Arthritis

Question 1

Definition

Answer 1

Generic term for conditions that involve inflammation of one or more joints

There are more than 100 different forms of arthritis, each characterized by varying degrees of joint damage, restriction of movement, functional limitation, and pain

Question 2

Disease scope

Answer 2

Leading cause of disability in United States

50 million affected (22% of adult population)

~$128 billion in health care spending each year

Prevalence higher in women

Question 3

Common types

Answer 3

Osteoarthritis (OA)—most common
Rheumatoid (RA)
Gout
Spondylarthropathies

Question 4

Pathophysiology (osteoarthritis)

Answer 4

Degradation of joints

Affects articular cartilage and subchondral bone

Results in host of processes leading to joint space narrowing, loss of cartilage, bone-on-bone rubbing, ligament strain/weakness

Hands, feet, spine, hips, and shoulders

Some genetic link but also injury and obesity

Question 5

Pathophysiology (rheumatoid)

Answer 5

More likely in females

Result of chronic autoimmune disorder (systemic infection)

Typically affects synovial joints (hands and feet)

Question 6

Common negative effects of most types of arthritis on

Answer 6

Exercise tolerance

Muscle strength

Aerobic capacity

ROM

Biomechanical efficiency

Proprioception

Question 7

Signs and symtpoms

Answer 7

Joint…

Pain

Stiffness

Effusion

Synovitits

Deformity

Crepitus

Question 8

Clinical considerations/evals

Answer 8

Assess history and physical exam

Assess joint ROM, alignment, and function

Assess symptoms and family history

Assess extra-articular features specific to their type of arthritis

Question 9

Osteoarthritis distinguishing characteristics

Answer 9

Joint pain

Consistent crepitus

Gel phenomenon (stiffness after periods of sitting)

Question 10

Osteoarthritis presentation

Answer 10

Affects hands, hips, knee, spine

Pain worsens throughout day

Question 11

Knee clinical OA diagnosis

Answer 11

Knee pain and any 3 of the following

Age: 50+

Stiffness: 30+ minutes

Crepitus

Bondy tenderness

Bone enlargement

No warmth

Question 12

Knee clinical and radiographic diagnosis

Answer 12

Knee pain and one of the following

Age: 50+

Morning stiffness: 30+ minutes

Crepitus

Osteophytes on x-ray

Question 13

Hip osteoarthritis diagnosis

Answer 13

Hip pain and one of the following

Erythrocyte sedimentation rate (ESR): <44

Osteophytes on hip x-ray

Joint space narrowing on hip x-ray

Question 14

Hand osteoarthritis diagnosis

Answer 14

Hand pain or stiffness and 3 of the following

Bony enlargement of two or more DIP joints

Bony enlargement of two or more of the 2nd and 3rd DIPs, 2nd and 3rd PIPs, 1st CMC

Fewer than 3 swollen MCPs

Deformity of t at least one of the 2nd and 3rd
DIPs, 2nd and 3rd PIPs, 1st CMC

Question 15

Exercise testing OA

Answer 15

Done to rule out something else such as CVD

Cardiovascular testing may be needed in patients who are at risk of CVD:

Those with RA are at increased risk due to the associated systemic inflammation

Those who are sedentary for extended periods and have other risk factors may also be at risk

Question 16

Rheumatoid arthritis distinguishing characteristics

Answer 16

Hand pain

Swelling

Fatigue (only in RA not osteoarthritis)

Prolonged morning stiffness (doesn’t loosen up over time)

Question 17

RA presentation

Answer 17

Affects wrists MCPs, and PIPs

Symmetric

Question 18

RA diagnostics

Answer 18

A score of >6 out of 10 based on the following

Joint involvement

Serology

Acute phase reactants

Question 19

RA diagnostics: joint involvement

Answer 19

2 to 10 large joints = 1

One to 3 small joints = 2

Four to 10 small joints = 3

More than 10 joints = 5

Question 20

RA diagnostics: serology

Answer 20

Low positive rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) = 2

High positive RF or ACPA = 3

Question 21

RA diagnostics: acute phase reactants

Answer 21

Abnormal CRP or ESR = 1

Duration of symptoms > 6 weeks = 1

Question 22

Exercise testing RA

Answer 22

Musculoskeletal and ROM testing can be performed to provide a baseline for changes to help guide the exercise prescription

Question 23

RA treatment goals

Answer 23

Reduce disability

Restore physical activity

Improve body composition

Control symptoms and reduce pain

Focus is now on movement vs previously on rest (69% inactive)

Question 24

Exercise prescription RA goals

Answer 24

Maintain or improve physical function by maintaining or improving muscle strength, cardiovascular fitness, and ROM

Improve body composition (i.e., restore muscle mass and reduce fat mass) and, when appropriate, reduce body weight

Reduce the risk of comorbidities such as CVD and osteoporosis

Reduce inflammation and pain

Prevent contractures and deformities

Question 25

Exercise prescription RA improvement considerations

Answer 25

Preventing musculoskeletal injury

Fatigue

Previous joint replacement

Time of day

Water therapy

Footwear

Corticosteroids

Body composition

Question 26

Arthritis conclusion

Answer 26

Properly performed exercise is safe and effective for individuals with OA, RA, and AS.

In the short term, exercise:

increases strength

increases aerobic capacity

increases range of motion

improves body composition

enhances physical function

attenuates stiffness and often pain