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PTRS 746 Exam 2 > OA & RA > Flashcards

OA & RA Flashcards

1
Q

Q: How is arthritis the following things?

  1. Complicated
  2. Highly prevalent
  3. Not just for old people
  4. Getting worse
A
  1. Consists of 100+ diseases/conditions
  2. affects 1 in 5 americans; 52.5 million
  3. 2/3 with condition are < 65
  4. Projected 67 mill by 2030
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2
Q

Q: What type of arthritis is typically in younger individuals?

A

RA

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3
Q

Defn: Rheumatoid Arthritis (RA)

A

a systematic inflammatory disease primarily affecting **joint synovium **

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4
Q

Defn: Osteoarthritis (OA)

A

A **localized **process involving desctruction of cartilage tissue - “wear and tear”

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5
Q

Q: What is another name for OA?

A

Degenerative joint disease (DJD)

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6
Q

Diagram: Identify the condition

A

OA/DJD of knee affecting the medial WB surface

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7
Q

Diagram: Identify the condition

A

OA/DJD of hip affecting superior WB surface

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8
Q

Diagram: Identify the condition

A

Normal right wrist

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9
Q

Diagram: Identify the condition

A

RA of the right wrist

yellow = inflammation

red/green = joint erosion

blue = joint space narrowing

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10
Q

Q: How would you describe the unique feature of an OA xray?

A

Areas of OA “Light Up” due to thickening of the bone

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11
Q

Q: How would you describe the unique of a RA xray?

A

Washed out appearance - bones turn to “Mush”

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12
Q

Q: OA is a _____________ process that is __________ to the affected joints

A

localized, confined

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13
Q

Content: Two pathologic characteristics of OA

A
  1. Progressive desctruction of articular cartilage
  2. Formation of bone/osteophytes at the margins of the joint
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14
Q

Defn: Osteophytes

A

Formation of bone

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15
Q

Q: How is a OA diagnosis determined? (3)

A
  1. Signs/symptoms
  2. Distribution of involvement
  3. Imaging
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16
Q

Content: Diagnostic Criteria for OA (4)

A
  1. Asymmetrical joint involvement
  2. Lack of generlaized symptoms
  3. Morning/post inactivity stiffness (shorter duration)
  4. Variable pain that occurs/worsens with motion
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17
Q

T/F: Radiographic tests always match the severity of the condition.

A

False, may not match

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18
Q

Q: OA affects > ______ million people in the US, with common onset in those over ____ years old, and widespread in those over _______ years old.

A

27, 40, 65

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19
Q

Q: What is the distribution of men and women with OA?

A

Men > women until 5th decade, then reverses

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20
Q

T/F: OA is more common in the hip than the knee.

A

False, knee

knee = 13.8% in those 55-74 yo

hip = 3.1% in those 55-74 yo

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21
Q

Content: Etiology of OA (3)

A
  1. No single predisposing factor has been identified
  2. Primary or Idiopathic (unknown etiology)
  3. Secondary (trauma, congential malformation, musculoskeletal disease)
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22
Q

T/F: OA is a normal part of aging.

A

False: not normal

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23
Q

Content: Risk Factors for OA (5)

A
  1. Increased age
  2. Trauma (early/repetitive microtrauma)
  3. Occupational/functional tasks
  4. Obesity
  5. Infection
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24
Q

Content: Pathophysiology of OA (4)

A
  1. Initial increase in articular cartilage H20 content
  2. **Proteoglycan ** and collagen synthesis increase (Shift from type2>1, fibrillation and fraying of articular cartilage)
  3. Later, **proteoglycan loss **reduces compressive stiffness/elasticity
  4. Begins to affect subchondral bone and periarticular surfaces
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25
Q

Q: What effect does proteoglycan loss during OA have on function? (3)

A
  1. Decreased joint loading capacity
  2. Increased friction forces
  3. Decreased shock absorption
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26
Q

Q: What part of the pathophysiology of OA leads to joit replacement?

A

When the subchondral bone and periarticular structure become affected

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27
Q

Q: What 3 things does the Kellgren & Lawrence scale (0-4) evaluate?

A
  1. Presence of osteophytes
  2. Joint space narrowing
  3. Deformity
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28
Q

Q: What things are ruled out in a differential diagnosis of OA? (3)

A
  1. RA
  2. Infection
  3. Other rheumatic conditions
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29
Q

T/F: A differential diagnosis for OA should look at joint ditribution/symmetry, radiographic findings, and laboratory findings.

