Arthritis and Related Disorders Flashcards
What are the 4 Stages of RA?
I. acute stage
II. subacute stage
III. chronic-active or destructive stage
IV. chronic-inactive or skeletal collapse and deformity stage
What are the characteristics of Stage I of RA?
Acute stage
pain, swelling, inflammation
symptoms usually bilateral in PIP, MCP, and wrists
no destructive changes yet
resisting orthosis indicated for pain relief as needed
What are the characteristics of Stage II of RA?
Sub-acute stage [proliferative phase]
synovium begins to invade soft tissues producing tenosynovitis and limiting joint movement
reduction in symptoms, but decreased mobility is apparent
inflammation of synovium to joints and tendon sheathscauses mild changes in articular cartilage through formation of a pannus
night orthosis to alleviate residual pain and prevent deformities
What are the characteristics of Stage III of RA?
chronic-active or destructive stage
destruction to bone and cartilage with ensuing joint deformity
often less pain, but more obvious joint deformities
functional day orthosis is indicatedas well as night orthosis
What are the characteristics of Stage IV of RA?
chronic-inactive or skeletal collapse and deformity stage
severe joint deformity and disorganization
fibrosis replaces inflammation
joint fusion, instability, or dislocation can occur
orthoses are for comfort and to provide joint stability
what are the symtpoms of septic arthritis?
pain, swelling, decreased AROM/PROM, and loss of function in affected joints
in 45% of people with septic arthritis, previous underlying joint disease with asymmetry typically occurs, which is important for diagnosis
what is Juvenile Idiopathic arthritis (JIA)?
formerly Juvenile Rheumatoid Arthritis (JRA)
one of the most common chronic joint inflammatory disease in the pediatric population under age 16
what are the types of Juvenile Idiopathic arthritis (JIA)?
Oligoarthritis: most common, previously called pauciarticular arthritis, occurs when there are 4 or fewer joints involved in the first 6 months of the disease, found in 40% of all cases, usually in bigger joints more common in girls
Polyarthritis: found in 25% of cases, can affect larger or smaller joints, more common in girls
systemic arthritis: found in 10% of cases, entire body is affected, not just joints, fevers, faint rash, inflammation of spleen and membranes of heart and lungs impacted
what are the four grades of stenosing tenosynovitis at the A1 pulley?
Grade I: Pretriggteering, pain but no active triggering
Grade II: Active: active catching but full digit AROM
Grade III: A/B: Passive: A: cathing which requires passive extension; B: catching with inability to flex
Grade IV: contracture
what is the most common collapse deformity in the rheumatoid thumb?
boutonniere deformity
what is the second most common collapse deformity in the rheumatoid thumb?
swan-neck deformity with MCP joint hyperextension and IP joint flexion, and metacarpal adduction
In what order do the digits experience extensor tendon attrition ruptures and in what direction do they rupture?
Small finger most affected
then RF, MF, and finally the IF
tendons rupture in a radial direction, resulting in tendons shifting ulnarly
what is the preferred treatment method after attritional tendon rupture?
tendon transfer
therapy consists of edema mgmt, orthosis protection of tendon transfer, tendon transfer training, and functional re-training
during acute stage of RA, how much sleep is recommended per night?
10-12 hours for every 24 hours
encourage pt to balance activity with daytime rest to avoid fatigue
What are the two types of Scleroderma?
Diffuse Cutaneous Systemic Sclerosis
Limited Cutaneous Systemic Sclerosis
Describe Diffuse Cutaneous Systemic Sclerosis
typically presents with a rapid progression of skin thickening beginning distally
includes the trunk
there is more visceral involvement than can include kidneys and heart and often more severe hand deformities
Describe Limited Cutaneous Systemic Sclerosis
sclerosis is limited the extremities, including the limbs (distal to elbows and knees) and th head
major variant is CREST syndrome
what is CREST syndrome?
a major variant of Limited Cutaneous Systemic Sclerosis. Stands for Calcinosis, Reynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia
with scleroderma, which type of pinch is the most important to preserve?
Lateral pinch
pt’s lose 2pt pinch, then palmar pinch, and finally lateral pinch is lost last, which is devastating to hand function
lateral pinch is the most functional
what are the goals in treating scleroderma?
- maintain max ROM ( don’t expect to increase ROM)
*prevent unncessary contractures with daily ROM
*maintain MCP flexion and thumb abduction
*prevent wrist and elbow contractures
*maintain lateral pinch
*use assistive devices to improve function
*encourage optimal skincare
*use orthotics to prevent deformity
what are risk factors for OA?
trauma
obesity
genetic factors
increasing age
occupational activities
local mechanical factors
what is psoriatic arthritis?
a combination of psoriasis and inflammatory arthritis
classic finding is scaly, erythematous skin rash
pt’s with PA have negative rheumatoid factor on serology testing
what nail changes can be seen in psoriatic arthritis
pitting
onycholysis
transverse ridging
discoloration of margins of nails
what is Arthritis Mutilans?
rare subgroup of psoriatic arthritis, which can result in severe bony destruction and joint instability. Bone absorption of phalanges/metacarpals results in digits shortening. Bone and joint destruction may eventually result in collapse of finger soft tissue leading to “opera glass hand.”
what is ankylosing spondylitis?
also known as axial spondyloarthritis, is an inflammatory disease that, over time, can cause some of the bones in the spine, called vertebrae, to fuse. This fusing makes the spine less flexible and can result in a hunched posture.
