/3 of adults with arthritis are aged 18-64 years.
Types of Disorders:
- Local Disorders:
- Osteoarthritis
- Infectious arthritis (e.g., Lyme disease)
- Systemic Disorders:
- Immune-mediated conditions (e.g., rheumatoid arthritis)
- Post-infectious joint issues
- Joint dysfunction secondary to other diseases (e.g., psoriatic arthritis, gout)

Definition: Most common arthritis globally; degenerative disorder associated with aging and repetitive stress.
Characteristics:
- Loss of articular cartilage
- Calcification of cartilage
- Bone spur formation
- Primarily affects weight-bearing joints.

Factors that increase wear and tear:
- Obesity: Increases stress on joints.
- Joint Trauma: Previous injuries can predispose.
- Congenital Disorders: Structural malformations.
- Lifestyle and Occupation: High-stress activities on joints.
- Genetic Factors: Hereditary predispositions.
- Hormonal Changes: Particularly in postmenopausal women.

Initial Injury:
- Chondrocytes release enzymes that promote breakdown, leading to collagen fatigue.
- Resulting in microfractures.
Progressive Damage:
- Structural damage leads to osteophyte (bone spur) formation, synovial inflammation, joint effusion, and loss of proteoglycan and collagen matrix.

Symptoms include:
- Localized joint pain
- Crepitus (grating sensation) with movement
- Morning stiffness
- Bony enlargements (e.g., Heberden and Bouchard nodes)

Findings:
- Bony proliferation at joint margins.
- Asymmetric narrowing of joint spaces.
- Subchondral bone sclerosis.
- Joint malalignment and cyst formation.

Goals: Decrease joint stress, manage pain, and protect against further trauma.
Medications:
- Acetaminophen and NSAIDs (e.g., COX-2 inhibitors like Celebrex)
- Intra-articular injections of hyaluronan
- Physical therapy to improve function
- Surgery as a last resort.

Overview: Autoimmune inflammatory disease affecting synovial membranes, cartilage, and surrounding structures.
Demographics: Primarily affects women and peaks between ages 40-50.
Cause: Unknown; linked to abnormal autoimmune responses potentially triggered by infections in predisposed individuals.

Initial Phase: Immune response appears localized in synovial tissue with activation of B cells, T cells, and macrophages.
Inflammatory Phase: Immune mediators escalate inflammation, leading to the formation of a pannus that destroys cartilage.
Destruction Phase: Ongoing inflammation results in joint subluxations and deformities.

Symptoms:
- Bilateral symmetric polyarthritis mainly in smaller joints
- Malaise and fatigue
- Swelling, particularly in hands, wrists, knees, and feet.
- Characteristic hand deformities (e.g., swan-neck and boutonniere deformities).

Cardiac Issues: Pericarditis, myocarditis, mitral valve disease.
Pulmonary Issues: Pleuritis, pulmonary effusion.
Ophthalmic Issues: Scleritis, particularly associated with Sjögren's syndrome.

Criteria: According to guidelines, requires:
- At least one swollen joint
- No alternative diagnosis explaining the swelling
- Minimum score of 6 on the diagnostic criteria scale.

Goals: Manage symptoms, prevent joint damage, maintain function.
Medications:
- NSAIDs, corticosteroids, and disease-modifying antirheumatic drugs (DMARDs)
- Biological agents targeting TNF-α and IL-1
- Tyrosine kinase inhibitors (oral).

Common Conditions: Diabetes, hemophilia, and metabolic disorders associated with chronic diseases.
Gout:
- Characterized by hyperuricemia and deposition of uric acid crystals in joints.
- Common in middle-aged men and postmenopausal women.

Phases:
- Asymptomatic Hyperuricemia: Elevated urate levels with no clinical signs.
- Acute Gouty Arthritis: Involves warm, red, and tender joints, most commonly the great toe.
- Intercritical Gout: Intervals between acute attacks without symptoms.
- Chronic Tophaceous Gout: Development of tophi and possible joint deformities after 10 years.

Diagnosis: Joint fluid analysis, serum uric acid levels, imaging tests.
Treatment: Colchicine for acute attacks, NSAIDs, and medications to correct hyperuricemia.

Rheumatic disorders encompass a range of conditions affecting joint function, with specific local (e.g., osteoarthritis) and systemic (e.g., rheumatoid arthritis) implications, involving complex pathophysiological processes necessitating comprehensive management strategies.