Osteoarthritis and Rheumatoid Arthritis

Question 1

Rheumatic Disease Etiology

Answer 1

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.

Question 2

Osteoarthritis (OA), (DJD) Risk factors

Answer 2

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.

Question 3

Primary OA can be?

Answer 3

No know caused may be localized or generalized.
DIP and first CMC joints most often involved
Incidence increase with age

Question 4

Secondary OA

Answer 4

Has identifiable causes such as trauma

Any age

Question 5

What is OA?

Answer 5

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.

Question 6

Which common joints are affected with OA?

Answer 6

hip, knee, IP, CMC, and spine.

Question 7

OA is two part process name it.

Answer 7

Deterioration of articular cartilage

Reactive bone formation (osteophyte formation).

Question 8

What is the clinical manifestations?

Answer 8

Joint pain
Boney enlargement 
Stiffness
tenderness 
Limited motion
Crepitus
Malalignmnet 
Joint deformity 
Inflammation (edema, soft-tissue can be observed in acute exacerbations)

Question 9

Joint Deformities associated with OA

Answer 9

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

Question 10

What is the OT treatment for OA?

Answer 10

Patient education - weight management 
Joint protection techniques 
Adaptive equipment 
Environmental modifications 
Energy conservation

Question 11

Joint protection techniques

Answer 11

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

Question 12

OT intervention for OA

Answer 12

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

Question 13

OA Surgical Treatment

Answer 13

Join replacement 
Hip
Knee
CMC - ligament reconstruction tendon interposition 
- gold standard treatment 
- trapezium removed tendon “anchovies”

Question 14

Rheumatoid Arthritis definition

Answer 14

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

Question 15

Clinical Manifestations of RA

Answer 15

Symmetrical polyarticular pain
Swelling 
Morning stiffness (1-2)
Joint deformities 
Rheumatoid nodules 
Fatigue 
Depression

Question 16

Stages of Disease Process stage 1

Answer 16

Stage 1: early phase (acute) joint swelling and inflammation, no destructive changes, possible presence of osteoporosis on x-ray flare

Question 17

Stages of RA stage 2

Answer 17

Moderate phase (proliferative) synovium begins to invade the soft tissues producing tenosynovitis and limiting joint movement adjacent muscle atrophy (no joint deformity)

Question 18

Stage 3 RA

Answer 18

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

Question 19

Sage 4 RA

Answer 19

Terminal phase (chronic) synovial activity ‘burn out’ fibrosis or bony ankylosis

Question 20

Joint Deformities associated with RA

Answer 20

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

Question 21

OT treatment for RA

Answer 21

Education - prevent joint deformities 
Sleep and rest 
Modalities 
Therapeutic exercises 
Adaptive equipment 
Splinting 
- for rest, deformity, function 
Joint protection 
Fatigue management 
Energy conservation

Question 22

Surgical treatment for RA

Answer 22

medication management reduced need for surgeries 
Synovectomy 
Arthoplasty 
Arthodesis 
Joint fusion