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*CLINICAL EXERCISE PHYSIOLOGY > EXAM3/CH24- Arthritis > Flashcards

EXAM3/CH24- Arthritis Flashcards

1
Q

arthritis

A

generic term for conditions that involve inflammation of 1 or more joints
-arthritis is an overall blanket term

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2
Q

there are more than ____ different forms of arthritis

A

100

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3
Q

how are the different forms of arthritis characterized

A

by varying
-degrees of joint damage
-restriction of movement
-functional limitation
-pain

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4
Q

osteoarthritis

A

what we think of when we think of arthritis

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5
Q

most common form of arthritis

A

osteoarthritis

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6
Q

what is the leading cause of disability in the U.S.

A

arthritis

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7
Q

____ million are affected with arthritis

A

52.5 million
-23% of adults

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8
Q

arthritis has debilitating effects on ____

A

social functioning
-increased isolation, pyschological stress, depression
-decreased QOL (quality of life)

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9
Q

what is most affected by osteoarthritis

A

-hands
-feet
-spine
-weight-bearing joints
(associated with commonly used)

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10
Q

why is “wear + tear” a common misnomer for arthritis

A

people think that because of overuse or repetitive movements, that is what is causing the pain
-misnomer because its not the repetition or wear + tear that is causing the pain but rather a result of what our body does in response to that wear + tear

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11
Q

secondary issue of osteoarthritis

A

loss of strength due to reduced movement
-this is because when people have OA they are in pain, + when people are in pain they don’t want to move
-if we are sedentary + not using muscles, they are going to atrophy

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12
Q

in order to have a comprehensive program for someone with OA, what should we do

A

make sure we are including some aspect of resistance training to counteract that atrophy that likely has occurred from not moving

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13
Q

what is osteoarthritis caused by

A

continuous abnormal remodeling of joint tissues driven by inflammatory mediators

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14
Q

what does osteoarthritis result in

A

-loss of cartilage
-bone rubbing on bone
-periarticular muscle loss
-ligaments becoming strained + weakened
-pain

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15
Q

severity of OA

A

mild to severe

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16
Q

mild OA

A

-beginning of loss of cartilage
-synovial fluid becomes effected
-bone spurs forming

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17
Q

what happens if we don’t address earlier stages of OA through exercise + weight loss

A

those initial formations will just worsen + worsen until subchondral bone becomes involved, inflammatory mediators produced there

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18
Q

bone on bone

A

-very bumpy
-may even make noise

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19
Q

OA pathophysiology

A
  1. cartilage damage (pitted, rough, brittle)
  2. underlying bone thickens to reduce load on cartilage, causing
  3. swelling of synovial membrane + increased synovial fluid
  4. thickening of surrounding ligaments
  5. narrowing of joint space
  6. loss of cartilage, bone on bone, weakened ligaments
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20
Q

OA pathophysiology- underlying bone thickens to reduce load on catilage

A

this is our body trying to do a good thing that ultimately becomes a bad thing

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21
Q

OA pathophysiology- swelling of synovial membrane + increased synovial fluid

A

immune system sends inflammatory mediators to try + fix the issue but because of this swelling, we get thickening of surrounding ligaments

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22
Q

bone spurs

A

-bone spurs is another thing that tries to be good but ends up being bad
-as that cartilage is breaking down, our body tries to create bone spurs to create some type of covering but they obviously are just painful for the person with the OA

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23
Q

rheumatoid arthritis

A

-chronic autoimmune disorder, immune system is attacking healthy issue
-characterized by systemic inflammation + symmetrical polyarthritis (affects > 4 joints)

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24
Q

rheumatoid arthritis is more common in women/men

A

women

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25
Q

rheumatoid arthritis affects > ____ joints

A

4

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26
Q

principal target of rheumatoid is what

A

synovial joints (synovitis)

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27
Q

rheumatoid arthritis is mediated by what system

A

immune system

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28
Q

synovitis

A

inflammation that stems from inflammatory markers being in synovial fluid

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29
Q

secondary effects of RA

A

-muscle loss
-increased adiposity
-fatigue
-cardiovascular disease
-metabolic syndrome
-type 2 diabetes
-osteoporosis risk

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30
Q

what causes the muscle loss in RA

A

lack of movement

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31
Q

most of the secondary effects of RA are due to what

A

the fact that people with this want to be sedentary as a result of chronic pain

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32
Q

RA pathophysiology

A
  1. chronic immune dysfunction attacking healthy tissue + joints
  2. synovial joint inflammation (synovitis) from excessive fluid production + synovial cell hyperplasia
  3. formation of pannus (pannus = abnormal tissue layer over the joint)
  4. cartilage + bone erosion
  5. joint destruction + ankylosis
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33
Q

ankylosis

A

complete stiffening + immobility of the joint all together
-RA leads to this in its most severe form
-no ability to flex knee or finger, etc.

