Autoimmune Diseases Flashcards
Give examples of organ specific autoimmune diseases
Diabetes mellitus
Hashimoto’s thyroiditis
Grave’s diseases
Crohn disease
Give examples of systemic autoimmune diseases
Scleroderma
Psoriasis
Systemic lupus erythematosus
Celiac disease
Multiple sclerosis
Myasthenia gravis
Ankylosions spondylitis
Rheumatoid arthritis
What is the pathogenesis of autoimmune diseases ?
Disruption of immunoregulatory mechanism
Antibodies are directed against body’s own cells
Body’s fails to distinguish self from non self
Risk factors : hormones, environment, genetics
Define rheumatic disease
Systemic diseases affecting any and all body systems
Characterized by periods of exacerbation and remission
Chronic conditions with long term rehab needs
What is rheumatoid arthritis ?
A chronic systemic inflammatory disease affecting synovial lining of joints and other connective tissues. Present with wide range of articular and extra articular findings. Cardiovascular, pulmonary and gastrointestinal systems may be involved.
What are the extra-articular manifestations of rheumatoid arthritis ?
Affects bones, skin, lungs. Causes eye lesions, infections and osteoporosis.
Does RA affect more men or women ? At what age ?
3X more women than men, peak onset being 60 yo but can be any age.
What are the pathophysiological findings in RA ?
Hypertrophic joint with thickened synovium
Due to :
1) proliferation of synovial macrophages, fibroblasts and endothelial cells
2) causing neovascularization, angiogenesis
3) leading to pan us tissue formation
What are the most frequently involved joints in RA ?
Wrist, knee, fingers, hands and feet
What are the subjective manifestations of RA ?
- fatigue
- weight loss
- weakness
- general diffuse MSK pain
- deconditioning
- depression
What are the objective manifestations of RA ?
- localized symptoms to specific joints
- multiple joints presentation (and symmetrical)
- edema, warm joint, pain
- morning stiffness > 30mn up to several hours
- gradual joint deformity (ulnar deviation, swan neck, boutonniere difformities)
- RA nodule in the skin
What are the soft tissues symptoms in RA ?
Synovitis, bursitis, tendinitis, fasciitis, neuritis, vasculitis
What are the spine symptoms in RA ?
- deep aching cervical pain
- frequent occipital headaches
- C1 and C2 mostly affected
- increased risk of atlanto axial (C1-C2) subluxation
What is class I of functional capacity in RA ?
Completely able to perform usual activities of ADLs
What is class II of functional capacity in RA ?
Able to perform usual self care and vocational activities but limited in leisure’s
What is class III of functional capacity in RA ?
Able to perform usual self care activities but limited in vocational and a vocational activities
What is class IV of functional capacity in RA ?
Limited in ability to perform usual self care, vocational and avocational activities
What are the aims of treatment in RA rehab ?
- maintain state of remission
- reduce pain
- maintain mobility
- minimize stiffness, edema and joint destruction
- restore function
- prevent contractures
- improve strength
- enhance cardio respiratory condition
- enhance aerobic condition
What to assess in RA ?
- overall assessment of ADLs
- feet assessment (bunions, claw toe ?)
Uneven or pathologic weight bearing patterns
Check the shoes
Need for assistive device ?
What are the Ottawa guidelines for RA rehab program ?
Functional strengthening + low or high intensity exercises can relieve pain and improve overall function
When do you need to modify the program ?
When the patient experiences acute pain during the exercise
When post-exercise pain lasts more than 1 hour
In general what are the types of therapeutic exercises recommended for RA rehab ?
- functional strengthening exercises
- aerobic and resistance exercises
- balance, motion, coordination, posture, and ROM exercises
- hydrotherapy
What are the types of exercises that should be practiced in case of RA ?
-ROM exercises : 8 to 10 reps in sub acute phase
- Isometric exercises : short holds (4-6 seconds) with low reps (1-2 gradually increase to 4-6)
- strength training: low load and moderate to high intensity
Globally: 30mn of moderate exercise 4-5 times per week
Why are people with RA at higher risk to develop osteoporosis ?
- RA medication (glucocorticoid medication triggers bone loss)
- bone loss as a direct result of RA
- inactivity secondary to pain and disability caused by RA
What is thermotherapy and electrotherapy used in RA ?
