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MT 364 > Osteoarthritis, Rheumatoid Arthritis, Osteoporosis > Flashcards

Osteoarthritis, Rheumatoid Arthritis, Osteoporosis Flashcards

1
Q

Joints

A
  • Joints connect the bones to each other
  • most common & mobile joints in the body are synovial joints
  • approx. 200 bones of the adult skeleton are attached to each other
  • muscle & bones=stability & movmt.
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2
Q

joint capsule

A

tough, fibrous tissue that completely surrounds the joint

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3
Q

cartilage

A

tough, pearly-blue, rubbery tissue that covers the ends of the bones in a synovial joint, act as a shock absorber, protecting underlying bone

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4
Q

synovial membrane

A
  • all surfaces w/in the joint capsule (exception cartilage)
  • lined by thin ‘inner skin’
  • secretes synovial fluid into the joint space, making joint movmt. easy & smooth
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5
Q

ligament

A

strong fibrous bands connect ends of bones together (not stretchy, like duct tape)

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6
Q

tendons

A

white, glistening, fibrous cords attach muscles to bones (stretch, bungee cord)

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7
Q

Osteoarthritis (no disease)

A

chronic condition w/ deterioration of joint cartilage & formation of new bone (hypertrophy=extra growth) @ bone margins (bone spurs/osteophytes=extra cells @ edge of bone) caused by body’s failed attempts to repair damaged joint tissues

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8
Q

prevalance

A
  • widespread, most common form of arthritis

- 1/10, F>M, huge cost to health care system

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9
Q

etiology

A
  • idiopathic=unkown cause=majoirty

- trauma=secondary

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10
Q

anatomy/mechanism

A
  • injurty to cartilage->unsuccessful repair -> cartilage becomes rough and pitted -> loss of joint space -> ligaments loosen -> loss of joint support
  • bone joint surface unprotected by healthy cartilage similarity fails to repair correctly & bone spurs are formed at margins of joints, between vertebra bodies, cancause stenosis (narrowing, bones against bones) resulting in impingement on nerves
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11
Q

onset

A

insidious onset, after 40 yo

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12
Q

s&s

A

-affects isolated (not symmetrical), usually weight-bearing joints; hips, knees, neck and spine, hands and great toes (not wrist/ankle)

typical presentation:
*pain: deep acing joint pain after exercise/weight-bearing, relieved by rest, lessens w/ gentle movmt. increases over course of day may increase with weather

  • stiffness: decreased ROM, morning stiffness last <30 mins
  • swelling: minimal, crepitus (grating sensations=grinding of bone) on mvt, deformity minimal, bone enlargements possible (ex: bunions)
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13
Q

Rx

A

no cure

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14
Q

goals (Rx)

A
  • manage/control decr. pain
  • increase joint function,
  • incr. strength
  • incr. fitness
  • incr. nutrition
  • decr. falls
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15
Q

physical measures (excers., PT, OT) (Rx)

A

-Rest, ADL/activity analysis, balance activity w/ rest

  • joint protection, positioning, splinting
  • assistive devices, grips, corrective footware
  • mobility: gait training, use of cane & ambulation aids
  • exercises: ROM (flexibility), isometric strengthening (w/out moving the joint, ex: pressing palm together), low impact tai chi, yoga
  • hydrotherapy (hottub/swimming)=moist heat (reduces pain & stiffness & increase ROM)
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16
Q

counseling (Rx)

A

emotional support & patient & fam education, programs and workshops

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17
Q

nutritionist (Rx)

A

prevent obesity (reduce fat increase fibre), vit D

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18
Q

MT (Rx)

A

relaxation, coping skills, massage

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19
Q

medications (Rx)

A

analgesic: pain relieving (acetomenophen, tylenol), risk liver damage
anti-inflammatory: NSAIDS (advil), risk gastro-intestinal problem
corticosteroids: injections, limited freq/yr

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20
Q

surgery (Rx)

A

arthroscopy (scopt in joint), joint replacement; knee, hip; risk of DVT (deep vein thrombosis=bl. clot in calve, moves, turn to emoblism)

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21
Q

prognosis

A

course variable; progress, stable/suddenly deteriorate

22
Q

risk factors

A

age, obesity, hx previous injury

23
Q

prevention

A

none, minimize by lifestyle, diet, exercise

24
Q

problems/safety concerns

A

risk of falls, use it or lose it, quackery (placebo effect)

25
Q

Rheumatoid arthritis (RA)

A

a chronic, systemic (whole body), autoimmune inflammatory disease, affects the synovial membrane of multiple joints & surrounding tissues & can affect various organs and systems of the body (eyes, lungs, skin etc)

26
Q

prevalence

A

1/100, females > male, increases w/ age, rare total disability

27
Q

etiology

A

unkonw, theories combo. possible factors: infection, genetic, endocrine factors (hormonal changes)

