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Musculoskeletal Pathophysiology > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Which gender is affected more by general arthritis?

A

women

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2
Q

Monoarticular arthritis examples:

A

infection
trauma
crystal induced gout or pseudo-gout

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3
Q

Inflammatory polyarticular arthritis example(s):

A

RA

spndylarthropathy

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4
Q

Degenerative polyarticular arthritis example(s):

A

OA (primary or secondary)

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5
Q

Metabolic polyarticular arthritis examples:

A

gout
amyloid
hyperlipidemia
CPPD

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6
Q

Classic RA affects ___% of the US population.

A

1%

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7
Q

Classic RA female:male ratio?

A

3:1

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8
Q

Classic RA age of onset is:

A

30-50 years

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9
Q

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

A
  1. genetics
  2. intrasynovial immune response
  3. damage from pro-inflammatory cells and enzymes
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10
Q

RA is a ________ inflammatory response.

A

systemic

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11
Q

The course of RA is a chronic ______ course.

A

fluctuating

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12
Q

RA manifestations:

A

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

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13
Q

Diagnostic classification of RA: (7 Sxs)

A
  1. morning stiffness
  2. swelling/fluid > 3 joints
  3. hand arthritis
  4. symmetric involvement
  5. subcutaneous nodules
  6. abnormal serum RF
  7. radiolographic changes
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14
Q

What is RF?

A

rheumatoid factor

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15
Q

Hand/wrist conformation changes can be described as:

A

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

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16
Q

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

A

4

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17
Q

What is a sign of greater disease activity and erosions?

A

more swollen and involved joints at onset

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18
Q

What are the systemic features of RA?

A 
fatigue
malaise
weakness
fever
weight loss
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19
Q

How soon do RA patients show radiographic evidence of disease?

A

70% of patients - evidence appears within 2 years

Early radiographic evidence does not correlate strongly with outcomes

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20
Q

Arthritic radiological changes with RA include:

A

marginal erosions at joints
osteopenia
joint subluxation

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21
Q

What cervical changes can occur with RA?

A

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

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22
Q

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

A

CRP = C-Reactive Protein

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23
Q

Extra-articular rheumatoid nodules are associated with

A

low dose methotrexate

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24
Q

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

A

Extra-articular rheumatoid nodules

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25
Q

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

A

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

26
Q

What is the pharmacologic intervention for RA?

A

NSAIDS and COX II
DMARDS and Biologics
Glucocorticoids

27
Q

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

A

NSAID

28
Q

What is the initial pharmacologic intervention for RA?

A

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

29
Q

RA rehab goals:

A 
Muscular strength
Flexibility
Endurance 
Mobility 
Patient independence and self-management skills
30
Q

RA Acute inflammation interventions:

A

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

31
Q

RA subacute interventions:

A

dynamic and ROM exercises, ergonomic interventions

32
Q

RA inactive/chronic interventions:

A

aerobic exercises, work accommodations

33
Q

OA is a disease of the ____.

A

CARTILAGE

34
Q

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

A

remodeling

–> progressive loss of cartilage, subchondral thickening, marginal osteophytes

35
Q

Primary OA:

A

no preceding injury

36
Q

Secondary OA:

A

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

37
Q

______ pain is a late event in OA.

A

subchondral

38
Q

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

A

synovial and capsular tissues

39
Q

Sxs/Symptoms of OA:

A 
pain related to use
morning stiffness 
stiff after inactivity (gelling)
decreased ROM
swelling
joint instability
bony enlargement
restricted movement
crepitus
40
Q

OA joint involvement:

A 
hips
knees
spine
DIP (heberdon's nodes)
shoulders
elbow
41
Q

OA radiological changes:

A 
bone proliferation
joint space narrowing
subchondral sclerosis (hardening of tissue/compacted)
osteophytes
subchondral cysts
malalignment and subluxations
42
Q

Severe OA at knee often presents as genu _____.

A

Genu Varus

greater compression moment medially

43
Q

Spine radiological features of OA:

A

asymmetrical disc spaces

traction osteophytes

44
Q

Early pharmacological management of OA:

A

NSAIDs and Tylenol - early medications for pain relief

45
Q

Name 2 nutrient management “nutraceuticals” for OA:

A

glucosamine and chondroitin sulfate

46
Q

Chondroitin sulfate:

A

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

47
Q

Glucosamine:

A

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

48
Q

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

A

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

49
Q

Non-invasive OA management:

A

preserve motion and strength

reduce load on joint (decrease WB loads, use assistive device)

50
Q

Invasive OA management:

A

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

51
Q

What is a viscosupplement injection?

A

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

52
Q

Ank Spond is defined as:

A

sero-negative (no RF)

spondyloarthropathy

53
Q

Ank Spond begins usually as:

A

sacro-iliitis (fuzzy on radiograph)

54
Q

Due to fibrosis, ank spond is called “______ spine”

A

Bamboo spine due to fibrosis (syndesmophytes)

55
Q

Ank Spond most commonly affects which gender?

A

male

56
Q

Early ank spond Sxs:

A 
inactivity (am stiffness prominent)
Tenderness SI jt Early 
Fever
Weight loss, fatigue
Synovitis
Pain/stiffness with 
Enthesitis- achilles, patellar(men)
57
Q

Late ank spond Sxs:

A 
Osteophytes
Fibrosis
Loss ROM spine, hips
OA hip jts
Glaucoma, iritis
Bamboo spine
58
Q

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

A

10% aortic

5% pulmonary

59
Q

Ank Spond rehab:

A

exercise is very important

PNF, aerobic, flexibility, spinal extension especially

60
Q

Ank Spond pharmacologic management:

A

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

61
Q

What is the most common surgical technique for ann spond?

A

total hip replacement (TKR)

Musculoskeletal Pathophysiology (14 decks)

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