A

True

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30
Q

T/F: RA presents with bone formation and OA presents with bone erosion.

A

False, flip it

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31
Q

Content: Patterns of Joint Involvement for OA in the UE

A
  1. DIPs, PIPs, thumb CMC
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32
Q

Q: What type of arthritis are Heberden’s nodes more common in?

A

OA

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33
Q

Defn: Heberden’s nodes

A

Osteophyte formation at the DIP

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34
Q

Q: RA presents more _____________ (_____ and ____) while OA presents more ___________ (____/____)

A

proximally, wrist, CMC/MCP, distally, DIP, PIP

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35
Q

Content: Patterns of Joint Involvement for OA at the Hip (2)

A
  1. Protective position (Hip flex, abd, ER)
  2. Decreased hip ROM correlated to decreased walking speed and funcitonal limitations
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36
Q

Q: What is the most prevalent location for OA?

A

OA of the knee

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37
Q

Content: Kellgren and Lawrence System for OA - Grade 0

A

Normal

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38
Q

Content: Kellgren and Lawrence System for OA - Grade 1

A

Possible osteophytes, questionable joint narrowing; very early stage

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39
Q

Content: Kellgren and Lawrence System for OA - Grade 2

A

Definite osteophyte formation

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40
Q

Content: Kellgren and Lawrence System for OA - Grade 3

A

Moderate osteophytes, narrowing, possible deformity

41
Q

Content: Kellgren and Lawrence System for OA - Grade 4

A

Large osteophytes, marked narrowing, severe sclerosis, definite deformity

42
Q

Q: Pharmacologic therapy for OA is focused on ______ _________, traditional drugs ______ affect the disease progression.

A

pain, control, don’t

43
Q

Content: Pain Control Strategies for OA (4)

A
  1. Medications (NSAIDS)
  2. Pt. Education (low level activities)
  3. Joint protection (support/stability, i.e. knee sleeve)
  4. Exercise
44
Q

Content: Pharmoacolgical Therapy Options for OA (4)

A
  1. Oral Analgesics/NSAIDS
  2. Corticosteroid injections (temporary effect of 2-3 mo, no more than 2-3 injections)
  3. Viscosupplementation
  4. Topical analgesics (gate control theory)
45
Q

Q: How many criteria are there for RA and how many must be met to be diagnosed with RA?

A

7, 4

46
Q

T/F: 1-4 of the criteria must be met for < 6 weeks duration to be diagnosed as RA.

A

False, 6+ weeks

47
Q

Content: Diagnostic Criteria for RA (7)

A
  1. Morning stiffness (at least 1 hr)
  2. Arthritis of 3+ joint areas (PIP, MCP, wrist, elbow, knee, ankle, MTP)
  3. Arthritis of hand joints (wrist, PIP, MCP)
  4. Symmetry
  5. Rheumatoid nodules
  6. Positive serum rheumatoid factor
  7. Radiograpic evidence of erosion, bondy de-calcification
48
Q

Content: Epidemiology of RA

  1. Distribution
  2. W:M ratio
  3. Peak incidence
  4. Lower prevalence in…
  5. % of death due to arthritis/rheumatism
A
  1. 1.5 mil in US
  2. 2-3:1
  3. 60-70 yo
  4. African americans, Japanese, Chinese vs, Caucasian, (increased in native american)
  5. 22%
49
Q

Content: Etiology of RA (5)

A
  1. Considered autoimmune
  2. Unknown, likely multi-factorial
  3. Genetic predisposition (HLA-DR genes)
  4. Potential bacterial/viral component
  5. Smoking may contribute
50
Q

Content: Rhuematoid Factor

A
  1. Autoantibody against IgGFc
  2. Present in about 70% of RA pts.
51
Q

Content: Pathophysiology of RA

A
  1. Infiltration of synovium by CD4+ T cells, B cells, and monocytes/macrophages
  2. Production of inflammatory cytokines and chemokines
  3. Hyperplastic synoium (pannus) invades and erodes cartilage, subchondral bone, articular capsule, and ligaments
  4. Neutrophil infiltration of the synovial fluid, venous distention, capillary obstruciton, thrombus, and hemorrhage may also occur
52
Q

Content: Differential Diagnosis for RA (10 - general idea)

A
  1. Osteoarthritis
  2. Reactive Arthritis (Reiter’s Syndrome)
  3. Inflammatory bowel disease
  4. Gout
  5. Psoriatic arthritis
  6. Polymyalgia rheumatica
  7. Infection
  8. Fibromyalgia
  9. SLE
  10. Sarcoidosis
53
Q

