Lyme Disease (Inflammatory Arthritides)

Question 1

1. What are Inflammatory Arthritides?
2. What is Lyme Disease?

Answer 1

1. A group of inflammatory diseases affecting connective tissue including joints
2. A complex rheumatic disease that affects many systems of the body

Lyme disease mimics other diseases including the flu and several other rheumatic conditions

It is caused by the spirochete borrelia burgdorferi, which is transmitted to humans by tick bites

Ticks live outdoors in wooded or marshy areas and are most active in the spring and summer months. They spend part of their life cycle living on birds and other animals, then develop to their next stage were they bite humans

Question 2

symptoms

Answer 2

Lyme disease begins after an incubation period of up to 32 days

In most cases, a large expanding skin rash (erythema migrans) is noticed around the site of the tick bite, although the person may not have noticed the bite itself

In some people, the rash is ring-shaped
In others, there is a raised, vesicular mụn nước area in the centre

Several days after the onset of erythema migrans, severe headache, fever, chills, stiff neck, swollen lymph nodes, fatigue, muscle ache and joint pain occur
These symptoms are usually intermittent and changing

Brief, sporadic rải rác attacks of arthritis may affect large joints, especially one knee. These episodes may become longer after the second year of Lyme disease, lasting for months instead of weeks

Other more serious manifestations biểu hiện of Lyme disease are neurological abnormalities developing months after the initial symptoms, including meningitis, bilateral facial palsy, memory impairment and distal paresthesia. Cardiac involvement can include irregular or slow heartbeat

Question 3

treated

Answer 3

Medically, Lyme disease is treated with antibiotics and is curable if treatment is begun early

Preventative measures to avoid tick bites include wearing protective clothing that covers the legs and arms

After being in wooded areas, people should check for ticks on themselves, children and pets

Typically, ticks are attracted to warmer skin areas such as the axilla, inguinal area and trunk

If a tick is found attached to the skin, tweezers are used to carefully remove the tick without squeezing the tick’s body

After wiping the skin over the tick bite with an antiseptic sát trùng, the tick may be saved in a jar for later identification

Question 4

Contraindications

Answer 4

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

Question 5

Massage

Answer 5

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

Question 6

Self-Care

Answer 6

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