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ClinE 470 > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Define arthritis

A

A chronic joint disorder characterised by degeneration of joint cartilage and adjacent bone that can cause joint pain and stiffness

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2
Q

The most common form of arthritis is …

A

Osteoarthritis

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3
Q

Prevalence of osteoarthritis … with age

A

Increases

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4
Q

Which joints does osteoarthritis commonly affect?

A

Knees
Hips
Hands

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5
Q

Describe process of osteoarthritis

A
  1. Collagen/proteoglycan producing cells become abnormal
  2. An increase in cartilage growth initially and bone density (osteosclerosis) reducing joint space
  3. Cartilage thins and cracks, roughening causes pain during movement
  4. Bone erosion with bone on bone movement
  5. Compensation occurs with development of bone spurs leading to deformation and pain
  6. Inflammation thickens synovium
  7. Increase in synovial fluid –> joint swells –> overstretching of muscles causes weakness
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6
Q

Clinical features of osteoarthritis

A

Bone hypertrophy
Bone spurring
Fusiform swelling of joints (Bouchard’s nodes)
Heberdens nodes

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7
Q

Rheumatoid arthritis is an … disease affecting the … …

A

Autoimmune

Whole body

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8
Q

Rheumatoid arthritis affects … of the population

A

1%

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9
Q

RhA is … times more common in …

A

3

Women

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10
Q

Process of RhA

A
  1. T-cells in synovial fluid become unable to distinguish between foreign and normal body cells
  2. Excessive production of immunoglobulins and inflammatory cytokines (TnF alpha)
  3. Excessive Ig causes abnormal division and growth of synovial cells
  4. Leukocytes migrate to joints, release enzymes causing synovitis –> increases swelling, stretching of ligaments, enzyme release attacks hyaline cartilage
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11
Q

4 stages of RhA

A
  1. Synovitis (synovial membrane inflammation)
  2. Pan us (extensive cartilage loss, exposed and pitted bones)
  3. Fibrous ankylosis (invasion of joint with fibrous connective tissue)
  4. Bony ankylosis (fusion of bones)
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12
Q

What may blood tests reveal in RhA? Why does this happen?

A

Presence of rheumatoid factor (RF) antibody (80% sensitivity)

RF is produced to try and lower levels of other antibodies

(However some people with RF don’t have RhA and vice versa)

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13
Q

RhA usually affects joints …

A

Symmetrically

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14
Q

Joints commonly affected in RhA

A 
Wrists
Hands
Knees
Elbows
Shoulders
Ankles
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15
Q

Major aetiology of RhA

A

60% genetic plus environmental involvement

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16
Q

Non-genetic factors causing RhA

A 
Age
Hormonal factors
Infection 
Smoking
Obesity
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17
Q

What does ankylosing spondylitis cause?

A

Acute spinal pain and stiffness without significant decrease in mobility

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18
Q

Why is osteoarthritis joint specific but RhA whole body?

A

RhA is an autoimmune disease so affects multiple organs

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19
Q

Why do ligaments become lax in later stage arthritis?

A

Chronic inflammation causes over-stretching

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20
Q

What is TNF-alpha?

A

An inflammatory cytokines produced my macrophages

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21
Q

Name some extra-articular manifestations of RhA

A

TNF-alpha causes weakness, fatigue, loss of appetite, muscle pain, weight loss

Myocardial damage and pericarditis

Pleural fluid accumulation in lungs

In 1 out of 6 people can shorten life

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22
Q

Why is there increased prevalence of arthritis in older people?

A

Natural decline in glucosamine and chondroitin sulphate production (so less durable cartilage is produced)

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23
Q

Men have more … OA

A

Hip

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24
Q

Women have more …/… OA

A

Hand/knee

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25
Q

In general … develop RhA more frequently than …

A

Women

Men

26
Q

What hormone is protective of OA?

A

Oestrogen - increased OA prevalence post menopause

27
Q

Weakness of which muscle is a risk factor for OA?

A

Quadriceps (from inactivity)

28
Q

Top … for BM increases risk of hip and knee OA by … times

A

20%

7-10

29
Q

Modest weight loss … OA

A

Reduces

30
Q

History of joint damage … to OA

A

Predisposes

31
Q

True or false, there is conclusive evidence that overuse increases risk of OA

A

False - inconclusive data on athletes

32
Q

Moderate levels of physical activity … increase risk of OA

A

Doesn’t

33
Q

True or false, infection can predispose to arthritis

A

True - both OA and RhA

34
Q

There is a …-…% influence of genetics on development of arthritis

A

30-60%

35
Q

Arthritis symptoms (general)

A 
Pain and crepitation on movement 
Enlarged and deformed joints 
Inflammation of joints
Stretched ligaments - instability 
Decreased ROM or complete freezing of joints
36
Q

3 movements most affected by arthritis

A

Stooping/bending
Standing
Walking

37
Q

Exercise limitations in people with arthritis

A

Less muscular strength/endurance

Less flexibility and ROM

Lower peak VO2 (20-30%)

Increase in oxygen demand of movement due to movement inefficiencies

38
Q

Why do you get exercise limitations with arthritis?