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34
Q

how does OA look

A

joint space is narrowed + there is some inflammation in there

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35
Q

how does RA look

A

see synovitis aspect of it, synovial fluid full of inflammatory markers

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36
Q

ankylosing spondylitis

A

-chronic autoimmune disorder
-primarily effects spine + sacroiliac joint
-also causes synovitis in peripheral joint

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37
Q

ankylosing spondylitis is more common in women/men

A

men

38
Q

how can anyklosing spondylitis be diagnosed

A

blood test
-looking at those specific proteins + inflammatory markets, they can differentiate between AS vs RA; slight difference in the markers present

39
Q

anklyosing spondylitis pathophysiology

A
  1. chronic autoimmune response
  2. inflammation in ligaments of lower spine
  3. stimulates bone growth (spurs) within the ligaments
  4. growths form bridges between adjacent vertebrae which eventually fuse together
  5. subsequent low back pain + immobility
40
Q

2 most common areas for ankylosing spondylitis

A

spine + hips
-if a physician suspects AS, this will be the first place they will look

41
Q

syndesmophytes

A

bone spurs on the vertebrae
-they grow so much that we get fusion of the vertebrae

42
Q

what leads to fusion

A

combination of erosion + syndesmophytes

43
Q

secondary effects of all types of arthritis

A

-exercise tolerance
-muscle strength + endurance
-aerobic capacity
-range of movement (ROM)
-biomechanical efficiency
-proprioception
-social functioning

44
Q

if someone is in crhonic pain…

A

they will not want to exercise unless it is painfree or exercise that won’t exacerbate pain anymore

45
Q

what exercise is great for arthritis

A

swimming
-alleviates weightbearing

46
Q

biomechanical efficiency

A

the compensations our bodies make to injuries
-ex: lean on one side more or walk a certain way

47
Q

stages of arthritis

A

-acute (mild)
-chronic (moderate)
-chronic with acute exacerbation of joint symptoms (severe)

48
Q

stages of arthritis

acute (mild)

A

reversible signs + symptoms in the joint related to synovitis

49
Q

what is the only reversible stage of arthritis

A

acute (mild)
-once arthritis becomes chronic, cannot be reversed

50
Q

what is one of the key things someone with acute arthritis should do

A

start to exercise + lose weight

51
Q

stages of arthritis

chronic (moderate)

A

stable but irreversible structural damage brought on by the disease process
-stable, not the the point where it is really bad but it is irreversible

52
Q

stages of arthritis

chronic with acute exacerbation of joint symptoms (severe)

A

increased pain + decreased ROM and physical function
-worst stage of arthritis

53
Q

clinical considerations

signs + symptoms related to affected joints

A

-pain
-stiffness
-effusion
-joint locking
-synovitis
-deformity
-crepitus
-bone spur formation

54
Q

effusion

A

swelling from accumulation of water/fluid around the joint

55
Q

synovitis

A

inflammation of joint membrane

56
Q

crepitus

A

abnormal popping/cracking sound

57
Q

history + physical exam

A

-extent + severity of musculoskeletal symptoms, ROM, alignment, + function
-family history (genetic component) for arthritis
-current functional level + attempts at exercise interventions
-extra-articular features specific to types of arthritis to aid diagnosis

58
Q

4 cardinal signs of arthritis

A

-redness
-swelling
-pain
-heat

59
Q

if you have a family member with arthritis…

A

you are at risk too

60
Q

diagnostic testing for arthritis

A

-no definitive tests or markers for arthritis exist
-some serum + synovial fluid tests can assist in arthritis type differentiation
-joint imaging, MRI, + ultrasound may help assess severity + establish anatomical abnormalities

61
Q

what is the best sample you can get for diagnostic testing

A

synovial fluid

62
Q

often times how do we do diagnostic testing

A

blood test

63
Q

what may be needed in patients who are at risk of CVD

A

cardiorespiratory testing

64
Q

those with RA are ____ x as likely to have CVD + why

A

2x as likely
-due to the associated systemic inflammation

65
Q

who else may have risk factors for CVD

A

those who are sedentary for extended periods

66
Q

what can be performed to establish a baseline for changes + to guide exercise prescription

