HLTH 2501: joint disorders Flashcards
osteoarthritis prevalence
one in three adults have some degree of this, with men more affected
osteoarthritis
is a wear and tear joint disease, in which the articular cartilage is damaged and eroded, causing pain and inflammation of the joint
how does osteoarthritis develop?
the articular cartilage is damaged and eroded through stress, and the tissue damage causes the release of enzymes that accelerate the disintegration of the cartilage; the bone eventually is exposed, causing cysts, osteophytes, or new bone spurs to develop and break off into the synovial cavity; this causes the joint space to narrow and for inflammation to develop
osteophytes
bony lumps that grow on the bones in the spine or around joints
causes of osteoarthritis (primary and secondary)
primary is caused by obesity and aging and second is causes by injury or abuse; genetic factors, wear and tear, and sports also have an effect
most common affected joints in osteoarthritis
knees and hips
why is osteoarthritis a cycle?
because once the cartilage is damaged, joint alignment or the frictionless surface of the cartilage is lost, and then the mechanical stress is applied to other parts of the joint and to other joints
signs of osteoarthritis
pain and aching that occurs with movement and weight bearing, limited joint ROM, enlarged joints due to osteophytes, muscle atrophy, risk for falls, and crepitus may be heard
osteoarthritis diagnosis
not systemic so no other signs or changes in serum levels; other disorders must be ruled out; radiographic evidence may be used to look at joints
treatment for osteoarthritis
rest, minimizing impact on the joint, ambulatory aids like a cane, orthotic shoe inserts, PT, OT, static magnets, intra articular injection of synthetic synovial fluid, NSAIDs, analgesics, glucocorticoids, and sometimes surgery to replace joints
rheumatoid arthritis
is an autoimmune disorder causing chronic systemic inflammation disease; it more common in women
how does rheumatoid arthritis develop?
an abnormal immune response causes inflammation of the synovial membrane, along with vasodilation, increased permeability, and the formation of exudate, causing red, swollen and painful joints; often begins in the small joints in the fingers, followed by other joints like the wrists, eblows, knees
rheumatoid factor
is an antibody against immunoglobulin G
where does rheumatoid arthritis often develop?
the small joints first (such as the fingers), followed by larger joints like the elbows, wrists, and knees; TMJ and upper cervical vertebrae may also be affected
order of events in rheumatoid arthritis
synovitis, pannus formation, cartilage erosion, fibrosis, and ankylosis
panus formation
granulation tissue from the synovium spreads over the articular cartilage; this tissue which is called pannus releases enzymes and inflammatory mediators that destroy the cartilage
cartilage erosion
cartilage is eroded by enzymes from the pannus and the nutrients that are normally supplied by the synovial fluid to the cartilage are cut off by the pannus
fibrosis in RA
in time, the pannus between the bone ends becomes fibrotic, limiting movement and this calcifies
ankylosis
joint fixation and deformity develop
nodules
are small granulomas on blood vessels
what besides the inflammation process occurs in rheumatoid arthritis exacerbations?
muscles atrophy, leading to stretched tendons and ligaments; bone alignment shifts; muscle spasms may occur, causing misalignment; contractures and deformities with subluxation develop; and systemic signs
systemic effects of rheumatoid arthritis
nodules (small granulomas on blood vessels) may form on the pleura, heart valves, or eyes; fatigue, depression, malaise, anorexia and low-grade fever may also develop in response to circulating immune factors
causes of rheumatoid arthritis
genetic factors that cause autoimmune disorders, viral infections, and more common in older women
signs of rheumatoid arthritis
mild general aching, stiffness after rest, inflammation of the fingers and wrist, red and swollen joints, impaired joint movement, malocclusion of the teeth when TMJ is involved, and systemic signs (fatigue, anorexia, mild fever)
what occurs with each exacerbation of the disease?
the function of the affected joints is further impaired; eventually the joint is no longer inflamed but is fixed and deformed (burned out)
testing for rheumatoid arthritis
synovial fluid analysis and sometimes the presence of rheumatoid fever in the blood
treatment for rheumatoid arthritis
a balance between rest and moderate activity, PT, OT, aspirin, NSAIDs, or glucocorticoids, and sometimes immunosuppressants (ex. methotrexate), heat and cold, splints, wrist supports, and sometimes surgery
what NSAID inhibits prostaglandin during inflammation?
celecoxib which can be effective in RA, but may have risks associated with MIs and strokes
what are disease-modifying antirheumatic drugs?
gold salts, methotrexate, and hydroxychloroquine
what drug block tumor necrosis factor?
this is an inflammatory cytokine present in RA; infliximab is the drug
what drugs are used for pain in rheumatoid arthritis?
beta-cell depleting agents and interleukin-1 antagonists
how is surgery used for rheumatoid arthritis?