Content: RA Clinical Presentation (7)

A
  1. Insidious onset
  2. Symmetrical morning stiffness > 60 min
  3. Generalized fatigue/malaise
  4. Low grade fever
  5. Anorexia/weight loss
  6. Depression
  7. Progression most rapid in 1st 6 years
54
Q

Content: Disease Course for RA (3)

A
  1. Monocyclic - 20%
    • One episode which abates within two years of initial presentation
  2. Polycyclic - 70%
    • Fluctuating level of disease activity
  3. Progressive and unremitting - 10%
55
Q

Content: RA Patterns of Joint Involvement (4)

A
  1. Bilateral and symmetrical
  2. Most commonly hands and wrists
  3. Joint inflammation and Crepitus
  4. Permanent joint abnormalities within 10 years of diagnosis (80%)
56
Q

T/F: The axial skeleton and DIP are often involved in RA

A

False, rarely

57
Q

Q: What may accompany and be affected by RA?

A

Accompanied by joint ankylosis or ankylosing spondylitis

C-spine may be affected - can cause symptoms of cord compression

58
Q

Diagram: Review of ABCs of Radiology

A
59
Q

Content: RA Wrist Involvement (3)

A
  1. Volar subluxation and ulnar displacement of carpals in relation to radius
  2. Frequent development of flexion contractures
  3. DeQuervain’s and CTS are common due to synovitis
60
Q

Content: RA Hand Involvement

  1. MCP
  2. PIP
  3. Thumb
  4. DIP
A
  1. volar subluxaiton and ulnar drift
  2. Swan neck and Boutonniere deformities with osteophyte formation, Bouchard’s nodes
  3. IP hyperextension and MCP flexion, with progressive CMC involvement
  4. Usually uninvolved
61
Q

Q: What is often the first clinical feature of RA?

A

Symmetric MCP and PIP joint involvement

62
Q

T/F: Profound deformity and bone erosion is not associated with RA.

A

False, associated

63
Q

Defn: Mutilans Deformity

A

Severe deformity with profound instability and funcitonal impairment

64
Q

T/F: Hip involvement is more common in RA.

A

False OA

65
Q

Content: RA Hip Involvement (2)

A
  1. Joint space narrowing with intact articular cortex
  2. No sclerosis
66
Q

Content: RA Knee Involvement (5)

A
  1. Commonly involved due to large amount of joint synovium
  2. Flexion contracture are common due to pain, muscle guarding
  3. Joint collapse
  4. Absense of osteophytes
  5. Diffuse osteopenia
67
Q

Content: RA Foot and Ankle Involvement (5)

A
  1. Pronated hindfoot
  2. Collapse of longitudinal and transverse arches
  3. Hallux valgus
  4. MTP joint subluxation
  5. Hammer/claw toes
68
Q

Content: RA Muscle Involvement (5)

A
  1. Occurs at affected joints

Things that may contribute:

  1. Disuse atrophy
  2. Myositis
  3. Steroid induced myopathy
  4. Peripheral neuorpathy
69
Q

Content: RA Tendon/Ligament Involvement

A
  1. Altered biomechanics due to chronic inflammatory process
  2. Tenosynovitis interrupts gliding at tendon sheath, causing damage and potential for rupture
  3. Flexor tenosynovitis is considered a poor prognostic factor
70
Q

Content: Radiographic Feaures of RA during the following stages

  1. Early
  2. Moderate
  3. Severe
  4. Terminal
A
  1. No radiographic evidence, possible osteoporosis
  2. OP with slight cartilage destruction, muscle atrophy, no joint deformity
  3. OP and destruction of cartilage/bone, joint deformity w/o anklyosis, extensive atrophy
  4. Stage 3 + fibrous or bony ankylosis
71
Q

Content: RA Laboratory Tests (5)

A
  1. Rheumatoid factor (RF) - Negative in up to 30% with RA, ca be + in absence of RA
  2. Erythrocyte sedimentation rate (ESR) - often ^ in RA/other rheumatic diseases
  3. C-reactive protein - ^ indicates actue inflammation
  4. Complete blood count - decreased RBC, norm WBC, ^ platelets
  5. Synovial fluid analysis - usually turbid with neutrophils culture to rule out infection
72
Q

Content: Complication of RA - Deconditioning (2)

A
  1. Loss of lean body mass
  2. Elevated resting energy expenditure
73
Q

Content: Complication of RA - Vascular (3)

A
  1. CHF
  2. GI Bleeding
  3. Hemorrhage
74
Q

Content: Complication of RA - Neurological

A

Usually associated with compression/entrapment

75
Q

Content: Complication of RA - Cardiopulmonary (2)

A
  1. Impaired fitness
  2. Pericarditis - rare
76
Q

Content: Complication of RA - Ocular compromise

A

Sjogren’s Syndrome - inflammatory disorder of lacrimal and salivary glands

77
Q

Q: What is the goal of RA pharmacologic therapy?

