Autoimmune/systemic disorders

Question 1

WHAT is fibromyalgia?

Answer 1

SYNDROME which has physical, mental & social implications

Question 2

What are risk factors for fibromyalgia?

Answer 2

prolonged anxiety, stress, hypothyroidism, infection, trauma, rapid steroid withdrawal

Question 3

What CNS changes are seen with fibromyalgia?

Answer 3

increased substance P & decreased serotonin/HPA axis activity (central sensitization

Question 4

How is fibromyalgia diagnosed?

Answer 4

widespread pain > 3 mths, presence of 11/18 “tender points”

Question 5

Physiological effects of fibromyalgia:

Answer 5

decreased REM sleep/decreased GH
decreased blood circulation at rest, with exercise (fatigue) & barometric pressure changes
decreased use of diaphragm (access. muscles)
increased resting tone of muscles

Question 6

Lifestyle modifications to improve QOL:

Answer 6

education
aerobic conditioning (increased endog. opiates)
increase rest, pace activities
reduce stress, relaxation techniques
focus on nutrition
minimize painful stimuli

Question 7

PT considerations for fibromyalgia

Answer 7

aquatic exercise (low impact), walking/cycling
gentle stretching
manual therapy
minimize eccentric bc increased DOMS
avoid: jumping, heavy weights, stretching in end/pain range, high intensity aerobics, aggressive trigger point treatments
aerobic exercise

Question 8

What is ankylosing spondylitis?

Answer 8

spondyloarthropathy -inflammation of joints of spine

asymmetric involvement of small number of peripheral joints (SI, hip, shoulder)
inflammation of tendon/ligament-bone interface initially lumbar spine & SI joints & cartilage replaced by bone --> bamboo spine
systemic manifestations (IBS, fever, fatigue, loss of appetite, weight loss)

Question 9

Prevalance of AS

Answer 9

males > females
ages 15-40
women - milder cases/less spinal involvement

Question 10

Clinical symptoms of AS

Answer 10

insidious onset LBP, buttock or hip pain > 3 mnths
dull ache/poorly localized, sometimes sharp
becomes constant, increased w/ rest/decreased w/ movement
buttock pain may change sides
morning tenderness 1 hour
SI pain to palpation w/ paraspinal spasms

Question 11

Clinical findings

Answer 11

equal loss of ROM all planes
loss of lumbar lordosis & increased thoracic kyphosis
painful limitations of Cx spine
decreased chest expansion
hip flexion contractures

Question 12

Most helpful imaging test to diagnose AS

Answer 12

MRI (STIR images-cartilage changes)

Question 13

Drugs used to treat AS

Answer 13

DMARDs (prevent progression)

Question 14

PT implications

Answer 14

consistency is key
stretch shortened muscles (chest flexors/hip flexors
AVOID flexion exercises, exercise into extension
avoid high impact
aquatic therapy
sleep in prone

Question 15

Prognostic indicators for AS

Answer 15

first decade severity indicates long term severity

onset of hip disease

Question 16

Prevalance of Systemic lupus erythematosus

Answer 16

ages 14-40

women 90%

Question 17

Risk factors for SLE

Answer 17

pregnancy/estrogens, chemical exposure, UV radiation, diet, viral infetion, immunization, stress

Question 18

What is SLE/symptoms?

Answer 18

autoimmune disorder 
no 2 ppl have same symptoms
flares/remissions
symmetrical pain, unexplained fever, extreme fatigue, red rashes (butterfly)
raynaud's
mouth ulcers/swollen glands
anemia
HA, dizziness, confusion
seizures/depression

Question 19

Chronic effects of SLE

Answer 19

pulmonary hypertension, atelectasis, HTN, kidney disease, discoid rash, osteoporosis/arthritis

Question 20

Meds used for SLE

Answer 20

antimalarials - prevent flares
Corticosteroids
immunosuppressives
DMARDs
Anti-inflammatories

Question 21

Best types of intervention for SLE

Answer 21

walking/cycling
DO NOT use vigorous intensity exercise w/ acute flare
rest 3 min b/w sets of strength training
postural correction
educate on energy conservation

Question 22

Outcome measures used for SLE

Answer 22

fatigue severity scale

SLE disease activity index

Question 23

prognosis for SLE

Answer 23

10 year survival 90%

renal failure most common cause of death, CNS dysfunction next

Question 24

What is sickle cell anemia?

Answer 24

autosomal recessive disorder
abnormal hemoglobin (crescent shaped during deoxygenation)

Question 25

Vasoocclusive crisis

Answer 25

sickle cell anemia
pain everywhere - ischemic tissue damage, 5-6 days hospitalization
NSAIDs, opioids

Question 26

Acute chest syndrome

Answer 26

sickle cell anemia
leading cause of death
symptoms: fever, cough, chest pain & difficulty breathing
Analgesics, hydration, O2 supplementation, incentive spirometry, antibiotics

Question 27

Outcome measures used for sickle cell anemia

Answer 27

6 min walk test
fatigue impact scale
sickle cell impact measuring scales

Question 28

Prognosis for sickle cell anemia

Answer 28

median age of death is 42 for men/48 for women