Chpt. 8 RA, AS, Autoimmune Diseases Flashcards
How is OA initiated? which leads to breakdown or decreased production of what?
- by mechanical forces
- cartilage (cartilage also turns into bone when baby)
Primary OA is ____ but Secondary OA arises after what 4 reasons?
- unknown
- trauma
- inflammatory joint disease
- metabolic (hemochoromatosis) disorder
- endocrine (diabetes) disease
*What are the 8 common affected joints in OA?
- Cervical/Lumbar spine
- 1st CMC joints
- PIP
- DIP
- hip
- knee
- subtalar joint
- MTP (metatarsophalangeal) joint
*The ___ is affected in Heberden’s nodes?
DIP
*The ___ is affected in Bouchard’s nodes?
PIP
*What are 3 differences between OA and RA?
OA: nonsystemic, non-inflammatory, localized pahology
RA: systemic, inflammatory disease; affect multiple joints (affects Organ systems)
What is the basic difference between RA and OA?
RA: inflammed or erroded= need medication to reduce pain
OA: mechanical problem, NOT inflamation =block, osteophytes etc.
What are the 2 extreme scales for the Functional status of an RA client ?
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
**What is the Stage 1 scale for the Progression of RA?
- no destructive changes roentgenographic examination (other than evidence of osteoporosis)
**What is the Stage of 4 RA?
-Fibrous/ or bony ankylosis
- cartilage and bone destruction
- Joint deformity, such as subluxation, ulnar deviation, or hyperextension
- Extensive muscle atrophy
**What are 7 Inflammatory Arthropathies (disease of joint)?
- Rheumatoid arthritis
- Spondyloarthropathies
- SLE (Lupas)
- Scleroderma (also affects joints)
- Vasculitis (blood vessels)
- Infectious: septic joint, Lyme, gonococcal, hepatitis (monoarticular)
- Post-infectious: Reactive arthritis, rheumatic fever, parvo B19 (virus)
Why is the neck stiff in RA?
-inflammation of tendons in neck near C1-C2
What is the Tinel’s sign?
- tap on MEDIAN nerve to see if it’s compressed due to inflammation of tendon sheath
- a method to detect irritated nerves
What are 4 basic signs of early inflammatory response in RA in a joint?
- Osteoperosis in bones
- Inflammation of synovium
- Loss of cartilage
- Increased synovial fluid
*What are 2 rare variants/diseases with RA?
- FELTY syndrome: RA + splenomegaly (enlarged spleen)
2. STILL disease: jevenile (kids), fever, hepatosplenomegaly (enlarged liver and spleen)
What is our PT focus for RA (3) ?
- EXERCISE (decrease pain/swelling/ increase R.O.M)
- MODALITIES (TENS, IFC, acupuncture)
- JOINT MOBILITY (traction and glides to provide relief)
*What are 2 ex. for Group 1: Non Steroidal Anti-Inflammatory Drugs” or ‘NSAIDs’ ?
- IBUPROFEN (most common)
-COX-2 inhibitors: prevents inflammation; doesnt let WBC do their job
*What is an example for Group2:
‘Disease Modifying Anti-Rheumatic Drugs’ or ‘DMARDS’?
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
What is an example for Group3:
Cortico-Steroids or just Steroids?
PREDNISONE: relieves inflammation
*What is an example for Group4:
‘Biological Response Modifiers” or ‘BRM’s’?
Etanercept : inhibit action of cytokine called the “Tumor Necrosis Factor=TNF “
*they attack tumours/cancer
What are 4 exercise focuses for R.A?
- Maintaining appropriate body weight.
- Sustaining good postural alignment.
- Developing good muscular strength and length.
- Correct movements during functional activities.
What is important to work on in Osteoarthritis, due to joint inflammation?
-Re-establish muscle LENGTH and STRENGTH around the joint
What are 2 important things to teach R.A patients when inflammation fluctuates?
- How to recognize Symptoms
- How to Modify activity according to symptom development and stage of illness (when inflammation occurs, stop or decrease EXERCISE)
What type of exercises are good for RA?
How long do you hold it for?
- isometric contractions= (muscle contraction w/out moving/irritating joint)
- 6 sec. WORK, 20 sec. REST
- What 2 type of exercises are good for OA?
- Isotonic contractions usually,
Isometric contraction in ACUTE phase - Aquatic Therapy!!!
What are some benefits for Aquatic Therapy? (3)
- Allowing performance of movement patterns that may not be possible on land because of balance or strength deficits.
- Providing muscle relaxation.
- Modifying pain perception through sensory stimulation.
What are some Spondyloarthropathies (arthritis in Spine) ? (5)
- Ankylosing spondylitis
- Reactive arthritis= “Reiter’s syndrome”
- Psoriatic arthritis
- Juvenile spondyloarthropathy (spine disease)
- Axial arthropathy associated with inflammatory bowel disease
*What is very similar to RA but pain mainly stays in the back?
Describe 2 criterias for this disease?
