Autoimmune: RA, AS, and scleroderma Flashcards
what is slceroderma
- chronic connective tissue disease
- autoimmune rheumatic disease
- skin is stiff hard and tight
What are the two types of scleroderma
- localized scleroderma: only skin affected
- systemic scleroderma: affects other organs, such as heart, lungs, kidneys and digestive tract (most common)
Who does scleroderma mostly affect
- women>men
- between ages 30-50
- can run in families
What are common signs and symtoms of scleroderma
- skin changes
- raynaud’s disease
- Gastroesophageal reflux disease (GERD)
- restrictive lung disease/pulmonary fibrosis (lose elasticity)
- pulmonary HTN
- fatigue
Pulmonary fibrosis => pulmonary HTN: cant expand lungs causes hypoxia which causes the lungs to shunt blood to other areas of the lungs => leads to an increase risk of R heart failure
what are some medications used to treat scleroderma
- penicillamine (helps maintain skin elasticity)
- interferon-gamma (immunomodulator) immune effetcs
- calcium-channel blockers for raynauds: vasodilation
- antihistamine for itching
- organ specific medication
*there is no FDA approved drugs specifically for scleroderma
What are other potential treatments for scleroderma
- therapy: OT/PT for functional training, cardiovascular and pulmonary
- cosmetic procedures: UV light or laser for skin lesions/scars
- regular dental care, medical check ups
- surgery: usually related to severe raynaud’s disease (digit amputation)
*bad teeth can cuase heart disease
what is ankylosing spondylitis
- Chronic inflammatory disease
- unknown origin
- first affects spine and adjacent structures
- can progress to fusion of inovlved joints
who does ankylosing spondylitis typically affect
- develops between ages 17-45
- males more common
ankylosing spondylitis and back pain
also what symptoms are common
- usually affects low back and SI joints
- inflammatory vs mechanical pain
- worse with immobility and improved with activity
- relieved with NSAIDs
- fatigue
typically inflammatory pain
How is ankylosing spondylitis diagnosed
- X-ray, MRI,
- inflammatory markers: CRP, ESR, HLA-B27
- history
- HLA-B27 present in 90% of people with AS but only about 5% of people with HLA-B27 have AS
What are some PT considerations with ankylosing spondylitis
- flexibility: focus on extension avoid flexion, prone may help at night
- osteoporosis
- falls: spinal fracture
- cardiopulmonary fitness: increase risk fo CVD due to decrease fitness
- Land based may be better due to osteoporosis but aquatic can be good for pain
How is ankylosing spondylitis managed medically
- NSAIDs
- TNFi (tumor necrosis factor inhibitor) usually a cancer drug
- consider anti-rheumatic drugs or biologics if other drugs do not work
- systemic glucocorticoids not recommended but steriod injections may help during acute inflammation
What is Rheumatoid Arthritis?
- a chronic systemic inflammatiry autoimmune disorder
what is the clinical manifestation of Rheumatoid Arthritis
- morning stiffness related to immobilization which lasts great than 2 hours after rising
What are the typical features of Rheumatoid Arthritis
- chronic inflammation of synovium, perihperal articular cartilage, subchondral marrow spaces
- pannus formation: excess of cytokines, synovial fluid
- leads to erosion of articular cartilage
what is the etiology of Rheumatoid Arthritis
-
- unknown
- potentially triggered by bacteria or viruses
how is Rheumatoid Arthritis diagnosed
- based on clinical evidence and lab findings
labs include:
- decreased red blood cell (specific to RA)
- increased sed/ESR rate
- positive Rh factor
manifestations of Rheumatoid Arthritis
- muscule fibrosis and atrophy
- vasculitis, pericarditis
- fatigue
- weight loss
- generalized stiffness
- anemia
- pleural effusion, interstitial lung disease (becomes damaged)
- keratoconjunctivitis
- increased susceptibility to infection
- sensory loss
What is the prevalence of Rheumatoid Arthritis
- increases with age, peak incidence in 6th decade of life
- 2-3 times higher in women than men
- patients who smoke, have DM, or physically inactive tend to be at higher risk factors for developing co-morbidities such as CVD or respiratory disease
what are manifestations of Rheumatoid Arthritis in the joint specifically
- most joints involved within first year of disease
- joint mechanics change due to cartilage degeneration: ligamentous laxity, abnormal lines of pull from tendons, joint deformity
- cervical spinal cord compression may occur in some cases: radiular symptoms refer quicker
- due to tenosynovitis of the transverse ligament of C1 and carvial apophyseal joints
joint dysfunction caused by RA
- tenosynovitis
- synovitis: can cause nerve compression
- common hand deformities
- common feet deformities
hand deformities can impair function and ADL performance
what is a common foot deformity with Rheumatoid Arthritis
- subluxation of MT heads and migration of MTP fat pad result in significant pain in walking
Treatment for Rheumatoid Arthritis
goals for treatment
- reduce inflammation
- provide pain relief
- maintain and restore joint function
- decrease development of joint deformity
- MEds: NSAIDs, corticosteriods, slow acting anti-rheumatic drugs and DMARDs
PT intervention for Rheumatoid Arthritis
- education: balancing rest and activity
- avoid forceful stretching
- whole body functional strengthening at low intentisites
- aquatic therapy: beneficial but water temp may need to be higher than usual
- modalities: low level laser, US, heat, TENS
surgeries with
Rheumatoid Arthritis
- tenosynovectomy
- tendon repair
- synovectomy
- arthrodesis
- arthroplasty
