Arthritic Diseases Flashcards
Osteoarthritis (OA)
- progressive deterioration of articular cartilage and its underlying bone and overgrowth of periarticular bone
- as we get older, our joints get overused
- obesity has been linked to OA due to excessive loading (joints are not meant to have excessive weight on them - not moving, maintaining their ability, looseness, and decreased strength)
- incidence rises sharply after the age 50 and peaks in the 70-79 year old age group
- 1 in 10 adults aged 60 years and older have significant clinical problems attributable to OA
Result of tissue damage to a joint and the immune reaction that occurs as a result of that damage
- swelling of cartilage
- reduction in the thickness of the joint surface (having less padding)
- loss of elasticity of the cartilage (cannot absorb much force as it used to)
- most common type of arthritis
- primarily affects cartilage, the tissue that cushions the ends of bones within the joints
- affects hands and weight-bearing joints
- can cause joint pain and stiffness
- usually develops slowly over many years
- common areas = lower back, neck, hip, knees, and hands (getting lately more on the shoulder and thumbs)
Risk factors of OA
Modifiable:
- decrease in muscle strength and joint proprioception
- obesity = increase strength and aerobic exercise
- history of joint trauma
Non-Modifiable
- age
- gender
- hereditary
- race
- ethnicity
Age in and of itself does not cause OA = it does in relation to past experiences, activities, and comorbidities
Clinical signs and symptoms of OA
- pain worsens with activity and relieve by “rest”
- joint stiffness and achness
- swollen and “tight” joints
- joint enlargement and crepitus
- decreased ROM, muscle weakness, and posture abnormalities
*for people with arthritis on their back, it’s hard for them to stand all the way up, so they hunch their backs
Primary OA
- without a known cause (just part of your genes)
- usually affects hips, knees, hands, and wrist
Secondary OA
- results from a previous joint injury
- metabolic, anatomic, traumatic, or inflammatory incident
Prevalence of OA
- 5th most common cause of disability in adults
- arthritis cause pain while doing activity (people rest because it hurts too much and then it leads to obesity, HP, DM)
Signs and symptoms of OA
- primarily impacts the knees, hips, hands, and spine
- pain first appears to a particular joint
- visible and palpable swelling with tender points
- significant joint stiffness following a prolonged period of inactivity = resolves around 15-20 minutes following the movement
- post-activity flare-ups of swelling and pain that reoccur with prolonged activity, extensive use, and weather changes (barometric pressure putting pressure on the joints)
- joint locking (when straighten out the joint but cannot bend it back, sort of gets locked) or instability
- crepitus during ROM = crunching feeling or sound coming from the articular surface
- guard motion and avoid use of the painful joint = leads to the development of muscle weakness, feeling of fatigue, and reluctance to maintain typical habits and routines and to engage in desired or needed occupations
- 12.4% of individuals with OA are reported to have depression (not because of arthritis but because they cannot engage in the occupations)
Diagnosis of OA
- first step to diagnose regardless of its cause is to rule out other conditions like fracture, tumor, metabolic bone disease, bursitis, tendinitis, rheumatoid disease, internal derangement, soft tissue injury, and viral infection
- physical examination is best suited to diagnosing OA
- assessment of pain during movement and limitations in ROM
- bony nodules due to overgrowth of damaged bone
- x-rays
Course and prognosis of OA
- fat around the knuckles and skinny on the finger parts
Lifestyle changes can prevent further damage: - greater the body mass index, the more rapid the progression of disease of the weight-bearing joints
- highly repetitive tasks
- not considered a life-threatening disease
- disruption, imbalance, and ultimately inflammation of supportive structures leads to joint instability, limited movement, pain with use and sometimes at rest, weakness, disfigurement, and dysfunction
Medical management of OA
- slows the progression of the disease, reduce pain, and improve functional abilities that are limited by pain, ROM deficits, and weakness
Medications: - acetaminophen (Tylenol which affects your GI tract) = eventually may fail to reduce comfort
- NSAID (Motrin) = can cause GI bleeding and peptic ulcer and can accelerate joint destruction
- topical creams
- supplements
Surgical procedures of OA
- arthrodesis = fusion of joints such as vertebrae, DIP, PIP joints, and wrists
