EXAM3/CH24- Arthritis Flashcards
arthritis
generic term for conditions that involve inflammation of 1 or more joints
-arthritis is an overall blanket term
there are more than ____ different forms of arthritis
100
how are the different forms of arthritis characterized
by varying
-degrees of joint damage
-restriction of movement
-functional limitation
-pain
osteoarthritis
what we think of when we think of arthritis
most common form of arthritis
osteoarthritis
what is the leading cause of disability in the U.S.
arthritis
____ million are affected with arthritis
52.5 million
-23% of adults
arthritis has debilitating effects on ____
social functioning
-increased isolation, pyschological stress, depression
-decreased QOL (quality of life)
what is most affected by osteoarthritis
-hands
-feet
-spine
-weight-bearing joints
(associated with commonly used)
why is “wear + tear” a common misnomer for arthritis
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
secondary issue of osteoarthritis
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
in order to have a comprehensive program for someone with OA, what should we do
make sure we are including some aspect of resistance training to counteract that atrophy that likely has occurred from not moving
what is osteoarthritis caused by
continuous abnormal remodeling of joint tissues driven by inflammatory mediators
what does osteoarthritis result in
-loss of cartilage
-bone rubbing on bone
-periarticular muscle loss
-ligaments becoming strained + weakened
-pain
severity of OA
mild to severe
mild OA
-beginning of loss of cartilage
-synovial fluid becomes effected
-bone spurs forming
what happens if we don’t address earlier stages of OA through exercise + weight loss
those initial formations will just worsen + worsen until subchondral bone becomes involved, inflammatory mediators produced there
bone on bone
-very bumpy
-may even make noise
OA pathophysiology
- cartilage damage (pitted, rough, brittle)
- underlying bone thickens to reduce load on cartilage, causing
- swelling of synovial membrane + increased synovial fluid
- thickening of surrounding ligaments
- narrowing of joint space
- loss of cartilage, bone on bone, weakened ligaments
OA pathophysiology- underlying bone thickens to reduce load on catilage
this is our body trying to do a good thing that ultimately becomes a bad thing
OA pathophysiology- swelling of synovial membrane + increased synovial fluid
immune system sends inflammatory mediators to try + fix the issue but because of this swelling, we get thickening of surrounding ligaments
bone spurs
-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
rheumatoid arthritis
-chronic autoimmune disorder, immune system is attacking healthy issue
-characterized by systemic inflammation + symmetrical polyarthritis (affects > 4 joints)
rheumatoid arthritis is more common in women/men
women
rheumatoid arthritis affects > ____ joints
4
principal target of rheumatoid is what
synovial joints (synovitis)
rheumatoid arthritis is mediated by what system
immune system
synovitis
inflammation that stems from inflammatory markers being in synovial fluid
secondary effects of RA
-muscle loss
-increased adiposity
-fatigue
-cardiovascular disease
-metabolic syndrome
-type 2 diabetes
-osteoporosis risk
what causes the muscle loss in RA
lack of movement
most of the secondary effects of RA are due to what
the fact that people with this want to be sedentary as a result of chronic pain
RA pathophysiology
- chronic immune dysfunction attacking healthy tissue + joints
- synovial joint inflammation (synovitis) from excessive fluid production + synovial cell hyperplasia
- formation of pannus (pannus = abnormal tissue layer over the joint)
- cartilage + bone erosion
- joint destruction + ankylosis
ankylosis
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.
