Infectious Arthritis (Inflammatory Arthritides) Flashcards
- What are Inflammatory Arthritides?
- What is Infectious Arthritis?
- A group of inflammatory diseases affecting connective tissue including joints
- Joint inflammation resulting from infection by bacteria, viruses or fungi
In most cases, infectious arthritis involves one joint, such as the knee, hip, shoulder, elbow and small joints in the hand or foot
The affected joint(s) is red, hot and swollen with reduced range of motion due to pain
During the inflammatory response, fibrin is deposited on the cartilage and synovial lining leading to ischemia and necrosis
If untreated, as the inflammation resolves, relative capsular fibrosis or a reduced flexibility of the joint capsule is present
symptoms
Infectious arthritis may be caused by a number of organisms
Bacteria reach joints both directly, as a result of trauma or surgery and indirectly through the bloodstream from other sites of infection
With bacterial infections, the onset is usually sudden with symptoms such as fever, shaking and chills
Medically, it is important to treat bacterial arthritis quickly with a full course of antibiotics
Normal compressive forces of joints reduce the diffusion of medication from the bloodstream into the joint (so rest)
Arthritic reactions may follow a viral infection. Joint inflammation usually lasts 1-2 weeks and resolves on its own
Fungal arthritis develops very slowly over weeks or months. The fungi enters the skin through cuts. The fungi that cause arthritis are found in soil and bird droppings. Antifungal medications are used to treat this arthritis
Contraindications
Testing, except for active free ROM is CI’d on acutely inflamed joints
Hot hydrotherapy applications are CI’d during acute inflammation
General massage is CI’d with significant fever (38C, 101.5F)
Lymphatic drainage techniques proximal to the affected joint are avoided with acute infectious arthritis
Local massage is avoided on acutely inflamed joints or over open lesions. Avoid distal techniques that will painfully increase circulation through the joint
Joint play is CI’d on acutely inflamed joints to prevent aggravation of the condition
In tx and self-care, PROM or AROM used as remedial exercise is avoided on acutely inflamed joints
Between flare-ups, deep, vigorous techniques such as frictions and direct fascial techniques may provoke inflammation
With joint laxity and hypermobility, stretching techniques are used with caution
Health History Questions
How is your general health?
What specific inflammatory arthritide do you have?
When was the onset?
Is there a history of this arthritide in your family?
What is the frequency of acute attacks? When was the most recent flare-up?
What are your current symptoms?
What are your ADL’s?
How do you feel first thing in the morning?
Which joints are affected? Is ROM affected? Are there any associated systemic concerns?
Are you taking any specific medication for the arthritide?
Has there been any surgery for affected joints?
Are you doing any other therapies?
Further Assessment: Rheumatoid Arthritis & Other Inflammatory Arthritides
- Health History Questions:
Which inflammatory arthritide do you have?
What stage is the disease?
Is the condition physician diagnosed?
It is important to differentiate an inflammatory arthritide from osteoarthritis, as the treatments are different
- Observations:
Guarded movement to prevent pain and a possibly pained or medicated facial expression may be noted
Depending on the affected joints, gait and postural dysfunctions are likely present due to pain
A postural assessment may be performed to determine sources of muscle imbalance
Affected joints are red and swollen, more so during flare-ups. The skin may be taut and shiny over the joint
- Palpation:
Heat and tenderness of affected joints are palpated, which are worse during flare-ups
Affected joints have a spongy, soft feel due to synovitis
There may be spasm in muscles crossing affected joints. Between flare-ups, HT, TP’s, crepitus (sound cripy), adhesions and disuse atrophy may be palpated
Dense contractured tissue may be present with scleroderma and rheumatoid nodules may be present with RA
- Testing:
During flare-ups, only AF ROM is used with affected joints having reduced ROM due to pain and swelling
Between flare-ups, AF ROM of affected joints is also reduced due to pain and swelling, but not as much as during an attack
PR ROM is restricted due to pain
AR isometric testing is weak and possibly painful for muscles crossing the affected joint
Massage
Tx goals depend on the specific arthritide and whether the client is in remission or active flare-up
Tx goals can include:
Stress reduction and relaxation
Decreasing pain, edema and spasm
Maintaining joint mobility
Maintaining and increasing strength
Preventing or reducing postural changes and joint deformities
Reducing contractures is especially important with JRA
- During flare-ups:
If massage is tolerated by the client, massage is to the unaffected areas of the client’s body
The massage is limited to 30 mins in duration to avoid exhausting the client
The focus is on relaxation including unforced diaphragmatic breathing
Hydrotherapy is cold applications to the client’s tolerance at the affected joint
Positioning is whatever is comfortable for the client
- Between flare-ups:
The tx should be between 30-45 mins according to the client’s tolerance
Treatment is in the context of a relaxation massage, including diaphragmatic breathing
Positioning is for the client’s comfort
Hot hydrotherapy may be used with chronically arthritic joints as it controls pain and spasm
Specific tx of rhythmic techniques are used. Compensatory structures are treated to reduce HT and TP’s. Gentle fascial techniques are used if soft tissue contractures are present
Gentle joint play techniques may be used with caution on the affected joint capsule
Self-Care
Exercise to the client’s pain tolerance
Between flare-ups, self-stretching is used to prevent contractures
Submaximal isometric exercise to maintain strength of muscles crossing affected joints is progressed to low impact or water aerobics
Stress reduction exercises and diaphragmatic breathing are important
Splints to protect joints, orthotics and devices to help with ADL’s may be helpful
Larger objects are easier to grip than small ones
During flare-ups, cool hydrotherapy applications may relieve pain
Between flare-ups, heat is used on affected joints
