8.17 RA Flashcards
Where does RA start?
synovium
What is the cause of RA?
- some trigger
- autoimmune
RA is (symmetrical/asymmetrical)
symmetrical
Where is RA prevalent?
- hands
- wrists
- feet
- ankles
distal ends of extremities
(males/females) are at higher risk for RA
females
s/s of systemic inflammation
- fatigue
- mental issues (cognitive)
- anemia
- muscle inflammation/pain
- sleep problems (disruption/time)
RA: common deformities
- swan neck
- boutonniere
- ulnar drift of fingers
- rheumatoid nodules
- severe breakdown of bones
Why should an RA pt not have a walker unless it has platforms?
don’t want to facilitate gripping and making ulnar drift worse
Where are rheumatoid nodules typically located?
- over extensor surfaces
- can also be laid down internally (heart, liver, kidneys)
What are rheumatoid nodules?
- body lays down tissue
- not usually limiting, just there
RA: severe breakdown of bones
unable to continue providing structure because there’s no bone left
RA and stiffness
- morning stiffness
- lasts at leat an hour or two
RA: when should you treat and why?
Treat in early afternoon, not morning
Too late and you get fatigue. Too early and you get stiffness.
Significance of steroid use with RA pts
- higher risk of infections and OP
- slower healing wounds
Why is computer work no bueno for someone with RA?
puts the hand in ulnar deviation
RA pt: splinting
- early splinting in functional position of the hand
- definitely night
- maybe during the day as well
What tools might an RA pt need in addition to a walker with a platform?
- built up silverware to create open hand position
- reacher (may need to be built up)
RA: exercise and position
try not to exercise in deformed position if possible
Is RA always there once a person has it?
yes
get flare-ups and periods where it’s under control
exacerbation periods of RA
- inflammation is greater
- bone loss and other issues worsen
What should be done during an acute exacerbation?
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
What is the focus of exercise during an exacerbation?
- maintain strength
- prevent atrophy
DON’T EXERCISE INTO FATIGUE
What type of exercise is good for maintaining strength and preventing atrophy during an acute exacerbation?
multiple angle isometrics
3x6-10s hold
5 P’s
- prioritizing
- planning
- power
- position
- pacing
Can PT’s treat someone with RA?
Can treat, but should regularly check in with rheumatologist for meds
(OA/RA) has a much faster progression
RA
OA slowly builds up and gets worse
Big picture focus for RA pts
lots of education for lifestyle changes
What happens in the synovium with RA?
- attacked by the body
- causes formation of a pannus around the capsule
What happens to the ligaments with RA?
compensation creates huge deformities
What happens with bone in RA?
- bone on bone
- erosion of bone (much more than with OA)
- PAIN
What happens with the cartilage in RA?
erosion
What happens with muscle in RA?
- compensation creates huge deformities
- guarding leads to compensation (same as OA)