how does OA look
joint space is narrowed + there is some inflammation in there
how does RA look
see synovitis aspect of it, synovial fluid full of inflammatory markers
ankylosing spondylitis
-chronic autoimmune disorder
-primarily effects spine + sacroiliac joint
-also causes synovitis in peripheral joint
ankylosing spondylitis is more common in women/men
men
how can anyklosing spondylitis be diagnosed
blood test
-looking at those specific proteins + inflammatory markets, they can differentiate between AS vs RA; slight difference in the markers present
anklyosing spondylitis pathophysiology
- chronic autoimmune response
- inflammation in ligaments of lower spine
- stimulates bone growth (spurs) within the ligaments
- growths form bridges between adjacent vertebrae which eventually fuse together
- subsequent low back pain + immobility
2 most common areas for ankylosing spondylitis
spine + hips
-if a physician suspects AS, this will be the first place they will look
syndesmophytes
bone spurs on the vertebrae
-they grow so much that we get fusion of the vertebrae
what leads to fusion
combination of erosion + syndesmophytes
secondary effects of all types of arthritis
-exercise tolerance
-muscle strength + endurance
-aerobic capacity
-range of movement (ROM)
-biomechanical efficiency
-proprioception
-social functioning
if someone is in crhonic pain…
they will not want to exercise unless it is painfree or exercise that won’t exacerbate pain anymore
what exercise is great for arthritis
swimming
-alleviates weightbearing
biomechanical efficiency
the compensations our bodies make to injuries
-ex: lean on one side more or walk a certain way
stages of arthritis
-acute (mild)
-chronic (moderate)
-chronic with acute exacerbation of joint symptoms (severe)
stages of arthritis
acute (mild)
reversible signs + symptoms in the joint related to synovitis
what is the only reversible stage of arthritis
acute (mild)
-once arthritis becomes chronic, cannot be reversed
what is one of the key things someone with acute arthritis should do
start to exercise + lose weight
stages of arthritis
chronic (moderate)
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
stages of arthritis
chronic with acute exacerbation of joint symptoms (severe)
increased pain + decreased ROM and physical function
-worst stage of arthritis
clinical considerations
signs + symptoms related to affected joints
-pain
-stiffness
-effusion
-joint locking
-synovitis
-deformity
-crepitus
-bone spur formation
effusion
swelling from accumulation of water/fluid around the joint
synovitis
inflammation of joint membrane
crepitus
abnormal popping/cracking sound
history + physical exam
-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
4 cardinal signs of arthritis
-redness
-swelling
-pain
-heat
if you have a family member with arthritis…
you are at risk too
diagnostic testing for arthritis
-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
what is the best sample you can get for diagnostic testing
synovial fluid
often times how do we do diagnostic testing
blood test
what may be needed in patients who are at risk of CVD
cardiorespiratory testing
those with RA are ____ x as likely to have CVD + why
2x as likely
-due to the associated systemic inflammation
who else may have risk factors for CVD
those who are sedentary for extended periods
what can be performed to establish a baseline for changes + to guide exercise prescription
musculoskeletal + ROM testing
keys to exercise testing for arthritis
-small increases in intensity
-mode appropriate
keys to exercise training- small increases in intensity
because WE DO NOT WANT TO MAKE THE PROBLEM WORSE
appropriate mode- treadmill
minimal to mild joint impairment
-more for someone in beginning stages because treadmill will be too high impact, especially if lower body is affected
appropriate mode- cycle ergometer
mild to moderate LOWER extremity joint impairment
-great, low impact
appropriate mode- arm ergometer
severe lower extremity joint impairment
what should be emphasized to control arthritis activity + minimize symptoms
exercise + medication
____ % of adults with any form of arthritis reported performing no leisure time physical activity
32%
goals of arthritis treatment
-counteract physical inactivity (get them moving)
-control symptoms, reduce pain, improve function
-restore/maintain a healthy body composition
-reduce comorbidity symptoms + risk
non-pharmacologic treatment for arthritis
-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)
what varies according to the form of arthritis
pharmaceutical interventions
most common pharmaceutical interventions for arthritis
-NSAIDs (help with inflammation)
-analgesics (topical pain relievers)
-corticosteroids
what is available for autoimmune inflammatory arthropathies, RA, + AS
disease-modifying antirheumatic drugs (DMARDs)
-specially geared toward mediating the autoimmune response
exercise prescription goals for arthritis
-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
exercise prescription considerations
-joint impairments
-level of fitness
-surgeries
-comorbidities
-age
-goals
-medications
-lifestyle
dexercise prescription consierations cont.
-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
KAATSU study background
low-load resistance training with blood-flow restriction (BFR) is a potential intervention for lowering training-related joint pain
KAATSU study participants
60+ y.o. with symptomatic knee osteoarthritis
KAATSU study groups
- moderate-intensity (60% 1RM) resistance training (control)
- low-load (20% 1RM) resistance training with BFR (KAATSU group, experimental group)
KAATSU study training
-3 sessions/wk for 12 weeks
-4 lower body exercises per session
-3 sets to volitional fatigue
control group of KAATSU did what type of training
standard resistance training
what did KAATSU study show
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
KAATSU training
-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
weight for KAATSU training
-use a much lower weight in these exercises
-lower the weight = less stress we are putting on injured area/affected joint
idea behind KAATSU training
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
KAATSU study results
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
