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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

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
Features of psoriatic arthritis
Dactylitis: sausage like fingers d/t swelling Enthesitis: usually in heels and back
26
psoriatic arthritis Rx - Meds + PT Goals
Meds: acetaminophen, NSAIDs, DMARDs, corticosteroids, biological response modifiers PT Goals - joint protections strategies - maintain joint mechanics - endurance
27
What is Enteropathic spondylitis? What conditions is it seen in?
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
What triggers reactive arthritis
Infection in bowel or GI tract
29
What are the features of reactive arthritis
- hot swollen joints - may go away and return - LE - Symmetrical
30
What is ankylosing spondylitis
stiffness/fusing of spine d/t inflammation
31
Is ankylosing spondylitis unilateral or bilateral
usually bilateral disease, but may start initially as unilateral then migrate
32
When is the onset of ankylosing spondylitis
Usually before 40 - delay is diagnosis of 8-9years
33
Ankylosing spondylitis cause
Unknown Associated with HLA B27 marker
34
Clinical features of ankylosing spondylitis
- 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
What causes altered breathing mechanics in ankylosing spondylitis?
- Flexion posture | - Costovertebral and costochondral involvement of the chest wall limiting lateral costal breathing
36
What is the typical posture in ankylosing spondylitis
- FHP - Flattening of the anterior chest wall - Thoracic kyphosis - Protrusion of abdomen - Flattening of the lumbar lordosis - Slight flexion of the hips
37
What causes fatigue in ankylosing spondylitis
Disease process Cardiac involvement Decreased vital capacity
38
What are the features of AS (MSK and other systems/organs involved)
- Scroiliitis - Enthesitis - Synovitis - Eyes - Bowels - lungs: apical fibrosis, restrictive lung disease, avoid smoking - Heart: inflammation/scarring of conduction system, aorta inflammation
39
What is the progression of enthesitis
- Early stage: bony loss - osteopenia - Later stage: osteoporosis and fusion/rigidity = risk of fractures - Fractures can impinge on spinal nerves - Stiffness
40
What is the proposed sequence of structural damage in ankylosing spondylitis
Inflammation at corners and edges of vertebral bodies Erosive damage and repairs New bone formation - syndesmophytes Fusion/bridging of syndesmophytes
41
Clinical criteria for ankylosing spondylitis
- 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
ankylosing spondylitis Physical Ax
- 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
Ankylosing spondylitis Rx - Meds and physical management
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
Ankylosing spondylitis outcome measures
- BASFI (impact of disease on function in last week) | - BASDAI (how disease is managed)
45
Inflammatory back pain vs. Mechanical back pain: Duration
>60 min | <40 min
46
Inflammatory back pain vs. Mechanical back pain: Age of onset
12-40yrs 20-65years
47
Inflammatory back pain vs. Mechanical back pain: Max pain/stiffness
Early am Late in day, increase with activity
48
Inflammatory back pain vs. Mechanical back pain: Type of condition
Chronic Acute/chronic
49
Inflammatory back pain vs. Mechanical back pain: X-ray
Sacroiliitis, syndesmophytes, spinal ankylosis Osteophytes, decreased disc space, misalignment

PCE - Multisystem conditions (12 decks)

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