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Clinical Medicine II > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Define rheumatoid arthritis

A
  • a chronic systemic inflammatory disorder with autoimmune origin
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2
Q

Rheumatoid arthritis demographics

A
  • 1-2% of the US population
  • Females > males
  • typically onset at 20-40 years old
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3
Q

Risk factors for RA

A
  • autoimmune disease (Hashimoto’s/hypothyroidism and Graves/hyperthyroidism)
  • hormones
  • infection
  • genetics
  • environmental
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4
Q

Clinical characteristics for RA

A
  • usually effects symmetrically
  • wrists, fingers, knees, ankles, & feet are the most commonly effected
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5
Q

Joint symptoms for RA

A
  • morning stiffness > 1 hour
  • joints may feel warm, tender, and stiff when not used for an hour
  • joint pain is symmetrical
  • loss of ROM
  • deformity
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6
Q

Other symptoms of RA

A
  • chest pain when taking a breath (pleurisy)
  • dry eyes & mouth (Sjogren syndrome)
  • numbness, tingling, or burning in the hands & feet
  • sleep difficulties
  • nodules under the skin
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7
Q

Pathogenesis of RA

A
  • synovial membrane proliferation
  • infiltration of immune cells (T lymphocytes) into synovial tissue
  • edema
  • tumor necrosis factor (TNF) & interleukin 1 (IL-1) perpetuate the inflammatory process
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8
Q

What does stimulate secretion of protein degrading enzymes cause

A
  • cartilage destruction
  • synovial hyperplasia
  • inhibition of bone formation
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9
Q

Pathology of synovitis

A
  • synovial hyperplasia
  • destruction of articular cartilage
  • Pannus formation
  • increased intracapsular pressure
  • joint surface irregularities
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10
Q

Describe the Pannus

A
  • destructive vascular granulation tissue
  • disrupts synovial function
  • destroys collagen, cartilage, and subchondral bone
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11
Q

Diagnostic testing for RA

A
  • Rheumatoid factor
  • Anti-CCP antibody test (very specific so if it is positive you have RA)
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12
Q

Describe Rheumatoid factor

A
  • autoantibody: antibody directed against an individual’s own proteins (blood, synovial fluid, or synovial membranes)
  • 80% Rh positive
  • 5% false negative
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13
Q

Describe anti-CCP

A
  • anti-cyclic citrullinated peptide antibody
  • 100% specificity (if pos. you have it) and 50% sensitivity (if neg. you don’t have it)
  • <20 negative and >60 high/strong positive
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14
Q

Other diagnostic tests for RA

A
  • C-reactive protein
  • Erythrocyte sedimentation rate
  • CBC
  • X rays
  • Synovial fluid analysis
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15
Q

Describe erythrocyte sedimentation rate

A
  • relative activity of disease process
  • non-specific measure of inflammation
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16
Q

Describe synovial fluid exam

A
  • increased WBC (white blood cell count)
  • signs of breakdown: increased collagenase and increased debris (proteins)
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17
Q

Describe radiography for RA

A
  • irregular joint surfaces
  • joint space narrowing
  • abnormal joint alignment
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18
Q

Joint manifestations of RA

A
  • edema
  • warmth
  • pain
  • stiffness
  • decreased ROM
  • symmetrical
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19
Q

Commonly involved joints in RA

A
  • MCP
  • wrist
  • knee
  • ankle/foot
  • upper cervical spine
20
Q

Old diagnostic criteria for RA

A
  • need 4+
  • morning stiffness > 6 weeks
  • inflammation of at least 3 joints > 6 weeks
  • swelling wrist, MCP, & PIP > 6 weeks
  • symmetric joint swelling
  • radiographic evidence of joint erosion in wrist & hand joints
  • nodules
  • positive serum Rh factor
21
Q

Current diagnostic criteria for RA

A
  • 2010 ACR/EUCLAR
  • Joint involvement: 1large joint (0), 2-10 large joints (1), 1-3 small joints (2), 4-10 small joints (3), >10 joints (5)
  • Serology: neg. RF or neg. ACPA (0), low pos. RF or low ACPA (2), high pos. RF or high pos. ACPA (3)
  • Acute-phase reactants: normal CRP and normal ESR (0), abnormal CRP or abnormal ESR (1)
  • Duration of symptoms: >6 weeks (0), 6 weeks or more (1)
22
Q