28
Q

anatomy/pathophysiology

A

invasion of synovial membrane (joint lining) by immune cells

  • > swelling into joint due to thickening of synovial membrane & incr. synovial fluid production
  • > layer of granulation tissue invades cartilage
  • > erodes, destroys bone & result joint destruction (eventually no joints, bone on bones)
  • > causes: deformity, immobility, possibly ankylosis (fused joint)
29
Q

classification

A

RA, also Juvenile RA (JRA)

30
Q

onset

A

insidious, gradual onset, peak onset: 40-60 yo

31
Q

s&s

A

synovitis (infection of the synovial membrane)=hallmark

initial/early: fatigue +++, anorexia, low gr. fever

intermediate: pain in affected tissue (joint pain)
* symmetrical involvement (small join in hand/feet, shoulder, wrist, knees)
* pain on mvt & at rest
* joints stiffen after rest/inactivity (morning stiffness last >1hr)
- reduced ROM, decreased joint funct.
- fatigue
- joint damage & deformities possible: swan neck (crooked fingers seen in LTC), boutonnier deformity (blister)

32
Q

diagnosis

A
  • early diagnosis vital, get specialist care & prevent loss of joint funct.
  • x-ray
33
Q

Rx objectives

A
  • decr. inflammation, pain
  • prevent long term joint deformities
  • maint. joint fucnt.
  • incr. quality of life
34
Q

Rx

A

NOT too little, too late

med:
- >pain relief only (acetominophen=analgesic), NSAIDS

  • > corticosteroids, side effects
  • > DMARDS, strong, prevent irreversible damage
  • > rest, naps, energy saving

->PT, gentle exc., ROM, strenth, endurance, hot/cold pain relief, cane
cold reduces swelling, pain
->OT, splints (rest/work), joint position/protection
->nutrition, possible anemia (caused by drugs)
->stress reduction, ergonomics, education
->surgery, joint replacement
->psychological support, coping strategy. relaxtn, taichi, MT

35
Q

prognosis

A
  • course unpredictable,
  • flare-ups,
  • generally progress to some deformity,
  • remissions possible return to normal funct.
36
Q

risk factors

A

gender, age, family hx, smoking

37
Q

prevention

A

none

38
Q

probl./safety concerns

A

depression
risk of falls
neck problems

39
Q

Osteoporosis

A

a progressive metabolic bone disease in which bone mass is diminished but relative composition unchanged; bones become brittle, porous and vulnerable to fragility fracture due to decreased calcium & phosphate in bones

40
Q

prevalence

A
  • affects 1/4 F, 1/8 M, over age 50, esp. postmenopausal, small-boned
  • 80-% of all fractures over 50 yo due to osteoporosis (more info on handout)
41
Q

etiology

A

A. Primary - affects older men & post-menopausal women
Bone mass/densty loss due to combination predisposing factors:
-estrogen deficiency; hormone estrogen blocks bone loss=accelerated bone loss in first 2 decades after menopause, F>M
-prolong inadequate dietary calcium, and insufficient Vit D
-sedentary (seated too much) lifestyle (lack weight bearing stress/exercise), alcohol, smoking, caffeine

B. secondary to: immobilization, diabetes & kidney disease

42
Q

pathophysiology

A
  • osteoblast build bone, while osteoclast resorb bone
  • peak bone mass occurs at mid-twenties, plateau for 10 yrs then resorption create > bone creation, aging cause loss of 0.5%/yr & accelerates 3-5% loss/yr in women at menopause. Men start w/ greater bone mass
43
Q

anatomy

A

-fragility fractures (due to osteoporosis, even fall from standing)

  • common fractures:
  • > wrist fractures; 50% morbidity (couldn’t bounce back) (disabled+++)
  • > hip fracture
  • > vertebral fractures; pain, compression rx causes decrease height
44
Q

classification

A

primary & secondary

45
Q

onset

A

after 50yo

46
Q

s&s

A
  • silent
  • asymptomatic: spontaneous fractures (no trauma/fall)esp. vertebrae in mid-thoracic level/thoracolumbar area
  • first fracture often wrist
47
Q

diagnosis

A

lab test for bl./urine

48
Q

Rx

A

modify risk factors, preserve bone mass, prevent fractures

  • diet: calcium (incr. bone metabolism)
  • vit D3
  • exercise: weight-bearing to decr. rate of bone loss & inc. m. strength & resistance training (biking)

drugs - antiresorptive;
*Phosphate supplment-bisphophonate

meds: analgesic, muscle relaxants

rest, relaxation

spinal support, rolling walker to spread the weight

  • education, risk management, tai chi
  • surgery: internal fixation of fractures, total hip joint replacements
49
Q

prognosis

A

the course varies w/ cause, complete permanent disability possible

50
Q

risk factors

A

nonmodifiable=build, age, race

modifiable=coffee, alcohol, smoking

51
Q

prevention

A

calcium & protein rich diet, daily exercise, early screening: all F//M over age 50

52
Q

problems/safety concerns

A
  • risk of falls
  • respiratory problems, ribs tou
  • MT considerations

MT 364 (7 decks)

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