OA/RA Flashcards
RA
systemic autoimmune inflammatory disorder
symmetrical pain & swelling, morning stiffness, malaise, fatigue, smaller joints affected
Why does joint damage occur w/ RA?
proliferation of synovial intimal layer forming a pannus that invades cartilage/bone
Which joints are most affected by RA?
MCP, PIP, C-spine (AA)
Medications used for RA?
DMARDs (slows progression) NSAIDs (early on) Corticosteroids (while awaiting DMARD effects) TNF inhibitors (inhibit inflammation) COMBO THERAPY
PT considerations for RA:
reduce joint stress (assistive devices, braces, splints)
educate to avoid vigorous activity w/ flareups
osteoporosis if on corticosteroids
whole body low intensity activities, functional knee strengthening
Hallmark signs of OA
destruction of cartilage & formation of bone margins at joint
Classification of knee OA
5/6: bony enlargement morning stiffness < 30 min bony tenderness no warmth knee pain crepitus
Classification of hip OA
- hip IR > 15* w/ pain, morning stiffness < 60 min. & > 50 y/o
- hip IR < 15, hip flexion < 115
what happens w/ OA at joint level?
increase in water content of cartilage
changes in composition of proteoglycans
proteoglycans are lost (stiff/brittle/decreased water contact/type 2 —> 1 collagen)
Which joints affected by OA most?
knee hip DIPs (heberden's nodes/PIPs (bouchard's nodes) lumbar spine feet (1st MTP) CMC joint
Meds given for OA:
acetaminophen (1st line)
NSAIDs
Cortisone injections
Hyaluronic acid injection (to decrease cartilage degeneration)
PT considerations for OA
unloading bracing (knee increases valgus moment to unload medial joint
concentric/eccentric resistance training for knee hand strengthening walking program jogging in water yoga manual therapy + PT
Side effects of DMARDs (methotrexate)
bone marrow suppression hepatotoxicity nephrotoxicity Rash stomatitis/diarrhea photosensitivity
Side effects of NSAIDs
increased BP
upset stomach/ulcer
Side effects of long term use of corticosteroids
osteoporosis
high BP