can remove pannus, replace damaged tendons, reduce contractures, or replace joints; more common in the hands
juvenile rheumatoid arthritis
the onset is more acute than the adult form, systemic effects are more present, large joints are affected, and rheumatic factor and rheumatoid nodules are absent
what is the antibody present in JRA?
antinuclear
still disease
is the systemic form of JRA and develops with fever, rash, lymphadenopathy, and hepatomegaly
uveitis
inflammation of the iris, ciliary body, and choroid in the eye
examples of types of juvenile rheumatoid arthritis
still disease (systemic form), polyarticular inflammation, and uveitis (eye inflammation)
infectious arthritis
aka septic arthritis; usually develops in a single joint and the joint is red, swollen, painful, with decreased ROM; is caused by a bacteria
causes of infectious arthritis
bacterial infection from for example gonococcus or staphylococcus; can also develop from osteomyelitis infections
how is infectious arthritis treated?
immediate aggressive antimicrobials treatment
lyme disease
is caused by a spirochete and transmitted by ticks; a migratory arthritis and rash develop, in which the knee and other large joints are affected
psoriatic arthritis
is an autoimmune form of arthritis that is accompanied by the skin disease psoriasis; there are five forms
five forms of psoriatic arthritis
symmetric, asymmetric, distal interphalangeal dominant, spondylitis, and arthritis mutilans
causes of psoriatic arthritis
unknown but is a combination of genetic and environmental factors
symptoms for psoriatic arthritis
swollen, tender joints, morning stiffness, swollen fingers and toes, painful muscles and tendons, scaly skin patches, flaky scalp, fatigue, nail pitting, seperation of the nail from the nail bed, eye redness, and eye pain
treatment for psoriatic arthritis
NSAIDs, DMARDs, biologics, steroids, immunosuppressants, topical treatments, and light therapy
gouty arthritis
is a joint disease the results from deposits of uric acid and urate crystals in the joint that then cause an acute inflammatory response usually in a single joint
who is gouty arthritis common in?
men > 40
uric acid
is a waste productnof purine metabolism that is normally excreted through the kidneys
hyperuricemia
may develop if renal excretion is not adequate or due to a metabolic abnormality
what precipitates an attack of gout?
a sudden increase in serum uric acid levels
acute gout inflammation episode
usually a single joint is affected and the articular cartilage is damaged, causing redness, swelling, and pain of the joint
tophus
is a large, hard nodule consisting of urate crystals that have been precipitated in soft tissue or bone, causing a local inflammatory reaction
where do tophus develop?
at the joint bursae, the extensor surfaces of the forearm, or the pinnae of the ear
treatment for gouty arthritis
reducing serum uric acid levels by drugs and dietary changes; increasing fluid and increasing the pH will cause more uric acid excretion; colchicine is used during an acute episode and allopurinol is used as a preventative measure
what is the risk of uric acid in the blood?
kidney stones may develop
ankylosing spondylitis
is a chronic progressive inflammatory conditions that affects the sacroiliac joints, intervertebral spaces, and costovertebral joints of the axial skeleton
risk population for ankylosing spondylitis
more common in men and ages 20-30
causes of ankylosing spondylitis
it is an autoimmune disorder with a genetic basis and the presence of the HLA-B27 antigen
what happens in ankylosing spondylitis?
the vertebral joints become inflamed, followed by fibrosis and calcification or fusion of the joint, and this results in ankylosis of fixation of the joints; inflammation develops in the lower back, followed by kyphosis; osteoporosis and lung expansion difficulties may develop as a result
signs of ankylosing spondylitis?
low back pain, morning stiffness, pain that radiates to the legs, rigid spine, systemic signs like fatigue, fever, and weight loss, and uveitis
treatment for ankylosing spondylitis
pain relief and maintenance of mobility, along with sleeping supine, exercising, and antiinflammatory drugs
bursitis
is an inflammation of the bursae associated with bones, muscles, tendons, and ligaments
bursae
small, fluid-filled sacs that act as cushions at or near the structures of joints
causes of bursitis
repetitive motions that physically irritate the bursae, ex. washing floors on hands and knees and throwing a baseball
diagnosis of bursitis
physical examination (looks for red, swollen, achy and stiff joints) and MRI
treatment for bursitis
rest, cold compress, anti inflammatory drugs, PT, and antibiotics (when infection is the cause)
synovitis
inflammation of the synovial membrane lining the joint; movement of the joint is painful and the joint is swollen, red, and warm
how is synovitis diagnosed?
analyzing the synovial fluid for signs of infection or crystals
tendonitis
is the irritation or inflammation of the tendon, often characterized by a dull ache at the site of tendon attachment, tenderness, and mild swelling
tendinitis causes
a sudden, single trauma or repetitive motions
