Arthritis Flashcards
1
Q
OA or RA
Insidious onset
A
Both
2
Q
OA or RA
Morning pain more than 30 minutes
A
RA
3
Q
OA vs RA
Palpation of affected tissues feels spongy
A
RA
4
Q
OA or RA
Symptoms on both sides (symmetrical)
A
RA
5
Q
OA or RA
Presence of nodules
A
RA
6
Q
OA or RA
Wearing away of joint cartilage
A
Both
7
Q
OA or RA
Immune system attacking synovium
A
RA
8
Q
OA or RA
Palpation feels narrowing of joint space and bony spurs
A
OA
9
Q
arthritis
A
group of diseases (100+) characterized by inflammation in joints and other areas of the body
10
Q
osteoarthritis
A
wear and tear arthritis; body’s failed attempt to repair damaged joint tissues from aging or injury
11
Q
Most common type of arthritis (general)
A
osteoarthritis (OA)
12
Q
arthro + itis
A
joint + inflammation
13
Q
consequences of arthritis
A
redness, swelling, pain
can lead to damage, loss of function, disability
14
Q
arthritis = chronic or acute
A
chronic
15
Q
osteoarthritis
A
progressive disease of whole joint leading to breakdown of cartilage and underlying bone
16
Q
osteoarthritis pathology
A
pathology:
equilibrium of chemical reactions in articular cartilage disrupted
collagen in cartilage becomes disorganized, loses elasticity
cartilage cracks and fissures, articular surface erodes
formation of bony spurs
17
Q
osteoarthritis tissue types affected
A
whole joint: ARTICULAR CARTILAGE LOSS, bone, soft tissue, ligament laxity, muscle atrophy, synovium, increased volume of synovial fluid with reduced viscosity, menisci
18
Q
osteophyte
A
boney spurs
19
Q
Primary vs Secondary OA
A
Primary = aging (most common, 55-60 yrs)
Secondary = specific cause, such as trauma or injury, usually develops earlier in life (45-50 yrs)
20
Q
Diagnostic tool and treatment guide for OA
A
Radiography
Note: early may not reflect symptoms; later may appear worse than symptoms
Kellgren - Lawrence classification tool
21
Q
Kellgren-Lawrence grade 1
A
Grade 1 DOUBTFUL narrowing of joint space possible osteophyte formation no sclerosis no bone end deformity
22
Q
Kellgren-Lawrence grade 2
A
Grade 2 possible narrowing of joint space DEFINITE osteophyte formation no sclerosis no bone end deformity
23
Q
Kellgren-Lawrence grade 3
A
Grade 3 DEFINITE narrowing of joint space moderate osteophyte formation SOME sclerosis possible deformity of bone ends
24
Q
Kellgren-Lawrence grade 4
A
grade 4 = greatest severity SEVERE narrowing of joint space LARGE osteophyte formation MARKED sclerosis DEFINITE deformity of bone ends
25
OA Assessment - Lateral knee OA
valgus deformity present during gait analyses
26
OA risk factors
```
Age
Women
BMI
ethnicity
joint abnormalities, trauma, surgery
heavy physical activity, demanding occupation
muscle weakness
```
27
OA Signs/symptoms
joint pain increases with activity
pain especially present after period of rest
short morning stiffness (less than 30 min)
joint swelling (fluid/bony), crepitus, instability
disfunction during daily living due to pain and reduced ROM
asymmetric usually
any joint - especially weight bearing joints of hip, knee, hand, foot, spine
28
WOMAC = Western Ontario and McMaster Universities Arthritis Index
Self administered questionnaire used in assessment of patients with Hip and Knee OA
0-4 with 4 being extreme
pain during activities, stiffness occurrence, physical function for activities
29
OA Assessment - General
NWBA
palpate warmth, swollen, crepitus, bony spurs
joint tenderness, painful/limited ROM, hallux valgus
GAIT
antalgic gait, reduced gait speed/cadence
pain/stiffness and muscle weakness in joint
increased risk of falls
30
OA Assessment - Hallux valgus
pain avoidance in late stance phase