Ankylosing Spondylitis:
1. Low back pain and (morning) stiffness of greater than 3 months duration
- Limitation of motion of the lumbar spine in both the sagittal and frontal planes, limitation of chest expansion
**What is a very good exercise for Ankylosing spondylitis (AS)?
Extension
*What is Ankylosing spondylitis (AS)?
WHEN and WHO does it affect more, men or women?
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)
*What are 4 treatments for AS?
- Reduce inflammation (modalities ex.laser)
- Exercise program to maintain/improve Mobility.
- Extension exercises !!!!!!!!
- ROM, stretching strengthening
*****What is Uveitis ?
- Inflammation of the anterior uveal tract (part of the EYE)
- Uveitis presents as acute unilateral pain, photophobia, and blurring of VISION
What are 3 symptoms of Uveitis?
- Pain
- Redness
* 3. Visual changes such as floaters (debris in the visual field)
*What are 4 Non-Inflammatory Diseases?
- Fibromyalgia
- Chronic Fatigue Syndrome
- Multiple ChemicalSensitivities
- Gulf War Syndrome
What is Fibromyalgia?
fibro=fibers
myalgia= muscle
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
When is Fibromyalgia triggered and who is mostly affected by this condition?
- intensified by physical or mental stress, poor sleep, trauma
- females
There are 2 types of Fibromyalgia: Primary and Secondary.
Who and when does Primary (PFS) usually occur?
- type A females
- stressed, tense, depressed, anxious
***How is Fibromyalgia diagnosed?
Out of 18 how many tender point sites have to affected and last for how long?
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)
What is the main prescription of Fibromyalgia ?
light aerobic exercises = main prescription/treatment
What is Chronic Fatigue Syndrome (CFS) ?
What is the CAUSE?
- 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
Which gender is mostly affected and which age group?
Women; 30-50
What are other 3 symptoms are associated with CFS?
- Lymph node tenderness
- swelling in the Neck or Armpit
- Sore throat, red but without pus
What are 6 Inflammatory Arthropathies?
- Reactive arthritis aka Reiter’s syndrome
- Psoriatic arthritis
- Gout
- Lupus
- Systemic Scleroderma/Sclerosis
- Vasculitides
What is Reactive arthritis aka Reiter’s syndrome?
- 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
What is HLA-B27?
- 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
In Reiter Syndrome, inflammation is at the tendinous insertion into ___, rather than ___ (common in insertions into calcaneus, ___ , and subtalar joints)
- bone
- synovium
- talar
***What are some areas affected by Reiter Syndrome?
Asymmetric joint stiffness:
- knees
- ankles
- feet
- low back pain with radiation to buttocks and thigh
What is Psoriatic Arthritis?
Form of arthritis that affects some people who have psoriasis
ex. affects DIP joints or knees
What is Gout?
Age?
peripheral arthritis resulting from the deposition of sodium urate crystals in one or more joints (USUSALLY 1ST MCP)
age: 30-60
What is Systemic Lupus Erythematosus (SLE)?
- a skin disease caused by symptoms such as
- fever, fatigue, weight loss, or anemia (like R.A.)
- also Recurrent miscarriages (because of inflammatory process)
How is lupus detected in young women?
-general inflammation
What are 2 drugs used for Lupus Erythematosus (SLE)?
Might there be other diseases involved when having Lupus?
- NSAIDS (musculoskeletal complaints and mild serositis)
- Prednisone
Yes!
What is the first symptom of Diffuse SSc (Systemic Sclerosis= Scleroderma)?
What are other 2 symptoms/signs of Scleroderma?
- Hand swelling
1. “mouse face”
2. Ulcer
What is Systemic Sclerosis/Scleroderma?
autoimmune or connective tissue disease. It is characterized by thickening of the skin caused by accumulation of collagen
What is Vasculitis?
refers to a varied group of disorders which all share a common underlying problem of inflammation of a blood vessel
What are 2 signs of Vasculitides ?
- fever of unknown origin
- unexplained stroke: undiagnosed vasculotide
What are some examples of treatment for Vasculitis?
- cytotoxic/immunosuppressive agents
- IVIG
- Surgery
- Anticoagulation
What are 3 symptoms of Giant Cell/Temporal Arteritis?
*main symptom?
*mainly inflammation of peripheral
- Visual
- Claudications (jaw/tonque)
- Musculoskeletal
Kawasaki disease (mucocutaneous lymph node syndrome) is most common with which population?
What are some symptoms?
Baby Asian population
- red eyes,
- dry cracked lips
- red tongue
What is Kawasaki disease (mucocutaneous lymph node syndrome)?
causes inflammation in the walls of medium-sized arteries throughout the body, including the coronary arteries, which supply blood to the heart muscle
What is Buerger’s disease?
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
Polyarteritis Nodosa is a condition in which the large ___ ___ is ____
- blood vessel
- inflamed
All of the conditions listed above are autoimmune except for ____
OA!