A

musculoskeletal + ROM testing

67
Q

keys to exercise testing for arthritis

A

-small increases in intensity
-mode appropriate

68
Q

keys to exercise training- small increases in intensity

A

because WE DO NOT WANT TO MAKE THE PROBLEM WORSE

69
Q

appropriate mode- treadmill

A

minimal to mild joint impairment
-more for someone in beginning stages because treadmill will be too high impact, especially if lower body is affected

70
Q

appropriate mode- cycle ergometer

A

mild to moderate LOWER extremity joint impairment
-great, low impact

71
Q

appropriate mode- arm ergometer

A

severe lower extremity joint impairment

72
Q

what should be emphasized to control arthritis activity + minimize symptoms

A

exercise + medication

73
Q

____ % of adults with any form of arthritis reported performing no leisure time physical activity

A

32%

74
Q

goals of arthritis treatment

A

-counteract physical inactivity (get them moving)
-control symptoms, reduce pain, improve function
-restore/maintain a healthy body composition
-reduce comorbidity symptoms + risk

75
Q

non-pharmacologic treatment for arthritis

A

-education
-physical + occupational therapy
-braces + bandages
-canes + other walking aids
-shoe modification + orthotics
-ice + heat modalities
-weight reduction
-avoidance of repetitive-motion occupations
-joint irrigation + joint surgery (in select circumstances)

76
Q

what varies according to the form of arthritis

A

pharmaceutical interventions

77
Q

most common pharmaceutical interventions for arthritis

A

-NSAIDs (help with inflammation)
-analgesics (topical pain relievers)
-corticosteroids

78
Q

what is available for autoimmune inflammatory arthropathies, RA, + AS

A

disease-modifying antirheumatic drugs (DMARDs)
-specially geared toward mediating the autoimmune response

79
Q

exercise prescription goals for arthritis

A

-maintain or improve physical function
-comprehensive (address muscle strength, cardiorespiratory fitness, + ROM)
-improve body composition +, when appropriate, reduce body weight
-reduce the risk of comorbidities
-reduce inflammation, pain, + stiffness
-prevent contractures + deformities

80
Q

exercise prescription considerations

A

-joint impairments
-level of fitness
-surgeries
-comorbidities
-age
-goals
-medications
-lifestyle

81
Q

dexercise prescription consierations cont.

A

-preventing musculoskeletal injury (avoid high impact)
-fatigue
-previous joint replacement (avoid high impact)
-time of day (morning stiffness, cold weather)
-water therapy (avoid chlorine for some RA patients)
-footwear (orthotics, shock support)
-patients with ankylosing spondylitis (AS) may have a back brace
-corticosteroids (long-term bone loss/muscle atrophy)
-body composition

82
Q

KAATSU study background

A

low-load resistance training with blood-flow restriction (BFR) is a potential intervention for lowering training-related joint pain

83
Q

KAATSU study participants

A

60+ y.o. with symptomatic knee osteoarthritis

84
Q

KAATSU study groups

A
  1. moderate-intensity (60% 1RM) resistance training (control)
  2. low-load (20% 1RM) resistance training with BFR (KAATSU group, experimental group)
85
Q

KAATSU study training

A

-3 sessions/wk for 12 weeks
-4 lower body exercises per session
-3 sets to volitional fatigue

86
Q

control group of KAATSU did what type of training

A

standard resistance training

87
Q

what did KAATSU study show

A

doing a low load resistance training with blood flow restriction will yield similar if not better results to resistance training program than someone that does standard moderate resistance training

88
Q

KAATSU training

A

-same overall frequency, exercises, and sets
-20% 1RM completed to volitional fatigue
-BP cuff inflated prior to first lift
-1 minute rest period between each set (cuff remains inflated)
-3 minute rest period between machines

89
Q

weight for KAATSU training

A

-use a much lower weight in these exercises
-lower the weight = less stress we are putting on injured area/affected joint

90
Q

idea behind KAATSU training

A

idea is that by cutting off this blood flow we force the body to mimic the same type of intensity at the 20% 1RM with blood flow restricted vs 60% 1RM with no restriction

91
Q

KAATSU study results

A

by 12 weeks, compared to moderate-intensity group, BFR group had:
*greater improvement in knee extensor strength
*faster 400 m walk times
*lower self-reported knee pain

*CLINICAL EXERCISE PHYSIOLOGY (15 decks)

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