| rotate foot externally (toe off medially) or rotate foot internally (toe off laterally)
31
OA Assessment - Ankle OA
pain in dorsiflexion in late stance phase
| rotate foot externally (toe off laterally)
32
OA Assessment - Medial knee OA
varus thrust during stance phase
| varus deformity
33
OA Assessment - Hip OA
Trendelenburg gait
34
DD: OA vs inflammatory arthritis
Stiffness
OA = less than 30 mins morning stiffness
Inflammatory arthritis = greater than 30 mins
35
DD: OA vs other inflammatory/systemic conditions
| weight loss, fatigue, fever, loss of appetite
Radiology for DD
36
Most common type of inflammatory arthritis
Rheumatoid arthritis (RA)
compared to other inflammatory arthritis
37
2 arthritis in which early diagnosis significantly improves treatment outcomes
RA and Ankylosing Spondylitis
38
RA Pathology
Pathology: immune system attacks synovium
inflammatory cells/chemicals flood joint
results in damage to joint components, ligaments
synovial fluid builds up - swelling + pain
synovium thickens - pannus
sometimes results in scar tissue and fusion of bone
common outcomes are joint erosion, subluxation, deformity
39
RA etiology
```
genetics (not guaranteed if you have gene)
women
older age
environment, infection
SMOKING
```
40
Early RA signs/symptoms
non-specific S/S
unwell, tired, sore, slight fever, weight loss
reduced appetite
41
Late RA signs/symptoms
joints affected on both sides of body
SYMMETRICAL pattern common
morning stiffness greater than an hour
warmth/redness over joint, reduced ROM
occasionally nodules present on elbows, hand, or feet
small joints of hands, fingers, ankle, toes first
larger joints of knees, shoulders later
DIP joint usually spared
42
RA NWBA Assessment
```
NWBA = structural deformities of toes
(esp. hallux valgus)
pes planus
tenderness/swelling/warmth on joint line
affected area feels SPONGY or doughy
reduced ROM
presence of NODULES on pressure points of feet/knees
hyperkeratosis
```
43
RA Gait Assessment
antalgic gait
reduced speed/cadence/step length
increased double limb support time
increased rearfoot eversion
reduced peak ankle plantar flexion power poss. due to reduced ankle ROM and reduced strength of plantar flexor muscles
increased peak forefoot plantar pressure poss. due to reduced ankle ROM
44
Psoriatic Arthritis (PsA)
inflammatory arthritis that appears in some people with Psoriasis
45
Psoriasis
autoimmune disease affecting the skin
characterized by red, inflamed patches or silver-white scales covering skin
finger/toenails can also be affected
46
Psoriatic Arthritis Etiology
affected nails
gender equal
wide age range (20-50)
47
PsA signs and symptoms
```
joint pain, stiffness, swelling
morning stiffness greater than 1 hour
symmetric or asymmetric
periods of FLARES/remission
dactylitis/enthesitis
can affect DIP joint
```
48
gelling
prolonged stiffness
49
dactylitis
swollen fingers/toes
50
enthesitis
irritation and pain at point where ligaments/tendons attach to bone (e.g. Achilles tendon, plantar fascia)
51
Ankylosing Spondylitis
fusion + inflammation of the spine
inflammatory arthritis affecting spine / sacroiliac joints
autoimmune disease
52
ankylosing spondylitis etiology
```
men
younger age (15-30)
```
53
Ankylosing Spondylitis Signs/symptoms
```
inflammation starting at SI joints and spreading up
pain in hips/shoulders
stiffness, enthesitis
chronic low back pain and flares
pain/stiffness in morning
uvitis (inflammation of the eye)
```
54
arthritis in which individuals have 2x more foot problems than general population
RA
foot problems
55
Ankylosing Spondylitis WBA
WBA
increased hip/knee flex during static stance
flattening of lumbar curve
kyphosis - rounded upper back, anterior head
