Arthritis

Question 1

Which gender is affected more by general arthritis?

Answer 1

women

Question 2

Monoarticular arthritis examples:

Answer 2

infection
trauma
crystal induced gout or pseudo-gout

Question 3

Inflammatory polyarticular arthritis example(s):

Answer 3

RA

spndylarthropathy

Question 4

Degenerative polyarticular arthritis example(s):

Answer 4

OA (primary or secondary)

Question 5

Metabolic polyarticular arthritis examples:

Answer 5

gout
amyloid
hyperlipidemia
CPPD

Question 6

Classic RA affects ___% of the US population.

Answer 6

1%

Question 7

Classic RA female:male ratio?

Answer 7

3:1

Question 8

Classic RA age of onset is:

Answer 8

30-50 years

Question 9

RA is an autoimmune disease influenced by these 3 main factors:

Answer 9

1. genetics
2. intrasynovial immune response
3. damage from pro-inflammatory cells and enzymes

Question 10

RA is a ________ inflammatory response.

Answer 10

systemic

Question 11

The course of RA is a chronic ______ course.

Answer 11

fluctuating

Question 12

RA manifestations:

Answer 12

symmetric, erosive synovitis
extra-articular involvement
progressive joint destruction and deformity
premature death possible

Question 13

Diagnostic classification of RA: (7 Sxs)

Answer 13

1. morning stiffness
2. swelling/fluid > 3 joints
3. hand arthritis
4. symmetric involvement
5. subcutaneous nodules
6. abnormal serum RF
7. radiolographic changes

Question 14

What is RF?

Answer 14

rheumatoid factor

Question 15

Hand/wrist conformation changes can be described as:

Answer 15

ulnar drift at MCPs
rotary subluxation at wrist
swan-neck deformities
boutonneire’s deformity

Question 16

To be classified, you need ___ out of the 7 sxs.

Answer 16

4

Question 17

What is a sign of greater disease activity and erosions?

Answer 17

more swollen and involved joints at onset

Question 18

What are the systemic features of RA?

Answer 18

fatigue
malaise
weakness
fever
weight loss

Question 19

How soon do RA patients show radiographic evidence of disease?

Answer 19

70% of patients - evidence appears within 2 years

Early radiographic evidence does not correlate strongly with outcomes

Question 20

Arthritic radiological changes with RA include:

Answer 20

marginal erosions at joints
osteopenia
joint subluxation

Question 21

What cervical changes can occur with RA?

Answer 21

laxity of transverse ligament at C1 allows subluxation of C1/C2 causing SC compression
(dens translates backwards toward SC)

Question 22

______ is a non-specific marker of inflammation that rises and falls with inflammation.

Answer 22

CRP = C-Reactive Protein

Question 23

Extra-articular rheumatoid nodules are associated with

Answer 23

low dose methotrexate

Question 24

Areas of repeated friction and viscera of heart and lungs are susceptible to

Answer 24

Extra-articular rheumatoid nodules

Question 25

Increased ESR is a finding that frequently leads to RA diagnosis when it is active. What is ESR?

Answer 25

Acute phase response, elevated fibrinogens & globulins -> increases ESR (erythrocyte sedimentation rate)

Question 26

What is the pharmacologic intervention for RA?

Answer 26

NSAIDS and COX II DMARDS and Biologics Glucocorticoids

Question 27

Patients with RA are 2 x more likely as those with OA to have serious _____ complications.

Answer 27

NSAID

Question 28

What is the initial pharmacologic intervention for RA?

