Chpt. 8 RA, AS, Autoimmune Diseases Flashcards

1
Q

How is OA initiated? which leads to breakdown or decreased production of what?

A
  • by mechanical forces

- cartilage (cartilage also turns into bone when baby)

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2
Q

Primary OA is ____ but Secondary OA arises after what 4 reasons?

A
  • unknown
  • trauma
  • inflammatory joint disease
  • metabolic (hemochoromatosis) disorder
  • endocrine (diabetes) disease
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3
Q

*What are the 8 common affected joints in OA?

A
  1. Cervical/Lumbar spine
  2. 1st CMC joints
  3. PIP
  4. DIP
  5. hip
  6. knee
  7. subtalar joint
  8. MTP (metatarsophalangeal) joint
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4
Q

*The ___ is affected in Heberden’s nodes?

A

DIP

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5
Q

*The ___ is affected in Bouchard’s nodes?

A

PIP

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6
Q

*What are 3 differences between OA and RA?

A

OA: nonsystemic, non-inflammatory, localized pahology

RA: systemic, inflammatory disease; affect multiple joints (affects Organ systems)

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7
Q

What is the basic difference between RA and OA?

A

RA: inflammed or erroded= need medication to reduce pain
OA: mechanical problem, NOT inflamation =block, osteophytes etc.

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8
Q

What are the 2 extreme scales for the Functional status of an RA client ?

A

Class 1: Completely able to perform usual activities of daily living
Class 4: Limited in ability to perform usual self- care, vocational/avocational (job+hobby) activities

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9
Q

**What is the Stage 1 scale for the Progression of RA?

A
  • no destructive changes roentgenographic examination (other than evidence of osteoporosis)
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10
Q

**What is the Stage of 4 RA?

A

-Fibrous/ or bony ankylosis

  • cartilage and bone destruction
  • Joint deformity, such as subluxation, ulnar deviation, or hyperextension
  • Extensive muscle atrophy
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11
Q

**What are 7 Inflammatory Arthropathies (disease of joint)?

A
  1. Rheumatoid arthritis
  2. Spondyloarthropathies
  3. SLE (Lupas)
  4. Scleroderma (also affects joints)
  5. Vasculitis (blood vessels)
  6. Infectious: septic joint, Lyme, gonococcal, hepatitis (monoarticular)
  7. Post-infectious: Reactive arthritis, rheumatic fever, parvo B19 (virus)
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12
Q

Why is the neck stiff in RA?

A

-inflammation of tendons in neck near C1-C2

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13
Q

What is the Tinel’s sign?

A
  • tap on MEDIAN nerve to see if it’s compressed due to inflammation of tendon sheath
  • a method to detect irritated nerves
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14
Q

What are 4 basic signs of early inflammatory response in RA in a joint?

A
  1. Osteoperosis in bones
  2. Inflammation of synovium
  3. Loss of cartilage
  4. Increased synovial fluid
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15
Q

*What are 2 rare variants/diseases with RA?

A
  1. FELTY syndrome: RA + splenomegaly (enlarged spleen)

2. STILL disease: jevenile (kids), fever, hepatosplenomegaly (enlarged liver and spleen)

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16
Q

What is our PT focus for RA (3) ?

A
  1. EXERCISE (decrease pain/swelling/ increase R.O.M)
  2. MODALITIES (TENS, IFC, acupuncture)
  3. JOINT MOBILITY (traction and glides to provide relief)
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17
Q

*What are 2 ex. for Group 1: Non Steroidal Anti-Inflammatory Drugs” or ‘NSAIDs’ ?

A
  • IBUPROFEN (most common)

-COX-2 inhibitors: prevents inflammation; doesnt let WBC do their job

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18
Q

*What is an example for Group2:

‘Disease Modifying Anti-Rheumatic Drugs’ or ‘DMARDS’?

A

METHOTREXATE (most common): its a chemotherapy drug, and interferes with DNA and affects cells that reproduce often

*Group 2 primarily used to treat other diseases

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19
Q

What is an example for Group3:

Cortico-Steroids or just Steroids?

A

PREDNISONE: relieves inflammation

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20
Q

*What is an example for Group4:

‘Biological Response Modifiers” or ‘BRM’s’?

A

Etanercept : inhibit action of cytokine called the “Tumor Necrosis Factor=TNF “

*they attack tumours/cancer

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21
Q

What are 4 exercise focuses for R.A?

