Lecture 7 and 19 - OA and RA Flashcards

Question

RA - PT interventions. | Give some examples (tot:4)

Answer 1

Exercises ROM, strengthening ex’s, stretching, balance, whirlpool, land-based CV, water-based CV, HEP ``` Thermal modalities (Hot/cold packs, wax bath) Electrotherapy as needed ``` ``` Manual therapy Limited role because of jt instability +/- gentle accessory mobs (gr I-II) for “inactive” jt C-spine traction rarely used Manipulation techniques not indicated ``` Walking aids & gait training Other assistive device, splinting/ bracing (OT) Referrals: Rheumatologist, OT, Psychology, Social worker

Answer 2

Avoid strenuous ex’s during acute flare-ups/ inflammation ROM ex’s are appropriate Parameters for acute/painful/irritable condition Adequate warm-up and cool-down are important to minimize pain Suggest that they exercise at the moment during the day that their pain is typically less severe or during peak activity of pain meds

Answer 3

Need to look more closely at all the systems during the evaluation. Heart/lung involvement Can limit ability to work on improving endurance Neurological involvement Balance can be affected

Answer 4

Similar to RA Advices specific for skin rash Avoid exposure to sun Use sun block & protective clothing

Answer 5

Mainly supportive interdisciplinary approach ``` ROM ex’s for the affected jts (gentle) Facial and mouth exercises Strengthening ex’s Hot pack or wax bath Close monitoring of skin integrity with ROM/ stretching necessary ``` Education Avoid exposure to cold, monitor closely with heat (Raynaud’s phenomenon )

Answer 6

Exercises done 2X/day, 15 min each, over 18 wks Mean improvement in mouth opening 10.7±2.06 mm Improvements in eating, speaking, oral hygiene, and the insertion of their dentures was easier

Answer 7

Is there morning stiffness? Is there improvement in discomfort with exercise? Was the onset of back pain before age 40 years? Did the problem begin slowly? Has the pain persisted for at least 3 months? F: 4/5 positive questions

Answer 8

Loss of Lx lordosis, ↑ Tx kyphosis, compensatory ext of Cx spine

Answer 9

``` Finger-to-floor Occiput-to-wall Cx spine: all mvts T1-to-wall, T7-to-wall Lx spine: Modified Schober’s test ```

Answer 10

- duration of morning stifness - posture - spinal mobility - chest expansion at xiphoid process - active joint count

Answer 11

if peripheral jt involved

Answer 12

BASDAI Bath Ankylosing Spondylitis Disease Activity Index Measures fatigue, spinal pain, joint pain, swelling, areas of local tenderness, morning stiffness Self-administration, uses VAS BASMI (Metrology Index) Measures spinal mobility: tragus to wall, Lx flex, Cx rot, Lx SF, Intermalleolar distance BASFI (Functional Index) 10 questions on function and ability to cope with everyday life Self-administration, uses VAS BASGI (Global Index) 2 questions on the effect of the disease in the last wk and the last 6 mths Self-administration, uses VAS

Answer 13

Maintain a good posture and avoid stiffening in a flexed position Optimize spinal and chest mobility Optimize general ms strength Optimize CV function Maintain and improve general functioning and HR-QOL Design lifelong health and rehabilitation programs with the patient

Answer 14

Dx (spinal & CV components) Smoking reduction or cessation Nutrition, weight control, hydration Cold and flu prevention Benefits of aerobic, mobility and strengthening exercises Self-management Pacing and energy conservation Posture Keeping the spine as straight as possible while walking or sitting Avoid prolonged stooping or bending. Sleeping on back on a firm mattress using the thinnest possible pillow

Answer 15

Postural correction exercises / Global postural reeducation Spine & Chest wall mobility exercises Should include all planes of movement with a rotational component General trunk stretching Soft tissue mobilization Deep breathing exercises & breathing control, incentive spirometry, coughing maneuvers ROM exercises Strengthening exercises Gait reeducation Aerobic exercise

Answer 16

1. A secondary effect of corticosteroids AND NSAIDs is to bruise easily - TRUE 2. With corticosteroids and patients suffering from Osteoporosis -> be careful for potential risk of # - TRUE 3. With biologics and biosimilars, GI discomfort may interfere with rehab - NO thats with NSAIDS

Answer 17

1. increased risk of infection - bio/bio 2. Hyperglycemia - cortico 3. Dizziness - cortico 4. GI discomfort - NSAIDs 5. skin fragility - cortico 6. Stiffness - bio/bio 7. ms rigidity - bio/bio 8. impaired vision - cortico

Answer 18

RA/OA 1. Y/N 2. Y/N 3. Y/N

Answer 19

1. OA: DIP, PIP, 1st IP, MCP, CMC' joints & WB joints | 2. RA: typically small joints of hands and feet, but also wrists, ellbows, shld, hips, knees, neck

Answer 20

1. OA: changes in synovium are secondary | 2. RA: primarily auto-immune, primary changes in synovium

Answer 21

an abnormal layer of fibrovascular tissue | presenting as a thickening of synovial membrane that appears as a result of the inflammatory process.

Answer 22

The overall result of the pathology and inflammatory process is: • Joint degeneration • Ligamentous laxity • Joint deformities

Answer 23

