Arthritis

Question 1

What is the disease process in osteoarthritis?

Answer 1

Cells producing collagen and proteoglycans become abnormal
Increase in cartilage growth and bone density, reducing joint space
Cartilage thins and cracks, rough cartilage causes pain
Bone gets worn down, bone on bone causes pain
Spurs form to compensate then deform causing movement problems and more pain
Inflammation thickens synovium, increases fluid, swells joint, ligaments become lax and muscles overstretched

Question 2

What is the prevalence of rheumatoid arthritis? And osteo

Answer 2

1% of the population, 3:1 female:male

Like 50% by the age of 70

Question 3

What is the disease process for rheumatoid arthritis?

Answer 3

Inflammatory cytokines produced by macrophages cause: weakness, fatigue, loss of appetite, muscle pain and weight loss. Can cause myocardial damage and pleural fluid accumulation
T cells in synovial fluid can’t distinguish foreign/normal cells so antibodies/cytokines invade and cause growth of synovial cells. Leukocytes release enzymes causing: swelling of joint, stretching ligament and destruction of cartilage

Question 4

What are the 4 stages of rheumatoid arthritis?

Answer 4

Synovitis
Pannus
Fibrous ankylosis
Bony ankylosis

Question 5

What are the causes and contribution of RA?

Answer 5

Genetic: 60%

Non genetic: age, hormonal, infection, smoking, obesity

Question 6

What are the causes of osteoarthritis?

Answer 6

Age, gender (male hip - female hand /knee), inactivity, obesity, overuse, infection, genetic

Question 7

What are the signs and symptoms of arthritis?

Answer 7

Pain and crepitation
Large, deformed joints
Inflammation
Stretched ligaments
Reduced range of movement or joint freezing

Question 8

What are some limitations to exercise on arthritis?

Answer 8

Less strength and endurance: 25-50%
Reduced flexibility/ROM
Lower peak VO2: 20-30%
Pain
Balance
Stiffness

Question 9

Why are arthritis patients less tolerant of exercise?

Answer 9

Pain leads to inactivity leads to a detraining effect
Structural changes
Less coordination and control

Question 10

What are problems with arthritis causing inactivity?

Answer 10

Increase risk of CHD/diabetes/osteoporosis

Increase weight leading to further problems

Question 11

What are the aims of treatment?

Answer 11

Ease pain
Decrease inflammation
Increase function and exercise capacity
Decrease damage
Overall reduce mortality

Question 12

What are some none exercise treatments?

Answer 12

Firm bed/chair
Heat
Massage
Drugs - NSAIDS/DMARDS/steroids

Question 13

What are the benefits of exercise in arthritis?

Answer 13

Increase mobility, strength, 10-32% more stability, shock absorption, bone density, exercise capacity (17%)
Decrease falls, swelling, weight, pain

Question 14

How does exercise benefit arthritis?

Answer 14

As cartilage has no blood supply movement facilitates diffusion so more proteoglycans and cartilage production
Weight loss (fat)
Strengthen muscle - cushion
Less TNF alpha

Question 15

What exercise capacity test should be used for what severities of arthritis?

Answer 15

Treadmill - minimal to mild
Cycle - mild to moderate
Arm - severe

Question 16

What exercise should be done for arthritis patients?

Answer 16

Stretch: 10-30s, 3-4x, every day
Strength: start isometric (40-60% MVC, 1-10s) then isotonic (low weight increasing reps, 1-3 sets on 1-3 days)
Aerobic: low impact, 40-80% HRmax, 5-15 minutes, every other day building up to 30-40 minutes and 10% more intensity each time. Interval work better tolerated

Question 17

What is arthritis?

Answer 17

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