A
  1. Maintaining appropriate body weight.
  2. Sustaining good postural alignment.
  3. Developing good muscular strength and length.
  4. Correct movements during functional activities.
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22
Q

What is important to work on in Osteoarthritis, due to joint inflammation?

A

-Re-establish muscle LENGTH and STRENGTH around the joint

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23
Q

What are 2 important things to teach R.A patients when inflammation fluctuates?

A
  1. How to recognize Symptoms
  2. How to Modify activity according to symptom development and stage of illness (when inflammation occurs, stop or decrease EXERCISE)
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24
Q

What type of exercises are good for RA?

How long do you hold it for?

A
  • isometric contractions= (muscle contraction w/out moving/irritating joint)
  • 6 sec. WORK, 20 sec. REST
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25
Q
  • What 2 type of exercises are good for OA?
A
  1. Isotonic contractions usually,
    Isometric contraction in ACUTE phase
  2. Aquatic Therapy!!!
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26
Q

What are some benefits for Aquatic Therapy? (3)

A
  1. Allowing performance of movement patterns that may not be possible on land because of balance or strength deficits.
  2. Providing muscle relaxation.
  3. Modifying pain perception through sensory stimulation.
27
Q

What are some Spondyloarthropathies (arthritis in Spine) ? (5)

A
  1. Ankylosing spondylitis
  2. Reactive arthritis= “Reiter’s syndrome”
  3. Psoriatic arthritis
  4. Juvenile spondyloarthropathy (spine disease)
  5. Axial arthropathy associated with inflammatory bowel disease
28
Q

*What is very similar to RA but pain mainly stays in the back?
Describe 2 criterias for this disease?

A

Ankylosing Spondylitis:
1. Low back pain and (morning) stiffness of greater than 3 months duration

  1. Limitation of motion of the lumbar spine in both the sagittal and frontal planes, limitation of chest expansion
29
Q

**What is a very good exercise for Ankylosing spondylitis (AS)?

A

Extension

30
Q

*What is Ankylosing spondylitis (AS)?

WHEN and WHO does it affect more, men or women?

A

chronic inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine (usually ascending)

-20 and 30 years (MEN more than women)

31
Q

*What are 4 treatments for AS?

A
  1. Reduce inflammation (modalities ex.laser)
  2. Exercise program to maintain/improve Mobility.
  3. Extension exercises !!!!!!!!
  4. ROM, stretching strengthening
32
Q

*****What is Uveitis ?

A
  • Inflammation of the anterior uveal tract (part of the EYE)
  • Uveitis presents as acute unilateral pain, photophobia, and blurring of VISION
33
Q

What are 3 symptoms of Uveitis?

A
  1. Pain
  2. Redness
    * 3. Visual changes such as floaters (debris in the visual field)
34
Q

*What are 4 Non-Inflammatory Diseases?

A
  1. Fibromyalgia
  2. Chronic Fatigue Syndrome
  3. Multiple ChemicalSensitivities
  4. Gulf War Syndrome
35
Q

What is Fibromyalgia?
fibro=fibers
myalgia= muscle

A

chronic disorder characterized by achy pain, tenderness, and stiffness of MUSCLES

  • localized areas of the NECK, SPINE , SHOULDERS , and HIPS referred to as pressure points
36
Q

When is Fibromyalgia triggered and who is mostly affected by this condition?

A
  • intensified by physical or mental stress, poor sleep, trauma
  • females
37
Q

There are 2 types of Fibromyalgia: Primary and Secondary.

Who and when does Primary (PFS) usually occur?

A
  • type A females

- stressed, tense, depressed, anxious

38
Q

***How is Fibromyalgia diagnosed?

Out of 18 how many tender point sites have to affected and last for how long?

A

11/18 (classic acupuncture points!)

  • 3 months
  • classic sites: where large nerve innervates a muscle

ex.
- neck (sub occipita)
- shoulder (upp. trap)
- Knees (MCL)
- elbows (lateral epicondyle)

39
Q

What is the main prescription of Fibromyalgia ?

A

light aerobic exercises = main prescription/treatment

40
Q

What is Chronic Fatigue Syndrome (CFS) ?

What is the CAUSE?

