Arthritis Flashcards
1
Q
Define rheumatoid arthritis
A
- a chronic systemic inflammatory disorder with autoimmune origin
2
Q
Rheumatoid arthritis demographics
A
- 1-2% of the US population
- Females > males
- typically onset at 20-40 years old
3
Q
Risk factors for RA
A
- autoimmune disease (Hashimoto’s/hypothyroidism and Graves/hyperthyroidism)
- hormones
- infection
- genetics
- environmental
4
Q
Clinical characteristics for RA
A
- usually effects symmetrically
- wrists, fingers, knees, ankles, & feet are the most commonly effected
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
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
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
8
Q
What does stimulate secretion of protein degrading enzymes cause
A
- cartilage destruction
- synovial hyperplasia
- inhibition of bone formation
9
Q
Pathology of synovitis
A
- synovial hyperplasia
- destruction of articular cartilage
- Pannus formation
- increased intracapsular pressure
- joint surface irregularities
10
Q
Describe the Pannus
A
- destructive vascular granulation tissue
- disrupts synovial function
- destroys collagen, cartilage, and subchondral bone
11
Q
Diagnostic testing for RA
A
- Rheumatoid factor
- Anti-CCP antibody test (very specific so if it is positive you have RA)
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
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
14
Q
Other diagnostic tests for RA
A
- C-reactive protein
- Erythrocyte sedimentation rate
- CBC
- X rays
- Synovial fluid analysis
15
Q
Describe erythrocyte sedimentation rate
A
- relative activity of disease process
- non-specific measure of inflammation
16
Q
Describe synovial fluid exam
A
- increased WBC (white blood cell count)
- signs of breakdown: increased collagenase and increased debris (proteins)
17
Q
Describe radiography for RA
A
- irregular joint surfaces
- joint space narrowing
- abnormal joint alignment
18
Q
Joint manifestations of RA
A
- edema
- warmth
- pain
- stiffness
- decreased ROM
- symmetrical
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
Typical knee deformities related to RA
- Genu valgus
- Baker's Cyst
26
Typical ankle/foot deformities related to RA
- pronation
- Hallux valgus
- Claw toes
27
Extra articular manifestations of RA
- Nodules: tendon, bone, organs
- Vasculitis
- Cardiac issues (friction rubs)
- Pulmonary changes
28
Describe the stages of RA
- 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
Management of RA
- medical management
- therapy
30
Goals of physical therapy for RA
- decrease pain
- decrease inflammation
- maintain joint and muscle function
- preserve/maximize functional activity
31
Goals of medical management for RA
- pharmacological
- decrease joint inflammation
- inhibit disease progression
32
Drug categories for RA
- NSAID
- Corticosteroids
- DMARDS (disease modifying anti-rheumatic drugs)
33
Describe NSAIDs
- first line agents
- ibuprofen and naproxen
34
Describe Corticosteroids
- short term agents: severe inflammation and acute exacerbation
- dexamethasone and cortisone
35
Describe DMARDS
- slow down disease progression
- infliximab/remicade and methotrexate
36
What would we do in physical therapy for RA
- 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
Define osteoarthritis
- degenerative joint disease
- gradual progressive degeneration of joint structures
38
Risk factors for OA
- 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
Pathology of OA
- destruction of cartilage
- surface irregularities
- osteophyte formation
- subchondral bone thickening
- secondary inflammation of periarticular structures
40
Clinical characteristics of OA
- decreased ROM
- stiffness: relieved by movement
- pain: deep, aggravated by activity
- deformity
- crepitus
41
Diagnostic tools for OA
- radiography: decreased joint space in early stages/may see widening, osteophytes, cysts
- history/exam: trauma and functional limitations
42
Joint deformities related to OA
- Heberdens Nodes
- Bouchards Nodes
- Genu varus/valgus
43
Treatment goals for OA
- maintain ROM/gain ROM
- increase muscular support
- decrease joint stress
- pain management
44
Medical management for OA
- medications: pain and anti-inflammatories
- surgical intervention: if OA interferes with ADLs, work, sleep, and/or walking
45
What to do in physical therapy for OA
- therapeutic exercise
- mobilizations
- assistive devices
