Arthritis Flashcards
arthrtsis
a chronic joint disorder characterised by degreneration of joint cartlidge causing pain and stiffness
can limit physical function
process of osteoarthrsis
cells that produce collagen and proteoglycans become abnormal
initally an increase in cartlidge growth and bone dnsity - reducing joint space
soon cartlidge thins and cracks, rough cartlidge causes pain during movement
bone starts to be worn down, bone moves against bone increasing erosion and pain
spurs develop to compensate
inflammation means synovium is thickened - increase synovial fluid
joint swells
ligaments become lax and overstreatched casuing weakness
rheumatoid arthritsis
an autoimmune disease affecting the wholw body
affects 1% of the population
3x more common in women
effect of inflammatory cytokines
cause weakness, fatigue, loss of appetite, muscle pain and weight loss
may cause myocardial damage and pericarditis
process of rheumatoid arthritsis
T cells in synovial fluid become corrupted and unable to distinguish between foreign and normal body cells
excessive production of immunoglobins and inflammatory cytokines
aggressive productinon of interleukin 6 causes persisent inflamation and joint destruction
osteoclasts stimulated
excessive Ig causes abnormal growth and division of synoival and cartlidge cells
macropahges migrate to joints - release enzymes that cause synovitis
what is synovitis
increased swelling of joints
stretching of ligaments
enzymes released by macopahages attacks hyaline cartlidge
name some immunglobins
IgA
IgG
IgM
name some inflammaroty cytokines
Tnf alpha
Interleukins - IL6
5 stages of RA
healthy
synovitis
pannus - destroyed hyaline cartlidge, pitted bone, swelling
fibrous ankylosis - joining of connective tissue and bone
bony alkylosis - fixed joint
what can affect arthritsis
age gender inactivity obesity overuse infection
how does age affect arthritis
increased prevalence in older
natural decline in glucosamine and condition sulphate production
how does gender affect arthritis
men have more hip OA
women have more hand/knee OA
women>men RA
oestrogen appears to be protective, with increased OA post menopause
how does inactivity increase arthritis
weakness of quads increase risk of OA
how does obesity increase arthritis
top 20% for BMI increases risk 7-10 times for hip and knee OA
how does overuse affect arthritis
inconclusive data
but histoy of damage predisposed to OA
moderate levels of PA does not increase risk
symptons of arthritis
pain and crepitation of movement joints become enlarged and deformed inflammation ligaments become streched - unstable decreased ROM
problem activities
bending standing walking push climb carry sit reach reduces the amount of PA they do which is detrimental
effect of arthritis on strength
less muscular strength/endurance
decrease 25-50%
effect of arthritsis on flexibitly
decrease flex and ROM
effect of arthritis on peak VO2
lower
decrease 20-30%
why do exercise measurments decrease
inactivity causes detraining
structural changes in bones and tendon
reduce co-ordination and motor control
effect of decrease inactivity
increase risk of CHD, diabetes, osteoporsis
increase weigth = increase joint loading and reduces mobility further
aim of treatment
easing of pain decrease of pain and inflammation improvment in joint function lessening in joint damage improvement in functional capacity reduce risk of co-morbid conditions
non exercise treatment
balance between exercise and rest firm bed/chair heat massage drugs weight loss surgery
drugs
asprin ibuprofen steriods diease modifying anti-rheumatic drugs cox-2 selective inhibitors
benefits of exercise
increase joint mobility increase muscle strength around joint increase stability increase shock absorption increase bone density reduce swelling reduce weight reduce pain on movement
how does exercise help
cartlidge has no direct blood vesels or nerves
relies on movement to facilitate diffusion of nutients into cartlidge
movement increases ‘feeding’ of cartlidge
- increase prostagladin production
- increase glucosamine and chrondrontin sulphate secretion
benefit of muscle strength increase
quads strengthening acts to cushion force transmission through the muscle rather than the joint
improvement in quad/hamstring ratio helps balance loads on joint
aim of exercise
to preserve or increase ROM and flexibilty
increase muscle strength and endurance
aerobic condtioning
ameliorate health risks of inactivity
exercise considerations
decreased ROM work within pain threshold difficulty gripping balance problems reduce joint load joints stiffer when cold time of day - stiffer in morning
stretching
core of program all joints static stretching - hold 10-30 secs PNF if supervised - 5 sec hols followed by 10 - 30 sec asssited stretch 3-4 times