``` Fatigue General malaise Low grade fever (during active phase of the disease) Anemia Weakness Depression Weight loss ```

Answer 24

``` Typically, symmetrical pattern Pain in the affected joints Swelling of the joints Stiffness - commonly following periods of sitting, inactivity, and sleep (morning stiffness) Joint deformities ```

Answer 25

o MCP flexion o PIP extension o DIP flexion

Answer 26

o MCP Extension o PIP flexion o DIP extension

Answer 27

Zig-zag deformity of wrist & fingers (RD of wrist combined with UD of MCPs)

Answer 28

MTP hyperext; PIP flex; DIP ext

Answer 29

MTP hyperext; PIP & DIP flex

Answer 30

Hallux valgus | hammer toe

Answer 31

Genu varum | Genu valgum

Answer 32

C1-2 subluxation (due to laxity of transverse ligament)

Answer 33

Rheumatoid nodules – hard fibrous tissue nodules, generally in the subcutaneous tissue o Occur in up to 50% of pts with RA at some point o Associated with +ve rheumatoid factor (RF+) o Often over pressure areas (e.g. dorsal surface of F/A) but can present in any location and can also be internal (e.g. in the lungs)

Answer 34

- Rheumatoid nodules - vascular (vasculitis and raynaud synd. - sjogren synd - Resp: nodules, fibrosis, pleurisy ±effusion - cardiac: pericardial eff, pericarditis - Neuro: carpal tunnel synd, ulnar n entrapement, neuropathy, spinal cord compression - GI, renal, hemato (more info: p5 of the RA reading document)

Answer 35

F X-rays are generally not helpful for the purpose of diagnosis of RA but they can be helpful in assessing its severity and prognosis.

Answer 36

Assessment of increased bone remodelling at joints

Answer 37

F | SLE is a chronic, systemic, inflammatory, auto-immune disease with multi-organ involvement.

Answer 38

Sorry... my bad for this one SLE does not have any clear, characteristic pattern at onset of disease, nor any consistency in the course of disease.

Answer 39

Yes.... it touches litteraly EVERYTHING, (p8 for more info)

Answer 40

Antinuclear Antibodies (ANA) are present in the serum (ANA +) of ~95% of patients with SLE • Hematological abnormalities: Leukopenia (low white blood cells); Thrombocytopenia (low levels of platelets); Anemia (low levels of red blood cells); Pancytopenia (low levels of RBC, WBC, platelets) • Elevated Erythrocyte Sedimentation Rate

Answer 41

characterized by inflammation, vasculopathy involving small blood vessels, and fibrosis: collagen deposits (often quite large) cause a build-up of tough, scar-like, fibrous tissue.

Answer 42

Limited scleroderma (CREST) and diffuse scleroderma are the two types.

Answer 43

``` C = Calcinosis (Ca + deposits in soft tissue) R = Raynaud’s phenomenon E = Esophageal dysmotility (including acid reflux) S = Sclerodactyly (localized thickening and tightness of skin of fingers or toes) T = Telangiectasia (small dilated blood vessels near surface of skin or mucous membranes) ```

Answer 44

Lim/diff 1. the skin involvement is distal to the elbows and knees - lim 2. Permanent organ damage - diff 3. trunk and proximal limbs (upper arms and thighs) are commonly affected - diff 4.neck and face are not affected - lim 5.The disease often peaks after 5-6 years, followed by regression and softening of the skin -diff 6.Prognosis more favorable - lim

Answer 45

Early Edema (sausage digits) Later Thickening / tightening of skin (sclerodactyly) Bony resorption: distal phalanges shortened & nails deformed Contractures: MCP ext & PIP flex Calcium deposits: sometimes open areas oozing chalky material

Answer 46

Contraction and hardening of tissues of the face (most common in diffuse scleroderma) can lead to characteristic changes known as “Mauskopf”: ``` • Muscles atrophy at the temple, face and neck • Absence of normal skin folds • Thin pursed lips c̅ radial furrowing • Expressionless face • Narrowing of the oral aperture o poor dentition o difficulty eating ```

Answer 47

- 1st MTP - heels, ankles and knees - kidneys, causing kidney stones and renal damage

Answer 48

- axial skelton - sacroiliac joint - costovertebral, costotransvers joints - hip, knee, shld

Answer 49

Spine and | chest wall rigidity may also affect thoracic expansion, which can affect breathing and exercise capacity

Answer 50

20-40 years

Answer 51

* History of inflammatory low back pain (LBP) * Loss of spinal mobility * Radiological evidence of sacroiliitis

Answer 52

The DMARDs 1- have a immunostimulation effect- F 2- do not generally induce a complete remission - T 3- The disease activity may persist and joint damage may continue to progress - T 4- NSAIDS are prescribed for 6-12 months until the patient gets symptomatic relief from DMARDs - F (for 1-6 months)

Answer 53

Methotrexate

Answer 54

Should be considered when scheduling PT treatment Should be careful about cleaning therapy equipment appropriately before use with these patients Refer to MD if signs of infections

Answer 55

Serology: rheumatoid factor (RF) & anti–citrullinated protein antibody (ACPA) Acute Phase Reactants: C-reactive protein (CRP)& erythrocyte sedimentation rate (ESR)