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PCE - Multisystem conditions > Gout & arthritis & ankylosing spondylitis > Flashcards

Gout & arthritis & ankylosing spondylitis Flashcards

1
Q

What is gout?

A
  • genetic disorder of purine metabolism
  • Increase serum uric acid (hyperuricemia)
  • Acid ▲ to crystals and deposits into joints
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2
Q

Joints most commonly affected by gout

A

knee

great toe

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3
Q

Gout Rx Meds + PT

A

Meds: NSAIDS, cox2-inhibitors, corticosteroids, ACTH

PT goals: injury prevention, education, fast intervention

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4
Q

OA risk factors

A
  • Age
  • F>M
  • Obesity
  • Physical inactivity
  • Injury
  • Joint stress (occupation)
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5
Q

Joints primarily affected by OA

A
  • Spine: osteophytes in facet joints of L-spine = STENOSIS
  • Hand - PIP = Bouchard node. DIP = Heberden’s node. CMC joints (esp thumb)
  • Knee: most common joint affected by OA: varus, flexion contracture, crepitus
  • Hip: walk with Trendelenburg, groin pain, osteophytes, flexion deformities
  • Foot: 1st MT joint - osteophytes cause hallux valgus + rigidus, bunions
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6
Q

Uncommon sites for OA

A

Shoulder
Elbow
Wrist
Ankle

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7
Q

OA X-ray findings + grading system

A

1) joint space narrowing
2) osteophytosis
3) subchondral cysts
4) subchondral sclerosis

Grading: Kellgren – Lawrence System (0-4)

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8
Q

OA Dx history

A
  • Pain most days of the last month?
  • Pain over the last year?
  • Worse with activity- stairs (doing down worse), overdoing it
  • Relieved with rest - may have ‘gelling’ after inactivity period
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9
Q

3 tests indicative of knee OA

A
  • Flexion contracture
  • Abnormal gait
  • Swipe test/patellar tap test +ve
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10
Q

OA pain sources

A
  • Bone
  • Soft tissue
  • Inflammation
  • muscle spasm
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11
Q

OA Rx

A
  • Weight loss
  • Exercise
  • Protective aids
  • medications
  • Electromodalities
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12
Q

What is the goal for weight loss in OA

A

Decrease 10% body weight

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13
Q

What is the general exercise prescription for OA

A
  • 30 min mod aerobic training (most days): 10 min bouts

- L/E resistance training

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14
Q

What types of protective aids might be useful in OA

A

Braces
Orthotics
Adaptive aids

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15
Q

What type of medication is used to treat OA

A

Acetaminophen - because it is not inflammatory

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16
Q

What EPA might be useful in OA

A

Tens

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17
Q

What are the two types of femoral acetabular impingement

A
  • Cam

- Pincer

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18
Q

What is CAM impingement and who does it occur in

A

femoral head is not perfectly round leading to it driving into acetabulum with hip flexion

Young men

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19
Q

What is Pincer impingement and who does it occur in

A

abnormal acetabulum provides excessive cover of femoral head
• retroverted or deep acetabulum

women 30-40 years

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20
Q

Is rheumatoid factor present in spondyloarthritis

A

no

21
Q

What is spondyloarthritis

A

Arthritis that attacks the spine

22
Q

Characteristics of spondyloarthritis

A
  • Spine inflammation: spondylitis and sacroiliitis
  • Synovitis: unilateral peripheral joints
  • Eye inflammation: iritis/uveitis & conjunctivitis
  • NO rheumatoid factor (seronegative)
  • Can be hereditary HLA-B27
23
Q

What is psoriatic arthritis

A

a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales.

24
Q

Characteristics of psoriatic arthritis

A
  • Chronic, erosive, inflammation

- Affects digit joints + axial skeleton

25
Q

Features of psoriatic arthritis

A

Dactylitis: sausage like fingers d/t swelling

Enthesitis: usually in heels and back

26
Q

psoriatic arthritis Rx - Meds + PT Goals

A

Meds: acetaminophen, NSAIDs, DMARDs, corticosteroids, biological response modifiers

PT Goals

  • joint protections strategies
  • maintain joint mechanics
  • endurance
27
Q

What is Enteropathic spondylitis? What conditions is it seen in?