Answer 28

NSAIDs, salicylates or COX-2s Analgesic and anti-inflammatory properties (don't alter disease course or prevent joint destruction)

Question 29

RA rehab goals:

Answer 29

``` Muscular strength Flexibility Endurance Mobility Patient independence and self-management skills ```

Question 30

RA Acute inflammation interventions:

Answer 30

rest, splints, modalities, isometrics, ROM, energy conservation

Question 31

RA subacute interventions:

Answer 31

dynamic and ROM exercises, ergonomic interventions

Question 32

RA inactive/chronic interventions:

Answer 32

aerobic exercises, work accommodations

Question 33

OA is a disease of the ____.

Answer 33

CARTILAGE

Question 34

A disrupted ________ process leads to increased degenerative changes in OA.

Answer 34

remodeling --> progressive loss of cartilage, subchondral thickening, marginal osteophytes

Question 35

Primary OA:

Answer 35

no preceding injury

Question 36

Secondary OA:

Answer 36

after an injure to the joint (ex: fx or congenital abnormalities)

Question 37

______ pain is a late event in OA.

Answer 37

subchondral

Question 38

What are the primary sources of pain early on in OA?

Answer 38

synovial and capsular tissues

Question 39

Sxs/Symptoms of OA:

Answer 39

``` pain related to use morning stiffness stiff after inactivity (gelling) decreased ROM swelling joint instability bony enlargement restricted movement crepitus ```

Question 40

OA joint involvement:

Answer 40

``` hips knees spine DIP (heberdon's nodes) shoulders elbow ```

Question 41

OA radiological changes:

Answer 41

``` bone proliferation joint space narrowing subchondral sclerosis (hardening of tissue/compacted) osteophytes subchondral cysts malalignment and subluxations ```

Question 42

Severe OA at knee often presents as genu _____.

Answer 42

Genu Varus | greater compression moment medially

Question 43

Spine radiological features of OA:

Answer 43

asymmetrical disc spaces | traction osteophytes

Question 44

Early pharmacological management of OA:

Answer 44

NSAIDs and Tylenol - early medications for pain relief

Question 45

Name 2 nutrient management "nutraceuticals" for OA:

Answer 45

glucosamine and chondroitin sulfate

Question 46

Chondroitin sulfate:

Answer 46

part of a large protein molecule (proteoglycan) that gives cartilage elasticity (animal cartilage, such as tracheas or shark cartilage)

Question 47

Glucosamine:

Answer 47

a form of amino sugar believed to play a role in cartilage formation and repair. (crab, lobster or shrimp shells)

Question 48

What is the goal for use of glucosamine and chondroitin sulfate?

Answer 48

goal: pain relief, slow cartilage damage in people with OA

Question 49

Non-invasive OA management:

Answer 49

preserve motion and strength | reduce load on joint (decrease WB loads, use assistive device)

Question 50

Invasive OA management:

Answer 50

experimental: cartilage replacement surgical: arthroplasty (usually hips/knees)

Question 51

What is a viscosupplement injection?

Answer 51

KNEE only – injection of Synvisc or Hyalgan which are substances intended to substitute for hyaluronic acid

Question 52

Ank Spond is defined as:

Answer 52

sero-negative (no RF) | spondyloarthropathy

Question 53

Ank Spond begins usually as:

Answer 53

sacro-iliitis (fuzzy on radiograph)

Question 54

Due to fibrosis, ank spond is called "______ spine"

Answer 54

Bamboo spine due to fibrosis (syndesmophytes)

Question 55

Ank Spond most commonly affects which gender?

Answer 55

male

Question 56

Early ank spond Sxs:

Answer 56

``` inactivity (am stiffness prominent) Tenderness SI jt Early Fever Weight loss, fatigue Synovitis Pain/stiffness with Enthesitis- achilles, patellar(men) ```

Question 57

Late ank spond Sxs:

Answer 57

``` Osteophytes Fibrosis Loss ROM spine, hips OA hip jts Glaucoma, iritis Bamboo spine ```

Question 58

Complications of ank spond include: ___% aortic insufficiency, ___% pulmonary fibrosis

Answer 58

10% aortic | 5% pulmonary

Question 59

Ank Spond rehab:

Answer 59

exercise is very important | PNF, aerobic, flexibility, spinal extension especially

Question 60

Ank Spond pharmacologic management:

Answer 60

NSAIDs- early stages: Indomethecin (75 mg) DMARDS – sulfasalazine Immunosupressives – Inflixamib

Question 61

What is the most common surgical technique for ann spond?

Answer 61

total hip replacement (TKR)