56
Ankylosing Spondylitis Gait Assessment
GAIT
cautious gait partly due to reduced shock absorption
reduced velocity/stride length
poor balance due to anteriorly shifted center of mass
sagittal plane compensations
57
Gout
inflammatory arthritis caused by small crystals of uric acid forming in a joint
58
Gout pathology
uric acid results from body breaking down chemicals in cells and some protein rich foods
usually transported via blood to kidney for excretion
high uric concentrations crystallize in joint
immune system attacks crystals
joint becomes inflamed
59
Gout etiology
most common IA in men
post menopausal women
mid age range (30-60)
DIET excessive red meat, alcohol, sugar
high BP, diabetes, obesity, KIDNEY disease
heredity, trauma, dehydration, medications (including treatment for high BP)
exact cause of metabolic defect unknown
60
Gout Signs/symptoms
1st MTP joint most commonly affected
also affects ankle, knee, wrist, elbow, hand
SUDDEN onset, NIGHT PAIN
localized intense pain, joint swelling, warmth
red/PURPLE/SHINY/tense
active "attacks" and inactive periods
Tophi NODULES
61
Tophi
nodules of sodium urate deposits
associated with Tophaceous gout
form over course of multiple attacks in joints, bursa, cartilage, ligaments, subcutaneous tissue, synovium
enlarged can cause deformity and protrude through skin
use urate lowering drugs to reduce occurrence
62
Gout NWB Assessment
```
NWB
history of attacks
red shiny skin at 1st MTP joint
warm and sensitive to touch
reduced, painful ROM
```
63
Gout Gait Assessment
GAIT
Reduced velocity, stride length
Reduced peak plantar pressure under HALLUX
avoid weight bearing during TOE OFF phase
antalgic gait
64
Pseudogout
arthritis characterized by abnormal formation of Calcium Pyrophosphate Dihydrate (CPPD) crystals in joint tissue
65
Pseudogout Signs/symptoms
acute/chronic inflammation of the synovial joints
commonly affects knee, ankle, hip, wrist
one joint or multiple joints
chondrocalcinosis (calcium deposits) visible xray
redness/swelling/tenderness during attack
66
Pseudogout Etiology
```
gender equal
older age (commonly unrecognized in seniors)
```
67
Gout stages: acute
```
AKA Podagra
sudden onset
one or a few joints
NIGHT PAIN
active "attacks" and inactive periods
subsequent attacks longer duration
chronic joint deformity, limited ROM
```
68
Gout stages: tophaceous
most disabling stage
formation of tophi
progressive
permanent damage to joints, kidneys
69
Gout stages: Asymptomatic
hyperuricemia - elevated serum uric acid
| may go unrecognized if no manifestations
70
Gout stages: Intercritical
inactive periods between acute attacks
no symptoms
normal joint function
71
Reactive Arthritis
arthritis in joint due to previous INFECTION
72
Reactive Arthritis Signs/symptoms
pain, stiffness, redness, warmth, swelling in joint
common in LOWER LIMBS (knee, ankles, toes)
can affect other areas (eyes, skin, muscles, tendons)
pain worse in morning
hyperkeratic skin on palms of hands or soles of feet
73
Systemic Lupus Erythematosus
chronic autoimmune disease; body attacks its own tissues causing widespread tissue damage in affected organs
74
Systemic Lupus Erythematosus signs/symptoms
commonly mistaken for other conditions because of VARIATION in symptoms
affects skin, joints, kidney, heart, lungs, blood vessels, nervous system
varying severity, periods of flares
mostly in women
variation: red rash across nose/cheeks, photosensitivity, mouth sores, joint inflammation, decreased kidney function leading to swelling in legs and feet
75
Rheumatoid Arthritis (RA)
inflammatory arthritis and autoimmune disease in which immune system attacks synovium
