Management of RA

Question 1

what is RA?

Answer 1

chronic inflammatory disease with many jts affected

Question 2

what does RA affect?

Answer 2

jts, blood vessels, heart, lungs, eyes

Question 3

what is the goal of RA therapy?

Answer 3

slow down rate of deformity

Question 4

what are the types of RA?

Answer 4

1. self limited (resolves)
2. persistent
3. progressive

Question 5

what are the fxnl classifications for RA?

Answer 5

1. independent
2. independent in ADL, no avocation
3. self care, limited work
4. limited in all activity

Question 6

role of OT in drug therapy?

Answer 6

reinforce benefits of tx

Question 7

early vs late stage RA?

Answer 7

early: diffuse swelling
late: skeletal collapse, need surgery

Question 8

OT role in RA?

Answer 8

splints
education
assistive devices
sy management
exercise instruction
balance activity + rest

Question 9

acute goals for RA?

Answer 9

rest
splint
cold modality
gentle arom
positioning

Question 10

chronic active stage goals for RA?

Answer 10

jt protections
assistive tech
gentle ROM NOT stretching capsule
energy conservation

Question 11

chronic inactive stage goals for RA?

Answer 11

reduce stiffness with heat modalities
preserve mobility + strength
fatigue management

Question 12

when is splinting important?

Answer 12

post surgery

provides safe motion, alignment, prevents rigidity

Question 13

how do you tx ulnar drift?

Answer 13

dynamic splint that drops down at diff angle (not 90)

Question 14

what do cold PAM’s achieve?

Answer 14

reduce acute swelling, spasm

Question 15

what do heat PAM’s achieve?

Answer 15

decrease stiffness, spasm, pain

only use once inflammation is controlled

Question 16

what are PAM contraindications?

Answer 16

ultrasound and diathermy can cause stiffness

Question 17

what are exercises done in acute phase?

Answer 17

gentle active assistive

PROM

Question 18

what are exercises done in chronic active stage?

Answer 18

AROM
isometrics
short arc isotonics
low impact endurance

Question 19

what are exercises done in chronic inactive stage?

Answer 19

AROM/PROM
isometrics
isotonic arc with light resistance
low impact cardio

Question 20

how to do muscle strengthening with RA?

Answer 20

adapt exercise to stage of disease
reduce flare up
isometric –> isotonic
do warm up + cool down

Question 21

what does low impact aerobics provide?

Answer 21

reduced pain
self effectiveness
physical performance

Question 22

what is a possible problem with wrist involvement?

Answer 22

wrist drop could cause impingement

Question 23

what are characteristics of wrist RA?

Answer 23

synovitis + tenosynovitis
sublux
carpal tunnel

Question 24

what are characteristics of MCP RA?

Answer 24

synovitis
sublux
ulnar deviation
intrinsic muscle tightness

Question 25

how do you tx MCP RA?

Answer 25

intrinsic strengthening going radially

i.e. hook fisting, radial walking

Question 26

what is ulnar drift?

Answer 26

extensor tendons slip over + into ulnar gutter

can eventually cause MCP sublux

Question 27

when is a total jt arthroplasty considered?

Answer 27

unremitting pain
limited motion
severely impaired fx

Question 28

how do you tx while respecting pain?

Answer 28

maintain ROM + MS
use jts in stable fxnl plane
avoid positions of deformity
use strongest/largest jts for the job
assistive devices

Question 29

how do you use correct pattern of movement in tx?

Answer 29

avoid static for too long
avoid unstoppable activity
balance rest and activity
reduce the force