Inflammatory Arthritis

Question 1

UNEXPLAINED joint pain with associated swelling:

Answer 1

(No MOI but inflammation). Joint(s) can look acutely injured or infected (warm, red, swollen, painful)

Question 2

Frequently have ___ presentation

Answer 2

relapsing remitting

Question 3

Joints can become damaged over time leading to:

Answer 3

changes similar to OA (chronic joint degradation)

Question 4

Autoimmune -

Answer 4

body 
attacks itself

Question 5

Inflammatory Arthritis Pathophysiology:

Answer 5

Rheumatoid Arthritis
Psoriatic Arthritis
Lupus
Lyme’s
Gout

Question 6

Rheumatoid Arthritis:

Answer 6

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

Question 7

Psoriatic Arthritis:

Answer 7

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

Question 8

Lupus:

Answer 8

Arthritis/arthralgia is present in 95% of patients with systemic lupus erythematosus (SLE)

-Mimics RA in 5-15%

Question 9

Lyme’s:

Answer 9

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

Question 10

Gout:

Answer 10

Inflamed joints due to urate crystal formation in synovial fluid

3.9% in US

Question 11

IA RA Deformities:

Answer 11

Boutonniere
Swan-neck
Hitchhiker’s Thumb
Claw Toe

Question 12

Boutonniere Deformity

Answer 12

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

Question 13

Swan-Neck Deformity

Answer 13

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

Question 14

Hitchhiker’s Thumb (Z-Deformity)

Answer 14

Flexion of the metacarpophalangeal (MCP) joint and hyperextension of the interphalangeal (IP) joint of the thumb

Question 15

Claw Toe Deformity

Answer 15

Hyperextension of the metatarsophalangeal (MTP) joint and flexion of both the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints in the toes

Question 16

DMARDs: Disease Modifying AntiRheumatic Drugs

Answer 16

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

Question 17

Common Pharm:

Answer 17

Methotrexate
Leflunomide
Hydroxycholoroquine
Sulfasalazine

Question 18

DMARDs: Because they inhibit immune response, increased risk of ___

Answer 18

infection

Question 19

Identify when joints are “Hot”:

Answer 19

Red, swollen, painful/irritable

Question 20

IA PT Management- During Flare:

Answer 20

Reduce pain and inflammation, promote ROM and maintain strength

Avoid high impact activity

Question 21

IA PT Management - During Remission:

Answer 21

Promote physical activity to limit systemic impacts

Promote moderate intensity exercise and maintenance of strength and ROM to avoid deformity and/or dysfunction

Question 22

Always use your ___ to guide your treatment

Answer 22

irritability principles

Question 23

Splinting for ___

Answer 23

deformity