Who should be tested for RA

A
  • patients who have at least 1 joint with clinical synovitis plus the synovitis is not explained by another disease
23
Q

Typical cervical spine deformities related to RA

A
  • occiput C2 (40-88%)
  • transverse ligament laxity
  • subluxation: SAS - subaxial subluxation, 2mm = suspicious, 4mm = severe
  • possible neurologie involvement
24
Q

Typical hand deformities related to RA

A
  • Swan Neck
  • Bountonniere
  • Ulnar Drift
  • Thumb MP flexion with IP hyperextension
25
Q

Typical knee deformities related to RA

A
  • Genu valgus
  • Baker’s Cyst
26
Q

Typical ankle/foot deformities related to RA

A
  • pronation
  • Hallux valgus
  • Claw toes
27
Q

Extra articular manifestations of RA

A
  • Nodules: tendon, bone, organs
  • Vasculitis
  • Cardiac issues (friction rubs)
  • Pulmonary changes
28
Q

Describe the stages of RA

A
  • Stage I: synovitis - synovial membrane demonstrates infiltrating small lymphocytes, joint effusions, x-rays (no destructive changes)
  • Stage II: inflamed synovial tissue now proliferates & begins to grow into joint cavity across articular cartilage (which it gradually destroys) and narrowing of joint due to loss of articular cartilage
  • Stage III: Pannus of synovium, eroded articular cartilage & exposed subchondral bone, x-rays show extensive cartilage loos and erosions at margins of joint
  • Stage IV: end stage disease, inflammatory process is subsiding, fibrous or bony ankylosing of joint will end its functional life, nodules
29
Q

Management of RA

A
  • medical management
  • therapy
30
Q

Goals of physical therapy for RA

A
  • decrease pain
  • decrease inflammation
  • maintain joint and muscle function
  • preserve/maximize functional activity
31
Q

Goals of medical management for RA

A
  • pharmacological
  • decrease joint inflammation
  • inhibit disease progression
32
Q

Drug categories for RA

A
  • NSAID
  • Corticosteroids
  • DMARDS (disease modifying anti-rheumatic drugs)
33
Q

Describe NSAIDs

A
  • first line agents
  • ibuprofen and naproxen
34
Q

Describe Corticosteroids

A
  • short term agents: severe inflammation and acute exacerbation
  • dexamethasone and cortisone
35
Q

Describe DMARDS

A
  • slow down disease progression
  • infliximab/remicade and methotrexate
36
Q

What would we do in physical therapy for RA

A
  • education on joint protection (avoid positions of deformity and repetitive tasks), energy conservation, and assistive devices
  • therapeutic exercise to maintain ROM and focus on ADLs
37
Q

Define osteoarthritis

A
  • degenerative joint disease
  • gradual progressive degeneration of joint structures
38
Q

Risk factors for OA

A
  • age
  • sex: females at greater risk at 65+ and males at greater risk before age 50
  • history of trauma/joint injury
  • joint deformities
  • obesity
  • genetics
  • nutrition
  • smoking
  • generalized joint laxity
39
Q

Pathology of OA

A
  • destruction of cartilage
  • surface irregularities
  • osteophyte formation
  • subchondral bone thickening
  • secondary inflammation of periarticular structures
40
Q

Clinical characteristics of OA

A
  • decreased ROM
  • stiffness: relieved by movement
  • pain: deep, aggravated by activity
  • deformity
  • crepitus
41
Q

Diagnostic tools for OA

A
  • radiography: decreased joint space in early stages/may see widening, osteophytes, cysts
  • history/exam: trauma and functional limitations
42
Q

Joint deformities related to OA

A
  • Heberdens Nodes
  • Bouchards Nodes
  • Genu varus/valgus
43
Q

Treatment goals for OA

A
  • maintain ROM/gain ROM
  • increase muscular support
  • decrease joint stress
  • pain management
44
Q

Medical management for OA

A
  • medications: pain and anti-inflammatories
  • surgical intervention: if OA interferes with ADLs, work, sleep, and/or walking
45
Q

What to do in physical therapy for OA

A
  • therapeutic exercise
  • mobilizations
  • assistive devices

Clinical Medicine II (21 decks)

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