Arthritis Flashcards
Which gender is affected more by general arthritis?
women
Monoarticular arthritis examples:
infection
trauma
crystal induced gout or pseudo-gout
Inflammatory polyarticular arthritis example(s):
RA
spndylarthropathy
Degenerative polyarticular arthritis example(s):
OA (primary or secondary)
Metabolic polyarticular arthritis examples:
gout
amyloid
hyperlipidemia
CPPD
Classic RA affects ___% of the US population.
1%
Classic RA female:male ratio?
3:1
Classic RA age of onset is:
30-50 years
RA is an autoimmune disease influenced by these 3 main factors:
- genetics
- intrasynovial immune response
- damage from pro-inflammatory cells and enzymes
RA is a ________ inflammatory response.
systemic
The course of RA is a chronic ______ course.
fluctuating
RA manifestations:
symmetric, erosive synovitis
extra-articular involvement
progressive joint destruction and deformity
premature death possible
Diagnostic classification of RA: (7 Sxs)
- morning stiffness
- swelling/fluid > 3 joints
- hand arthritis
- symmetric involvement
- subcutaneous nodules
- abnormal serum RF
- radiolographic changes
What is RF?
rheumatoid factor
Hand/wrist conformation changes can be described as:
ulnar drift at MCPs
rotary subluxation at wrist
swan-neck deformities
boutonneire’s deformity
To be classified, you need ___ out of the 7 sxs.
4
What is a sign of greater disease activity and erosions?
more swollen and involved joints at onset
What are the systemic features of RA?
fatigue malaise weakness fever weight loss
How soon do RA patients show radiographic evidence of disease?
70% of patients - evidence appears within 2 years
Early radiographic evidence does not correlate strongly with outcomes
Arthritic radiological changes with RA include:
marginal erosions at joints
osteopenia
joint subluxation
What cervical changes can occur with RA?
laxity of transverse ligament at C1 allows subluxation of C1/C2 causing SC compression
(dens translates backwards toward SC)
______ is a non-specific marker of inflammation that rises and falls with inflammation.
CRP = C-Reactive Protein
Extra-articular rheumatoid nodules are associated with
low dose methotrexate
Areas of repeated friction and viscera of heart and lungs are susceptible to
Extra-articular rheumatoid nodules
Increased ESR is a finding that frequently leads to RA diagnosis when it is active. What is ESR?
Acute phase response, elevated fibrinogens & globulins -> increases ESR
(erythrocyte sedimentation rate)
What is the pharmacologic intervention for RA?
NSAIDS and COX II
DMARDS and Biologics
Glucocorticoids
Patients with RA are 2 x more likely as those with OA to have serious _____ complications.
NSAID
What is the initial pharmacologic intervention for RA?
NSAIDs, salicylates or COX-2s
Analgesic and anti-inflammatory properties
(don’t alter disease course or prevent joint destruction)
RA rehab goals:
Muscular strength Flexibility Endurance Mobility Patient independence and self-management skills
RA Acute inflammation interventions:
rest, splints, modalities, isometrics, ROM, energy conservation
RA subacute interventions:
dynamic and ROM exercises, ergonomic interventions
RA inactive/chronic interventions:
aerobic exercises, work accommodations
OA is a disease of the ____.
CARTILAGE
A disrupted ________ process leads to increased degenerative changes in OA.
remodeling
–> progressive loss of cartilage, subchondral thickening, marginal osteophytes
Primary OA:
no preceding injury
Secondary OA:
after an injure to the joint (ex: fx or congenital abnormalities)
______ pain is a late event in OA.
subchondral
What are the primary sources of pain early on in OA?
synovial and capsular tissues
Sxs/Symptoms of OA:
pain related to use morning stiffness stiff after inactivity (gelling) decreased ROM swelling joint instability bony enlargement restricted movement crepitus
OA joint involvement:
hips knees spine DIP (heberdon's nodes) shoulders elbow
OA radiological changes:
bone proliferation joint space narrowing subchondral sclerosis (hardening of tissue/compacted) osteophytes subchondral cysts malalignment and subluxations
Severe OA at knee often presents as genu _____.
Genu Varus
greater compression moment medially
Spine radiological features of OA:
asymmetrical disc spaces
traction osteophytes
Early pharmacological management of OA:
NSAIDs and Tylenol - early medications for pain relief
Name 2 nutrient management “nutraceuticals” for OA:
glucosamine and chondroitin sulfate
Chondroitin sulfate:
part of a large protein molecule (proteoglycan) that gives cartilage elasticity
(animal cartilage, such as tracheas or shark cartilage)
Glucosamine:
a form of amino sugar believed to play a role in cartilage formation and repair.
(crab, lobster or shrimp shells)
What is the goal for use of glucosamine and chondroitin sulfate?
goal: pain relief, slow cartilage damage in people with OA
Non-invasive OA management:
preserve motion and strength
reduce load on joint (decrease WB loads, use assistive device)
Invasive OA management:
experimental: cartilage replacement
surgical: arthroplasty (usually hips/knees)
What is a viscosupplement injection?
KNEE only – injection of Synvisc or Hyalgan which are substances intended to substitute for hyaluronic acid
Ank Spond is defined as:
sero-negative (no RF)
spondyloarthropathy
Ank Spond begins usually as:
sacro-iliitis (fuzzy on radiograph)
Due to fibrosis, ank spond is called “______ spine”
Bamboo spine due to fibrosis (syndesmophytes)
Ank Spond most commonly affects which gender?
male
Early ank spond Sxs:
inactivity (am stiffness prominent) Tenderness SI jt Early Fever Weight loss, fatigue Synovitis Pain/stiffness with Enthesitis- achilles, patellar(men)
Late ank spond Sxs:
Osteophytes Fibrosis Loss ROM spine, hips OA hip jts Glaucoma, iritis Bamboo spine
Complications of ank spond include: ___% aortic insufficiency, ___% pulmonary fibrosis
10% aortic
5% pulmonary
Ank Spond rehab:
exercise is very important
PNF, aerobic, flexibility, spinal extension especially
Ank Spond pharmacologic management:
NSAIDs- early stages: Indomethecin (75 mg)
DMARDS – sulfasalazine
Immunosupressives – Inflixamib
What is the most common surgical technique for ann spond?
total hip replacement (TKR)
