Arthritis Flashcards
Arthritis consists of over ___ different diseases/conditions
-___ under age 65
- 100
- 2/3
define rheumatoid arthritis
a systemic inflammatory disease primarily affecting joint synovium
define osteoarthritis/ degenerative joint disease
localized process involving destruction of cartilage tissue
What does OA look like on a radiograph?
sclerosis/thickening of the bone. lights up bright white
What does RA look like on a radiograph?
washed out bone, inflammation, joint space narrowing, joint erosion
RA
- spontaneous ____
- related to _____
- exacerbation and remission
- other rheumatologic conditions (JRA, SLE, scleroderma)
Criteria for RA (conditions)
must meet 4/7, 1-4 must be > 6 weeks duration
Criteria for RA
- morning stiffness (at least 1 hour)
- arthritis of 3 or more joint areas
- arthritis of hand joints
- symmetry
- rheumatoid nodules
- positive serum rheumatoid factor
- radiographic evidence
RA
- women __ men
- peak age
- more women than men (2:1 or 3:1 ratio)
- between 60-70
RA
- type of disorder
- etiology
- rheumatoid factor
- autoimmune
- unknown
- autoantibody against IgGFc; in about 70% of patients
Patho of RA
- infiltration of synovium by ___
- production of ____
- hyperplastic synovium invades ___
- other things that occur
- CD4+ Tcells, B cells, monocytes/macrophages
- inflammatory cytokines and chemokines
- (pannus) invades cartilage, subchondral bone, articular capsule, and ligaments
- venous distension, cap. obstruction, thrombus, hemorrhage
Diagnostic tests for RA
no single test
exclude other diagnoses
clinical presentation
lab/radiographic findings
differential diagnosis (name a few)
OA, reiter’s syndrome, IBD, gout, psoriatic arthritis, polymyalgia, infection, fibromyalgia, SLE, sarcoidosis
clinical presentation of RA
insidious onset, symmetrical morning stiffness, generalized fatigue, weight loss, depression, rapid progression in first 6 years
3 types of disease course
- monocyclic: (20%) one episode that abates within 2 yrs
- polycyclic: (70%) fluctuating
- progressive and unremitting (10%)
patterns of RA involvement
- symmetrical
- ____ most commonly involved
- joint _____
- crepitus
- 80% develop _____ within 10 years
- hands and wrists
- inflammation
- permanent joint abnormalities
patterns of RA involvement
- _____ rarely involved
- ______ sometimes affected
- may be accompanied by ________
- axial skeleton
- cervical spine
- joint ankylosis or ankylosing spondylitis
ABCs of radiology
alignment, bone density, cartilagenous spacing, soft tissue
RA involvement of wrist
volar subluxation and ulnar displacement of carpals in relation to radius
- flexion contractures
- De Quervain’s and carpal tunnel common (due to synovitis)
what is often the first clinical feature of RA?
symmetric MCP and PIP joint involvement
RA hand involvement
- MCPs
- PIPs
- Thumb
- DIPs
- volar subluxation and ulnar drift
- swan neck and boutonniere deformity with osteophytes, bouchard’s nodes
- IP hyperextension and MCP flexion, with progressive CMC involvement
- usually uninvolved
mutilans deformity
severe deformity with profound instability and functional impairment
RA of the hip joint
- not as common as in RA
- characteristic joint space narrowing with intact articular cortex
- consider treatments that reduce risk of hip joint degeneration
RA of the knee joint
commonly involved, large amount of synovium
-flexion contractures due to pain and muscle guarding
RA of the foot/ankle
- ____ hindfoot
- collapse of _____
- hallux valgus
- MTP ____
- ______ toes
- pronated
- longitudinal and transverse arches
- subluxation
- hammer/claw
RA muscle involvement contributions
disuse atrophy, myositis, steroid-induced myopathy/peripheral neuropathy
RA involvement of tendon/ligament
tenosynovitis: interrupts gliding at tendon sheath, causing damage and potential for rupture
- flexor tenosynovitis is a poor prognostic factor
radiographic features of RA (stages I-IV) -early -moderate -severe
- no radiographic evidence, possible OP
- OP with slight cartilage destruction, muscle atrophy, no joint deformity
- OP and destruction of cartilage and bone, jt. deformity without ankylosis, extensive atrophy
- stage III+ fibrous or bony ankylosis
- sensitivity
- specificty
- ability to avoid a false negative
- ability to avoid a false positive
lab tests (RA)
- RF
- erythrocyte sedimentation rate (ESR)
- C-reactive protein
- negative in up to 30% of those with RA, can be positive without RA
- often elevated
- elevation indicates acute inflammation
lab tests (RA)
- CBC
- synovial fluid analysis
- decreased RBCs (anemia or chronic disease), normal WBCs, platelets may be elevated
- usually turbid with neutrophils, culture to rule out infection
Complications/Impairments with RA
functional impairments, deconditioning, rheumatoid nodules, vascular complications, neuro complications, cardiopulm, ocular (sjogren’s syndrome)
Pharm for RA
NSAIDS, DMARD (disease modifying anti-rheumatic drugs), BRM (biological response modifiers)
Pharm for RA
NSAIDS, DMARD (disease modifying anti-rheumatic drugs), BRM (biological response modifiers)
OA is a ____ that is confined to ______
localized process
affected joints
2 pathologic features of RA
- progressive destruction of articular cartilage
- formation of bone (osteophytes) at the margins of the joint
Diagnostic criteria for OA
asymmetrical involvement, lack of generalized symptoms, morning or post-activity stiffness (shorter than RA), pain is variable, radiographic tests?
