Osteoarthritis and Rheumatoid Arthritis Flashcards
Rheumatic Disease Etiology
More then 100 conditions include; OA, RA, Lupus, Ankylosis Spondylitis, Scleroderma, Gout, Fibromyalgia
Characterized by chronic pain, progressive impairment of joints and soft tissues
1 in 4 Adults has s/s of Arthritis
Arthritis costs 128 billion in healthcare costs per year
Numbers will significantly increase due to the aging population.
Osteoarthritis (OA), (DJD) Risk factors
Third largest health problem in the world
After age 50 women have higher incidence
Risk factors include; age, gender, heredity, obesity, anatomic joint abnormality, injury, occupations.
Primary OA can be?
No know caused may be localized or generalized.
DIP and first CMC joints most often involved
Incidence increase with age
Secondary OA
Has identifiable causes such as trauma
Any age
What is OA?
Gradual loss of articular cartilage due to degenerative joint disease and chemical factors.
No longer though of as wear and tear but a complex disease process producing degradative enzymes.
Which common joints are affected with OA?
hip, knee, IP, CMC, and spine.
OA is two part process name it.
Deterioration of articular cartilage
Reactive bone formation (osteophyte formation).
What is the clinical manifestations?
Joint pain Boney enlargement Stiffness tenderness Limited motion Crepitus Malalignmnet Joint deformity Inflammation (edema, soft-tissue can be observed in acute exacerbations)
Joint Deformities associated with OA
CMC Jt commonly effected Characterized by thumb addiction and subluxation from the trapezium, MP, hyperextension, IP joint flex ion Pinch is painful Heberden’s nodes DIP Bouchard’s nodes PIP
What is the OT treatment for OA?
Patient education - weight management Joint protection techniques Adaptive equipment Environmental modifications Energy conservation
Joint protection techniques
Respect pain Minimize force and load on joints Balance rest and activity Use larger stronger joints Good body mechanics Avoid positions of deformity Decrease effort and resistance Maintain ROM
OT intervention for OA
Modalities (PAM’s) - depending on your state and facility Pain free ROM Isometric strengthening General conditioning Avoiding pinch strengthening Splinting Thumb - Short opponent splint Custom prefab neoprene
OA Surgical Treatment
Join replacement Hip Knee CMC - ligament reconstruction tendon interposition - gold standard treatment - trapezium removed tendon “anchovies”
Rheumatoid Arthritis definition
Chronic autoimmune disorder affecting 1.3 million Americans
Onset can be any age with a prevalence increasing with age with peak being between 40-60 yo
Rate is 2-3 times higher in females
Etiology is no well understood. Synovial membrane of a joint becomes inflamed and wears away at the bone, cartilage and soft tissues which contributes to joint deformities
Joint involvement is often symmetrical and bilateral throughout the body
Characterized by remission and exacerbations
Clinical Manifestations of RA
Symmetrical polyarticular pain Swelling Morning stiffness (1-2) Joint deformities Rheumatoid nodules Fatigue Depression
Stages of Disease Process stage 1
Stage 1: early phase (acute) joint swelling and inflammation, no destructive changes, possible presence of osteoporosis on x-ray flare
Stages of RA stage 2
Moderate phase (proliferative) synovium begins to invade the soft tissues producing tenosynovitis and limiting joint movement adjacent muscle atrophy (no joint deformity)
Stage 3 RA
Sever phase (destructive) synovial erosion causes irreversible changes including joint deformities, loosening of ligamentous insertions, impatient of tendon function, muscle atrophy and joint disorganization E-ray evidence of cartilage and bone destruction and osteoporosis
Sage 4 RA
Terminal phase (chronic) synovial activity ‘burn out’ fibrosis or bony ankylosis
Joint Deformities associated with RA
Ulnar deviation of digits at MP joints
Extensor tendon slip to the ulnar aspect of the metacarpal head
Swan-neck deformity due to erosion of the PIP collar plate rupture of lateral band or FDS rapture
Boutonnières deformity -caused by rupture or lengthening of the central slip of the EDC
OT treatment for RA
Education - prevent joint deformities Sleep and rest Modalities Therapeutic exercises Adaptive equipment Splinting - for rest, deformity, function Joint protection Fatigue management Energy conservation
Surgical treatment for RA
medication management reduced need for surgeries Synovectomy Arthoplasty Arthodesis Joint fusion