A

A spondyloarthritis (SpA) which occurs in patients with inflammatory bowel diseases (IBDs) and other gastrointestinal diseases,

Seen with:

  • ulcerative colitis (affects lower half of bowels)
  • Crohn’s disease (affects whole digestive system)
28
Q

What triggers reactive arthritis

A

Infection in bowel or GI tract

29
Q

What are the features of reactive arthritis

A
  • hot swollen joints
  • may go away and return
  • LE
  • Symmetrical
30
Q

What is ankylosing spondylitis

A

stiffness/fusing of spine d/t inflammation

31
Q

Is ankylosing spondylitis unilateral or bilateral

A

usually bilateral disease, but may start initially as unilateral then migrate

32
Q

When is the onset of ankylosing spondylitis

A

Usually before 40 - delay is diagnosis of 8-9years

33
Q

Ankylosing spondylitis cause

A

Unknown

Associated with HLA B27 marker

34
Q

Clinical features of ankylosing spondylitis

A
  • Pain: Worst after rest
  • Stiffness: AM stiffness in the spine, after periods of inactivity
  • Decreased ROM
  • Deformity/instability
  • Decreased strength - Altered posture/muscle imbalances
  • Altered breathing mechanics
  • Fatigue
  • Deconditioning
35
Q

What causes altered breathing mechanics in ankylosing spondylitis?

A
  • Flexion posture

- Costovertebral and costochondral involvement of the chest wall limiting lateral costal breathing

36
Q

What is the typical posture in ankylosing spondylitis

A
  • FHP
  • Flattening of the anterior chest wall
  • Thoracic kyphosis
  • Protrusion of abdomen
  • Flattening of the lumbar lordosis
  • Slight flexion of the hips
37
Q

What causes fatigue in ankylosing spondylitis

A

Disease process
Cardiac involvement
Decreased vital capacity

38
Q

What are the features of AS (MSK and other systems/organs involved)

A
  • Scroiliitis
  • Enthesitis
  • Synovitis
  • Eyes
  • Bowels
  • lungs: apical fibrosis, restrictive lung disease, avoid smoking
  • Heart: inflammation/scarring of conduction system, aorta inflammation
39
Q

What is the progression of enthesitis

A
  • Early stage: bony loss - osteopenia
  • Later stage: osteoporosis and fusion/rigidity = risk of fractures
  • Fractures can impinge on spinal nerves
  • Stiffness
40
Q

What is the proposed sequence of structural damage in ankylosing spondylitis

A

Inflammation at corners and edges of vertebral bodies
Erosive damage and repairs
New bone formation - syndesmophytes
Fusion/bridging of syndesmophytes

41
Q

Clinical criteria for ankylosing spondylitis

A
  • LBP + stiffness for more than 3 months - Improves with ex, worse with rest
  • AM stiffness
  • Altered posture/muscle imbalances
  • Decreased strength - deconditioning
  • Decreased L-spine ROM in sagittal + front planes - flexion posture
  • Altered breathing mechanics- decreased chest expansion compared to normal values, diaphragmatic breathing pattern, decreased vital capacity
  • Fatigue d/t disease process
    \
42
Q

ankylosing spondylitis Physical Ax

A
  • Posture (tragus to wall)
  • lateral trunk flexion
  • trunk flexion (modified Schober’s)
  • trunk extension (Smythe test)
  • trunk rotation
  • chest expansion
  • cervical mobility
  • muscle length and strength
  • enthesitis sites
  • peripheral joint scan
43
Q

Ankylosing spondylitis Rx - Meds and physical management

A

MEDS: DMARDs, NSAIDs, corticosteroids, biologics

PHYSICAL MANAGEMENT

  • control/decrease inflammation
  • Pain management
  • Decrease stiffness/Increase ROM (pool therapy is great)
  • posture correction (ergonomics, frequent position changes)
  • Increase mm strength and endurance, increase cardio
44
Q

Ankylosing spondylitis outcome measures

A
  • BASFI (impact of disease on function in last week)

- BASDAI (how disease is managed)

45
Q

Inflammatory back pain vs. Mechanical back pain: Duration

A

> 60 min

<40 min

46
Q

Inflammatory back pain vs. Mechanical back pain: Age of onset

A

12-40yrs

20-65years

47
Q

Inflammatory back pain vs. Mechanical back pain: Max pain/stiffness

A

Early am

Late in day, increase with activity

48
Q

Inflammatory back pain vs. Mechanical back pain: Type of condition

A

Chronic

Acute/chronic

49
Q

Inflammatory back pain vs. Mechanical back pain: X-ray

A

Sacroiliitis, syndesmophytes, spinal ankylosis

Osteophytes, decreased disc space, misalignment

PCE - Multisystem conditions (12 decks)

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