- low level laser therapy = for pain relieve in foot hand and knee
- therapeutic ultrasound = for pain relieve in hand
- Transcutaneous electrical nerve stimulation
—> high frequency : for pain relieve in hand and wrist
—> low frequency
Define ankylosing spondylitis
AS is a systemic rheumatic disease that affects the entire body. If affects more men than woman and starts between 15 to 30 yo.
What is the pathogenesis of AS ?
Poorly understood
Progressive fusion of the zygapophyseal joints and sic spaces of the axial skeleton resulting in a rigid kyphosis deformity of the thoracic spine and positive sagittal balance.
May be due to genetic, environmental factors, HLA-B27 antigen positive
What are the joints commonly involved in AS ?
-sacro illiac joint
- neck
- lumbrosacral joint
- shoulder
- hips
- heels
- knee
What happens to the spine in case of AS ?
Morphology alterations make the spine vulnerable to injury following minor or unrecognized trauma. Spine is unable to adequately accommodate to the normal mechanical forces which causes possible fractures at any level.
We observe healing with reactive bone formation secondary to the disruption of ligaments vertebral junction/attachment. Outer annular fibers of the intervertebral disks are replaced by bone and bones are fused (bamboo spine).
What is clinically observed in AS ?
Enthesitis : inflammation of the :
- ligaments attachments
- tendons attachments
- cartilage attachments
Decreasing ROM, causing tenderness, pain, stiffness in various joints
What are the signs and symptoms of AS ?
-Gradual onset of low back pain, buttock, and hip stiffness > 3 months
- morning stiffness >1 hour
- poorly localized pain at the beginning may become bilateral and persistant
- pain wakes you up at night
- tenderness in different body parts
- bowel irritation
- chronic fatigue
- eyes inflammation
- loss of spine mobility
- loss of lordosis
- development of kyphosis
- loss of chest wall excursion
- ribs tenderness
- shortness of breath after gentle activity
Why is the pulmonary function altered in AS ?
Ossification results in Kyphosis, reduced thoracic mobility and chest wall mobility.
The volume available for the lungs is reduced due to mechanical limitations.
What are the red flags related to AS ?
Sudden onset of lower back, SIJ or hip pain with no trauma (non mechanical cause) + signs and symptoms of systemic disease
What to assess in suspicion of AS ?
- spine and peripheral joints’ ROM and strength
Schubert test to assess lumbar spine flexion - chest expansion
- hip flexion contractons (need for hip arthroplasty? )
What instrument can the PT use to assess AS ?
The Bath Ankylosing Spondylitis Metrology Index (BASM) assessing :
- cervical rotation
- Travis to wall
- lumbar side flexion
- lumbar flexion (modified schober’s)
- intermalleolar distance
What are the exercise recommandations in case of AS ?
-Mobility exercises for spinal mobility and peripheral joint mobility
- stretching
- strengthening
- cardiopulmonrary
- functional
Consistency si the key factor
Avoid high-impact activities or contact sports
What is fibromyalgia syndrome ?
It is a syndrome characterized by chronic widespread pain at multiple tender points, joint stiffness and systemic symptoms.
What is the pathogenesis of fibromyalgia ?
Not yet clearly understood
Malfunction of the CNS
Complex interaction of pain and inflammation
Central sensitization
Change in the level of various inflammatory cytokines
Imbalance of neurotransmitters
What are the two characteristics of fibromyalgia ?
- hyperalgesia
- allodynia
What are the clinical signs and symptoms of fibromyalgia ?
- muscle pain
- diffuse pain
- tender points bilaterally
- sleep disturbances, fatigue
- diaphragm muscle is affected
- central sensitization of pain (wind up response)
- high level of muscle activity during ADLs
To which autoimmune disease is linked fibromyalgia ?
RA
What are the main tender points in fibromyalgia ?
- occiput
- lower cervical
- trapezium
- supraspinatus
- second rib
- lateral epicondyle of the elbow
- gluteals
- greater trochanter
- knee
What are the fibromyalgia criteria ?
If the following conditions are met :
- widespread pain index > 7 and symptom severity scale > 5 or WPI of 4-6 and SSS»_space;9
- generalized pain, defined as pain in at least 4 of 5 regions
- symptoms have been generally present for at least 3 months
What are the exercise recommandations for fibromyalgia management?
- strengthening exercies : low resistance training 10% intensity increase after 2 weeks if no symptoms exageration
- aerobic exercises : moderate intensity
(Combined) - therapeutic exercises such as tai chi, yoga, Nordic walk;ing, hydrotherapy for pain relieve.
