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Osteoarthritis vs rheumatoid arthritis pathophysiology
I thought aboutdrawing two different joints to show us the differencebetween rheumatoid and osteoarthritis. But then I thought showingit on the same picture might be easier to see the differences. But on this side we'll keepit rheumatoid arthritis, and the other side, green,will be osteoarthritis. Let's start with thepathophysiology of osteoarthritis
which is overuse. This is where elderlypeople, or people who are carrying a lot of extraweight, or have extra wear and tear on their jointstend to get osteoarthritis. And first thing's first, wehave our joint space here, this is a synovial joint, so it moves. These two bones move against each other. These are gonna be the bone parts.
We're not gonna do very much with them, we care about where they come together. This yellowish layer yousee here, is cartilage. It's kind of a cushionbetween the two bones. We don't want the two bonesto rub against each other. This soft, waxy cartilage,do rub against each other. Now over here we have the synovium, which is a very thin layer of tissue.
And its job is to produce synovial fluid, which is a lubricant of the whole system. Synovium if you look at the word, just as an extra trivia,syn means quot;similar toquot;, and ovium is referring tothe word quot;ovumquot; or quot;eggquot;. So synovial fluidsecreted by the synovium, is this whitish material,very, kind of like the consistency of egg whites.
I think that's where the word came from. Synovium, like egg whites. And that's all filled intheir joint space here, to lubricate the movementsbetween the two bones. So as you can imagine, thissystem allows the bones to move every whichway, gives us movement. Osteoarthritis if I had tosummarize it in two words, I would say it is cartilage destruction.
It is purely mechanical wear and tear of the cartilage layer, this cushioning. So we think of elderlypeople having this problem, but the truth is, thestate of one's cartilage is also genetic, some people have better or more cartilage to begin with. So the age issue aside,just think of it as the destruction ofcartilage layer with time.
Diagnosis and Treatment of TMJ Disorders
Welcome tothe Stanford Health Library. Thank you forcoming here tonight. My name is Michele Jehensonand I work at the orofacial pain at the StanfordPain Center in Redwood City. So today's topicis TMJ disorders. TMD, I'm going to speak aboutthe nature of the disorder. What a TMJ disorder really is. I'm going to also talk aboutwho is at risk for TMD.
And finally, I will touch onthe common treatments that are recognized asevidencebased treatment for TMJ disorders. So, I guess it's customary to talk about disclosures asto if I'm affiliated with any kind of pharmaceuticalcompany or anything like that. I have no disclosuresto be done. So, I wanted to first showyou the anatomy of a TMJ.
It's a joint that isvery unique in the body. It's one of a kind. There is a one disc, andyou can picture it as a donut. So, it's a circular,biconcave, just a donut, just doesn't have the actualhole in the middle. So it's kind of likea donut shape, and it separates the jawbone,which you see as the rounded bone in the picture,from the skull.
And particularly, the fossa,the articular fossa, and the eminence that you seeto the right of the fossa. So the disc is flexible. It's fiber cartilage, and it offers a perfect interfacebetween the skull and the jaw. It allows for smoother motion. The joint is also particularin a sense that not only it allows rotation ofthe joint, but it allows for
forward motion of the jaw. So, if you put your handlike slightly over your, in front of your ear and youopen your jaw wide and slow, you can see that initially,it just starts rotating and then you can feel itactually advance forward. And for some people, you canactually feel it coming out slightly, because even thoughthe jaw is seemingly fixed, the suture that is inthe front, it allows for
certain flexibility in andout of the joint itself. So, what is a TMJ disorderé So, a TMJ disorderis defined by pain, either at rest orupon function. It is defined by somethingthat is a painful noise. It can also be justa dysfunction, like a limited range ofmotion, or a jaw deviation such as this, like when youopen you go to one side or