A
  • fatigue lasting at least 6 months, and is NOT relieved by rest= AFFECTS THE IMMUNE SYSTEM
  • Cause UNKNOWN : but could be caused by inflamed nervous system pathways; viral illnesses
41
Q

Which gender is mostly affected and which age group?

A

Women; 30-50

42
Q

What are other 3 symptoms are associated with CFS?

A
  • Lymph node tenderness
  • swelling in the Neck or Armpit
  • Sore throat, red but without pus
43
Q

What are 6 Inflammatory Arthropathies?

A
  1. Reactive arthritis aka Reiter’s syndrome
  2. Psoriatic arthritis
  3. Gout
  4. Lupus
  5. Systemic Scleroderma/Sclerosis
  6. Vasculitides
44
Q

What is Reactive arthritis aka Reiter’s syndrome?

A
  • PERIPHERAL ARTHIRITS
  • INFECTION
  • peripheral arthritis lasting longer than 1 month
  • caused by an infection by bacteria that enters via mucosal surfaces…it is associated with HLA-B27, although not always present
45
Q

What is HLA-B27?

A
  • Human leukocyte antigen B27
  • HLA-B27 is a blood test to look for a protein that is found on the surface of white blood cells. These proteins help the body’s immune system tell the difference between its own cells and foreign, harmful substances
46
Q

In Reiter Syndrome, inflammation is at the tendinous insertion into ___, rather than ___ (common in insertions into calcaneus, ___ , and subtalar joints)

A
  • bone
  • synovium
  • talar
47
Q

***What are some areas affected by Reiter Syndrome?

A

Asymmetric joint stiffness:

  • knees
  • ankles
  • feet
  • low back pain with radiation to buttocks and thigh
48
Q

What is Psoriatic Arthritis?

A

Form of arthritis that affects some people who have psoriasis
ex. affects DIP joints or knees

49
Q

What is Gout?

Age?

A

peripheral arthritis resulting from the deposition of sodium urate crystals in one or more joints (USUSALLY 1ST MCP)
age: 30-60

50
Q

What is Systemic Lupus Erythematosus (SLE)?

A
  • a skin disease caused by symptoms such as
  • fever, fatigue, weight loss, or anemia (like R.A.)
    • also Recurrent miscarriages (because of inflammatory process)
51
Q

How is lupus detected in young women?

A

-general inflammation

52
Q

What are 2 drugs used for Lupus Erythematosus (SLE)?

Might there be other diseases involved when having Lupus?

A
  1. NSAIDS (musculoskeletal complaints and mild serositis)
  2. Prednisone

Yes!

53
Q

What is the first symptom of Diffuse SSc (Systemic Sclerosis= Scleroderma)?
What are other 2 symptoms/signs of Scleroderma?

A
  • Hand swelling
    1. “mouse face”
    2. Ulcer
54
Q

What is Systemic Sclerosis/Scleroderma?

A

autoimmune or connective tissue disease. It is characterized by thickening of the skin caused by accumulation of collagen

55
Q

What is Vasculitis?

A

refers to a varied group of disorders which all share a common underlying problem of inflammation of a blood vessel

56
Q

What are 2 signs of Vasculitides ?

A
  • fever of unknown origin

- unexplained stroke: undiagnosed vasculotide

57
Q

What are some examples of treatment for Vasculitis?

A
  • cytotoxic/immunosuppressive agents
  • IVIG
  • Surgery
  • Anticoagulation
58
Q

What are 3 symptoms of Giant Cell/Temporal Arteritis?

*main symptom?

A

*mainly inflammation of peripheral

  • Visual
  • Claudications (jaw/tonque)
  • Musculoskeletal
59
Q

Kawasaki disease (mucocutaneous lymph node syndrome) is most common with which population?

What are some symptoms?

A

Baby Asian population

  • red eyes,
  • dry cracked lips
  • red tongue
60
Q

What is Kawasaki disease (mucocutaneous lymph node syndrome)?

A

causes inflammation in the walls of medium-sized arteries throughout the body, including the coronary arteries, which supply blood to the heart muscle

61
Q

What is Buerger’s disease?

A

inflammation and thrombosis in small and medium-sized blood vessels, typically in the legs and leading to gangrene. It has been associated with smoking.
-tips of fingers are are black due to cigarettes

62
Q

Polyarteritis Nodosa is a condition in which the large ___ ___ is ____

A
  • blood vessel

- inflamed

63
Q

All of the conditions listed above are autoimmune except for ____

A

OA!