- joint replacement for shoulders, hips, and knees and thumb CMC joints
- significantly reduce pain and prevent the progressive nature of the disease but may impact function = loss of ROM
- joint replacement, fully remove the damaged bone, and ultimate provide significant pain relief, deformity correction, and functional improvements, although they may not restore every facet of previous function
Osteoarthritis vs Rheumatoid arthritis
Osteoarthritis:
- degenerative joint disease caused by the breakdown of cartilage between the joint bones
- the overuse of the cartilage
- local (joint)
- joint deformity
- acute joint injury
- occupational factors
- joint laxity
- muscle weakness
- sports participation
Rheumatoid arthritis:
- chronic, inflammatory type of arthritis
- also classified as systemic autoimmune disease
- systemic (all throughout the body)
- gender
- genetic factors
- obesity
- nutritional factors
- bone density
- age
- inflammation of the fluids around the joints (the inflammation and pressure causes the bone to erode)
Rheumatoid arthritis (RA)
- a chronic, systemic, inflammatory, autoimmune disorder created through a complex interplay of contextual factors, genes, and abnormal immune response
- significant joint inflammation leading to changes in the synovial membrane
- systemic condition = can also involve internal organs such as lungs, the skin, eyes, and the cardiovascular system
- RA leads to complications that impair function
- reduce the person’s ability to engage in meaningful daily activities and reduce quality of life
- ultimately and especially if left untreated, RA leads to increased morbidity and mortality
- bursitis
- tendinitis
- erosion of bone and cartilage
- synovitis
- polymorphonuclear leukocytes
- inflammation in subchondral bone
- affects the hips, knees, wrist, hand, big toe, shoulders, and neck
- causes redness, warmth, and swelling of joints
- usually affects the same joint on both sides of the body
- often causes a general feeling of sickness, fatigue, weight loss, and fever
- may develop suddenly within weeks or months
- most often begins between ages 25-50
Etiology of RA
- a combination of genetic and environmental factors
- autoimmune
- if left untreated, the autoimmune reactions cause joint damage, ligament laxity, and muscle imbalance
- affects women 3 times more than men because there is a hormonal component to it
Risk factors of RA
- age = likelihood increases with age (the onset of RA is highest among adults in their 60s)
- sex = 2-3 times higher on women than men
- genetics/inherited traits = people born with specific genes are more likely to develop RA (the risk of RA may be highest when people with these genes are exposed to environmental factors like smoking or when a person is obese)
- smoking = increases a person’s risk of developing RA and can make the disease worse
- obesity
Signs and symptoms of RA
- initial signs = fatigue and generalized weakness
- morning stiffness (lasts for an hour when you wake up)
- some exacerbations and remissions, some more consistent course
- can be symmetrical or asymmetrical
- once it gets super bad, it breaks down ligaments and bones which leads to physical bone changes
- loss of ROM
- pain
- limiting ROM may lead to contractures
- MCP and PIP joints are most severely impacted by RA = Swan-neck deformities and Boutonniere deformities
- ulnar drifts
How RA affects the body
- systemic!!!
- fever (constantly trying to fight off the inflammation)
- red, dry eyes
- breathing problems
- anemia
- fatigue
- skin lumps (nodules)
- stiff, swollen joints
- dry mouth
- depression
Stages of RA
Stage 1 - Early-stage = Initial inflammation in the joint capsule and swelling of synovial tissue. The swelling causes the symptoms of joint pain, swelling, and stiffness.
Stage 2 - Moderate stage = Inflammation of the synovial tissue that becomes severe enough to create cartilage damage. Symptoms consist of loss of mobility and decreased joint ROM becomes more frequent
Stage 3 - Severe stage = Inflammation in the synovial is now destroying not only the cartilage of the joint but the bone as well. Potential symptoms includes increased pain and swelling and a further decrease in mobility and even muscle strength. Physical deformities of the joint may start to develop as well
Stage 4 - End stage = Inflammatory processes ceases and joints stoic functioning altogether. Pain, swelling, stiffness, and loss of mobility are still the primary symptoms in this stage (everything is broken down)
Diagnosis of RA
- blood test
- synovial fluid testing
- imaging (x-ray)
- individuals will often self-manage 2-4 years prior to seeking medical intervention
- family medical history
- physical exam
- ESR test
