Inflammatory Arthritis Flashcards
UNEXPLAINED joint pain with associated swelling:
(No MOI but inflammation). Joint(s) can look acutely injured or infected (warm, red, swollen, painful)
Frequently have ___ presentation
relapsing remitting
Joints can become damaged over time leading to:
changes similar to OA (chronic joint degradation)
Autoimmune -
body attacks itself
Inflammatory Arthritis Pathophysiology:
Rheumatoid Arthritis
Psoriatic Arthritis
Lupus
Lyme’s
Gout
Rheumatoid Arthritis:
Fairly common: 0.3 – 1% in US
Chronic Systemic autoimmune disease that attacks the joints
Hands, wrists, shoulders, elbows, knees, ankles feet
General fatigue
How many joints and any structural deformity
Increased cardiovascular risk
* Promote physical activity
Psoriatic Arthritis:
Autoimmune disease in people with psoriasis that can impact joints
Nail and skin changes
1/3 of people with psoriasis
DIPs, wrists, ankles, knees
Can also impact enthesis (usually heel)
*where things insert into bone
Lupus:
Arthritis/arthralgia is present in 95% of patients with systemic lupus erythematosus (SLE)
-Mimics RA in 5-15%
Lyme’s:
Tends to occur in late stage infection
After systemic symptoms have resolved
Can have intermittent or persistent joint attacks
Lyme bacteria enters joint and can remain
Common in knee
Can have swelling without pain
Gout:
Inflamed joints due to urate crystal formation in synovial fluid
3.9% in US
IA RA Deformities:
Boutonniere
Swan-neck
Hitchhiker’s Thumb
Claw Toe
Boutonniere Deformity
Flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint
Damage to the central slip of the extensor tendon at the PIP joint
Swan-Neck Deformity
Hyperextension of the PIP joint and flexion of the DIP joint
Weakened or stretched volar plate (ligament at the PIP joint) allows the PIP joint to hyperextend, and the flexor tendons pull the DIP joint into flexion
Hitchhiker’s Thumb (Z-Deformity)
Flexion of the metacarpophalangeal (MCP) joint and hyperextension of the interphalangeal (IP) joint of the thumb
Claw Toe Deformity
Hyperextension of the metatarsophalangeal (MTP) joint and flexion of both the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in the toes
DMARDs: Disease Modifying AntiRheumatic Drugs
Many different DMARD protocols, used in virtually all inflammatory arthritis conditions
Typically have a maintenance dose that is then increased during flares
Trial and error to get maintenance and flare doses right (as little as gets the job done)
Can be combined with corticosteroids to minimize inflammation during flares
Common Pharm:
Methotrexate
Leflunomide
Hydroxycholoroquine
Sulfasalazine
DMARDs: Because they inhibit immune response, increased risk of ___
infection
Identify when joints are “Hot”:
Red, swollen, painful/irritable
IA PT Management- During Flare:
Reduce pain and inflammation, promote ROM and maintain strength
Avoid high impact activity
IA PT Management - During Remission:
Promote physical activity to limit systemic impacts
Promote moderate intensity exercise and maintenance of strength and ROM to avoid deformity and/or dysfunction
Always use your ___ to guide your treatment
irritability principles
Splinting for ___
deformity
