8.17 RA

Question 1

Where does RA start?

Answer 1

synovium

Question 2

What is the cause of RA?

Answer 2

• some trigger

- autoimmune

Question 3

RA is (symmetrical/asymmetrical)

Answer 3

symmetrical

Question 4

Where is RA prevalent?

Answer 4

• hands
• wrists
• feet
• ankles

distal ends of extremities

Question 5

(males/females) are at higher risk for RA

Answer 5

females

Question 6

s/s of systemic inflammation

Answer 6

• fatigue
• mental issues (cognitive)
• anemia
• muscle inflammation/pain
• sleep problems (disruption/time)

Question 7

RA: common deformities

Answer 7

• swan neck
• boutonniere
• ulnar drift of fingers
• rheumatoid nodules
• severe breakdown of bones

Question 8

Why should an RA pt not have a walker unless it has platforms?

Answer 8

don’t want to facilitate gripping and making ulnar drift worse

Question 9

Where are rheumatoid nodules typically located?

Answer 9

• over extensor surfaces

- can also be laid down internally (heart, liver, kidneys)

Question 10

What are rheumatoid nodules?

Answer 10

• body lays down tissue

- not usually limiting, just there

Question 11

RA: severe breakdown of bones

Answer 11

unable to continue providing structure because there’s no bone left

Question 12

RA and stiffness

Answer 12

• morning stiffness

- lasts at leat an hour or two

Question 13

RA: when should you treat and why?

Answer 13

Treat in early afternoon, not morning

Too late and you get fatigue. Too early and you get stiffness.

Question 14

Significance of steroid use with RA pts

Answer 14

• higher risk of infections and OP

- slower healing wounds

Question 15

Why is computer work no bueno for someone with RA?

Answer 15

puts the hand in ulnar deviation

Question 16

RA pt: splinting

Answer 16

• early splinting in functional position of the hand
• definitely night
• maybe during the day as well

Question 17

What tools might an RA pt need in addition to a walker with a platform?

Answer 17

• built up silverware to create open hand position

- reacher (may need to be built up)

Question 18

RA: exercise and position

Answer 18

try not to exercise in deformed position if possible

Question 19

Is RA always there once a person has it?

Answer 19

yes

get flare-ups and periods where it’s under control

Question 20

exacerbation periods of RA

Answer 20

• inflammation is greater

- bone loss and other issues worsen

Question 21

What should be done during an acute exacerbation?

Answer 21

try to prevent or limit deformity

• PROM in appropriate alignment (large joints)
• positioning to prevent deformity
• AAROM/AROM for smaller joints
• avoid full ROM exercise

Question 22

What is the focus of exercise during an exacerbation?

Answer 22

• maintain strength
• prevent atrophy

DON’T EXERCISE INTO FATIGUE

Question 23

What type of exercise is good for maintaining strength and preventing atrophy during an acute exacerbation?

Answer 23

multiple angle isometrics

3x6-10s hold

Question 24

5 P’s

Answer 24

• prioritizing
• planning
• power
• position
• pacing

Question 25

Can PT’s treat someone with RA?

Answer 25

Can treat, but should regularly check in with rheumatologist for meds

Question 26

(OA/RA) has a much faster progression

Answer 26

RA

OA slowly builds up and gets worse

Question 27

Big picture focus for RA pts

Answer 27

lots of education for lifestyle changes

Question 28

What happens in the synovium with RA?

Answer 28

• attacked by the body

- causes formation of a pannus around the capsule

Question 29

What happens to the ligaments with RA?

Answer 29

compensation creates huge deformities

Question 30

What happens with bone in RA?

Answer 30

• bone on bone
• erosion of bone (much more than with OA)
• PAIN

Question 31

What happens with the cartilage in RA?

Answer 31

erosion

Question 32

What happens with muscle in RA?

Answer 32

• compensation creates huge deformities

- guarding leads to compensation (same as OA)