A

Aggressive early disease managment to limit long term joint destruciton

78
Q

Content: RA Pharmacologic Therapy (3)

A
  1. NSAIDs - analgesic, antiinflammatory, usually COX2
  2. Disease Modifying Anti Rheumatic Drugs (DMARD) - early prolonged use, methotrexate
  3. Biological Response Modifiers (BRM) - DMARDs with block TNF-alpha or interleukin-1, Humira
79
Q

Content: Primary Indications for Surgical Management (3)

A
  1. Intractable pain
  2. Loss of function
  3. Progression of deformity
80
Q

Content: Soft tissue Procedures (3)

A
  1. Synovectomy
  2. Soft tissue release
  3. Tendon transfer
81
Q

Content: Bone/Joint Procedures (3)

A
  1. Osteotomy
  2. Arthroplasy
  3. Arthodesis
82
Q

Content: Red Flags (3)

A
  1. Recent trauma
  2. Constitutional signs
  3. Unusual pain or weakness, etc
83
Q

Content: OE ROM (4)

A
  1. Goni assessment
  2. Functional ROM
  3. Influence on ADLs
  4. Biomechanical impact on surrounding joints
84
Q

Content: OE Strength (2)

A
  1. Caution with MMT
  2. Modify or use funcitonal test
85
Q

Content: OE Joint Stability

A

Don’t want to do too much mobilization, use caution

86
Q

Content: Functional Assessment (4)

A
  1. Ideally should be standardized
  2. Functional status index
  3. Arthritis impact measurement scale
  4. WOMAC
87
Q

Content: Psyhological Status

A

Pain correlates more strongly with depression than function

88
Q

Content: Goals and Outcomes for Arthritis (7)

A
  1. Decrease pain, mechanical joint stress
  2. Increase or maintain ROM and strength
  3. Improve joint stability
  4. Increase functional endurance
  5. Maximize independence in ADL
  6. Improve gait efficacy and safety
  7. Establish exercise and conditioning programs
  8. Educaiton to increase capacity for self management
89
Q

Q: What directs the evulation and intervention for arthritis?

A

Stage of Inflammation

90
Q

Content: Acute Phase Rehab (4)

A
  1. Reduce pain and inflammation
  2. Rest affected joints
  3. Modalities
  4. Maintain ROM, strength, endurance, functional independence
91
Q

Content: Sub-Acute Phase Rehab (3)

A
  1. Progress ROM, strength, endurance and functional training
  2. Improve performance and range of ADL’s
  3. Joint protection
92
Q

Content: Chronic Phase Rehab (3)

A
  1. Independence in ADLs
  2. Return to vocation, recreation
  3. Pt. education
93
Q

Content: Modalities (5)

A
  1. Used to reduce pain and facilitate actvity
  2. Superficial head - dry heat pads, paraffin, etc
  3. Deep heat - US, diathermy (contraindicated for acute, usefulness for arthritis is questionable)
  4. Cold - for acute edema
  5. TENS
94
Q

Content: Joint Mobility (3)

A
  1. Positioning and self ROM
  2. Lengthen shortened muscle groups
  3. MT is usually not indicated for RA
95
Q

Content: Strengthening (4)

A
  1. Isometric or submax
  2. Add dynamic, concentric/eccentric
  3. Use resistnace with caution (pain free, monitor for exacerbation, incorporate functional activities)
  4. Exercise induced discomfort should subside within one hour
96
Q

Content: Gait and Functional Training (3)

A
  1. Improve walking speed and normalize gait
  2. AD selection
  3. Cane may unload hip by up to 60%
97
Q

Content: Joint Protection (4)

A
  1. Splints/Orthoses
  2. Maintain ROM
  3. Biomechanical support
  4. Reduce pain
98
Q

Content: Endurance Training

A

Consider NWB modes if possible

99
Q

Content: Education (4)

A
  1. Disease process
  2. Joint protection
  3. Pain management
  4. Resources

PTRS 746 Exam 2 (9 decks)

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