A

Inactivity causing retraining

Structural changes in bone and tendons

Reduced coordination and motor control

39
Q

What can imposed inactivity with arthritis cause?

A

Increased risk of CHD, diabetes, osteoporosis

Increased weight exacerbating joint loading and reducing mobility further

40
Q

Aims of treatment of arthritis (ACSM 2010)

A 
Ease pain and inflammation
Improve joint function
Lessen joint damage
Improve functional capacity
Reduce risks of comorbidities
41
Q

Non exercise treatment of arthritis

A

Firm beds/chairs
Heat - warm baths
Massage

Drugs: aspirin, ibuprofen, steroids, DMARDs, COX-2 inhibitors (reducing prostaglandins –> reducing inflammation)

42
Q

Exercise does not stop … … of arthritis, but does not exacerbate … or … …

A

Pathological process
Pain
Disease progression

43
Q

How can exercise help arthritis patients?

8

A

Increase joint mobility

Increase muscle strength around joint (improved stability, shock absorption, lower risk of falls)

Reduces swelling at joints

Reduces body weight

Increased bone density

Reduced pain on movement

Increased peak vo2

Reduced CHD RFs

44
Q

T or F, cartilage has direct blood vessels and nerves

A

False - cartilage has no direct vessels or nerves

45
Q

How does cartilage receive nutrients?

A

Movement of the joint allows diffusion of nutrients into cartilage

46
Q

How does movement increase “feeding” of cartilage?

A

Increased proteoglycan production

Increased glucosamine and chondroitin sulphate secretion from ECM (needed for cartilage production)

47
Q

Weight loss is important in reducing symptoms of OA, which is most important - body fat or body mass reduction?

A

Body fat reduction

48
Q

How does improvement in muscular strength help arthritis?

A

Quadriceps strengthening cushions force transmission through muscle rather than joint

Improvement in quad:hamstring ratio helps balance load on joint

49
Q

Exercise may help reduce … … production

A

TNF-alpha

50
Q

Aims of exercise in arthritis patients

A

Increase or preserve ROM and flexibility

Increase muscle strength and endurance

Increase aerobic conditioning

Ameliorate health risks of inactivity

51
Q

When should exercise be avoided in arthritis pts?

A

During ‘flares’ or if exercise is particularly painful

52
Q

Exercise considerations with arthritis pts

A

Decreased ROM

Work within pain threshold and maximum ROM

Difficulty gripping

Balance problems

Reduce load each joint is taking

Joints stiffer when cold

Stiffer in morning

53
Q

Considerations when undertaking pre-exercise testing in arthritis pts

A

Screen for CAD

Joint disease may affect ability to give true maximum effort

54
Q

Which exercise testing method would you use for a patient with: mild joint impairment, mild to moderate lower extremity impairment, and severe lower extremity impairment?

A

Mild - treadmill
Moderate - cycle regime try
Severe - arm ergometry

55
Q

A goniometer is used to test …

A

ROM

56
Q

How would you test balance in arthritis pt?

A

Figure right walking (mild)

Berg balance scale (moderate-severe)

57
Q

Recommended stretching exercises in arthritis pts

A

All joints
Static - hold 10-30s

PNF if supervised - 5s stretch followed by 10-30s assisted stretch

3-4 times/session

58
Q

Recommended strength exercises in arthritis

A

Isometric: start with isometric, 40-60% MVC, 1-10s, major muscle groups

Isotonic: low weight (40-60% 1RM), build up to high no. of reps, 1-3 sets 1-3 days/week, use fixed weights and bands, work all muscles

59
Q

Recommended aerobic exercises for arthritis pts

A

Low impact: 40-80% HRmax, RPE 12-14

Cycling, rowing, swimming, low impact aerobics

Start 5-15 mins every other day, increase to 30-40 mins

Increase in 10% intensity increments

Consider interval training

60
Q

Do you think that exercise training is worthwhile for people with RA?

A

Yes - muscle strength and aerobic capacity is vastly improved with exercise in RhA patients without negative effects in disease activity which may be improved

61
Q

What mechanisms may explain why and how exercise may bring about an improvement in disease activity and does this call for a reappraisal of the 2001 statement of the American College of Geriatricians about exercise and arthritis?

A

Aerobic exercise seems to reduce joint swelling in RA, strengthening exercise reduces pain reports in RhA patients.

Exercise-related changes in synovial circulation, immune response and inflammatory factors , and neuropeptide levels. General exercise research also may pertain to this population in terms of the benefits of neuromuscular learning and improved elasticity and strength of peri-articular structures

ClinE 470 (9 decks)

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