Arthritis Flashcards
Definition
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
Disease scope
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
Common types
Osteoarthritis (OA)—most common
Rheumatoid (RA)
Gout
Spondylarthropathies
Pathophysiology (osteoarthritis)
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
Pathophysiology (rheumatoid)
More likely in females
Result of chronic autoimmune disorder (systemic infection)
Typically affects synovial joints (hands and feet)
Common negative effects of most types of arthritis on
Exercise tolerance
Muscle strength
Aerobic capacity
ROM
Biomechanical efficiency
Proprioception
Signs and symtpoms
Joint…
Pain
Stiffness
Effusion
Synovitits
Deformity
Crepitus
Clinical considerations/evals
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
Osteoarthritis distinguishing characteristics
Joint pain
Consistent crepitus
Gel phenomenon (stiffness after periods of sitting)
Osteoarthritis presentation
Affects hands, hips, knee, spine
Pain worsens throughout day
Knee clinical OA diagnosis
Knee pain and any 3 of the following
Age: 50+
Stiffness: 30+ minutes
Crepitus
Bondy tenderness
Bone enlargement
No warmth
Knee clinical and radiographic diagnosis
Knee pain and one of the following
Age: 50+
Morning stiffness: 30+ minutes
Crepitus
Osteophytes on x-ray
Hip osteoarthritis diagnosis
Hip pain and one of the following
Erythrocyte sedimentation rate (ESR): <44
Osteophytes on hip x-ray
Joint space narrowing on hip x-ray
Hand osteoarthritis diagnosis
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
Exercise testing OA
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
Rheumatoid arthritis distinguishing characteristics
Hand pain
Swelling
Fatigue (only in RA not osteoarthritis)
Prolonged morning stiffness (doesn’t loosen up over time)
RA presentation
Affects wrists MCPs, and PIPs
Symmetric
RA diagnostics
A score of >6 out of 10 based on the following
Joint involvement
Serology
Acute phase reactants
RA diagnostics: joint involvement
2 to 10 large joints = 1
One to 3 small joints = 2
Four to 10 small joints = 3
More than 10 joints = 5
RA diagnostics: serology
Low positive rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) = 2
High positive RF or ACPA = 3
RA diagnostics: acute phase reactants
Abnormal CRP or ESR = 1
Duration of symptoms > 6 weeks = 1
Exercise testing RA
Musculoskeletal and ROM testing can be performed to provide a baseline for changes to help guide the exercise prescription
RA treatment goals
Reduce disability
Restore physical activity
Improve body composition
Control symptoms and reduce pain
Focus is now on movement vs previously on rest (69% inactive)
Exercise prescription RA goals
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
Exercise prescription RA improvement considerations
Preventing musculoskeletal injury
Fatigue
Previous joint replacement
Time of day
Water therapy
Footwear
Corticosteroids
Body composition
Arthritis conclusion
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
