My Hands Are Aching

My Hands Are Aching

1. Synovial Membrane

   • forms Synovial Fluid
     • found in
       • Tendon sheath
         • tubular bursa that covers a tendon
       • Synovial joints
     • function
       • lubrication
       • nutrition
     • components
       • hyaluronic acid
       • lubricin
       • proteinases & collagenases
   • made of 2 layers
     • Subintima
       • made of connective tissue
     • Intima
       • made of
         • fibroblast B cells
           • makes hyaluronan
         • macrophage like cells
           • filters synovial fluid from unwanted substances
       • beneath it we have a network of blood vessels

2. Joint Arthritis

   • inflammation of the joints
     • types
       • infection
         • septic arthritis
         • reactive arthritis
       • degenerative
         • osteoarthritis
       • autoimmune
         • Rheumatoid Arthritis
           • signs & symptoms
             • fever
             • joint
               • pain
               • stiffness
               • warmth
               • deformity
                 • botounniere
                 • swan neck
             • anemia
           • Investigations
             • tests
               • ESR & CRP
                 • positive
                 • Anti CCP
                   • positive
                   • RF
                     • positive
             • X-rays
               • periarticular osteopenia
                 • bone erosions
                 • soft tissue swelling
           • immunological aspect
             • autoreactive T cells activated by APCs; into Th1 and Th17 inflammatory cells
               • macrophages secreted and release metalloproteinases & IL8 & TNF
                 • Rheumatoid Factor (IGM) produced by B cells
           • Pathophysiology
             • activated immune cells will release inflammatory cytokines
               • acts on synovial fibroblasts
                 • promote swelling of synovial membrane & damage to soft tissues & cartilage
               • activation of osteoclasts and chondrocytes
                 • destruction of bone & cartilage
             • systemic complications
               • anemia
                 • anaemia of chronic disease
                 • Iron deficiency anaemia
                 • Bone marrow hypoplasia with anemia
               • osteoporosis
               • coronary artery disease
               • interstitial lung disease
           • Management
             • Pharmacotherapy
               • NSAIDS
               • DMARDS
               • Biological Therapy
               • Glucocorticosteroids
             • Physiotherapy
               • Cold/Hot applications
               • Electrical stimulation
               • Hydrotherapy
       • metabolic
         • Gouty arthritis

3. Anatomy of the Hand