Epidemiology of OA
-knee ___ hip
knee >hip 13.8%-3.1%
Primary OA
idiopathic, unknown etiology
Secondary OA
identifiable trauma, congenital malformation, or other musculoskeletal disease
-increased age (not normal aging though), trauma, occupational/functional tasks, obesity, infection
Pathophys of OA
initial increase in articular cartilage H2O, proteoglycan/collagen increase, later, proteoglycan loss reduces compressive stiffness and elasticity
Radiographic criteria for OA
osteophytes, joint space narrowing, deformity
Radiographic findings for OA vs. RA
OA- bone formation
RA- bone erosion
Radiographic findings for OA vs. RA
OA- bone formation
RA- bone erosion
UE joint involvement for OA
DIPs, PIPs, thumb, CMC
heberden’s nodes
osteophyte formation at the DIP (may also occur in RA, but more common in OA)
protective position of the hip in OA
hip flexion, abduction, external rotation
decreased hip ROM relates to _______
decreased walking speed and functional limitations
Knee OA
- most prevalent
- functional impact
-similar to CHF, COPD
Kellgren and Lawrence Grading system for OA
- grade 0
- grade 1
- grade 2
- grade 3
- grade 4
- normal
- possible osteophytes, questionable joint narrowing
- definite osteophyte formation
- moderate osteophytes, narrowing, possible deformity
- large osteophytes, marked narrowing, sclerosis, deformity
OA pharmacologic therapy
goal is pain control -medication, patient education -joint protection exercise -NSAIDS -Corticosteroid injection -viscosupplementation (hyalouronic acid) -topical analgesics
neutraceuticals
glucosamine sulfate
chondroitin sulfate
3 primary indications for sugery
intractable pain
loss of function
progression of deformity
soft tissue procedures
synovectomy
soft tissue release
tendon transfer
bone and joint procedures
osteotomy
arthroplasty
arthodesis
caution with _____
MMT, use or modify functional tests
Goals of rehab
decrease pain, increase or maintain ROM, increase or maintain strength, improve joint stability, decrease mechanical joint stress, increase functional endurance, maximize ADLs, improve gait gait efficacy and safety, establish conditioning programs
Goals of rehab
decrease pain, increase or maintain ROM, increase or maintain strength, improve joint stability, decrease mechanical joint stress, increase functional endurance, maximize ADLs, improve gait gait efficacy and safety, establish conditioning programs
Acute rehab mgmt
reduce pain and inflammation, rest affected joints, modalities, maintain ROM, strength, endurance, functional independence
subacute rehab mgmt
progress ROM, strength, endurance and functional training, improve performance and range of ADLs, joint protection
chronic rehab mgmt
independence in ADLs, return to vocation, recreation, patient education
Modalities for arthritis
superficial heat, deep heat (questionable), cold modalities, TENS
strengthening interventions
isometric or sub-max, add dynamic, concentric, and eccentric, use resistance with caution, exercise-induced discomfort should subside within one hour
gait/functional training
- improve ____
- cane
- walking speed, and normalize gait
- may unload hip up to 60%
Education
disease process, joint protection, pain mgmt, resources
