Osteoarthritis, Rheumatoid Arthritis, Osteoporosis Flashcards
Joints
- 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.
joint capsule
tough, fibrous tissue that completely surrounds the joint
cartilage
tough, pearly-blue, rubbery tissue that covers the ends of the bones in a synovial joint, act as a shock absorber, protecting underlying bone
synovial membrane
- 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
ligament
strong fibrous bands connect ends of bones together (not stretchy, like duct tape)
tendons
white, glistening, fibrous cords attach muscles to bones (stretch, bungee cord)
Osteoarthritis (no disease)
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
prevalance
- widespread, most common form of arthritis
- 1/10, F>M, huge cost to health care system
etiology
- idiopathic=unkown cause=majoirty
- trauma=secondary
anatomy/mechanism
- 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
onset
insidious onset, after 40 yo
s&s
-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)
Rx
no cure
goals (Rx)
- manage/control decr. pain
- increase joint function,
- incr. strength
- incr. fitness
- incr. nutrition
- decr. falls
physical measures (excers., PT, OT) (Rx)
-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)
counseling (Rx)
emotional support & patient & fam education, programs and workshops
nutritionist (Rx)
prevent obesity (reduce fat increase fibre), vit D
MT (Rx)
relaxation, coping skills, massage
medications (Rx)
analgesic: pain relieving (acetomenophen, tylenol), risk liver damage
anti-inflammatory: NSAIDS (advil), risk gastro-intestinal problem
corticosteroids: injections, limited freq/yr
surgery (Rx)
arthroscopy (scopt in joint), joint replacement; knee, hip; risk of DVT (deep vein thrombosis=bl. clot in calve, moves, turn to emoblism)
prognosis
course variable; progress, stable/suddenly deteriorate
risk factors
age, obesity, hx previous injury
prevention
none, minimize by lifestyle, diet, exercise
problems/safety concerns
risk of falls, use it or lose it, quackery (placebo effect)
Rheumatoid arthritis (RA)
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)
prevalence
1/100, females > male, increases w/ age, rare total disability
etiology
unkonw, theories combo. possible factors: infection, genetic, endocrine factors (hormonal changes)
anatomy/pathophysiology
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)
classification
RA, also Juvenile RA (JRA)
onset
insidious, gradual onset, peak onset: 40-60 yo
s&s
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)
diagnosis
- early diagnosis vital, get specialist care & prevent loss of joint funct.
- x-ray
Rx objectives
- decr. inflammation, pain
- prevent long term joint deformities
- maint. joint fucnt.
- incr. quality of life
Rx
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
prognosis
- course unpredictable,
- flare-ups,
- generally progress to some deformity,
- remissions possible return to normal funct.
risk factors
gender, age, family hx, smoking
prevention
none
probl./safety concerns
depression
risk of falls
neck problems
Osteoporosis
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
prevalence
- 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)
etiology
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
pathophysiology
- 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
anatomy
-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
classification
primary & secondary
onset
after 50yo
s&s
- silent
- asymptomatic: spontaneous fractures (no trauma/fall)esp. vertebrae in mid-thoracic level/thoracolumbar area
- first fracture often wrist
diagnosis
lab test for bl./urine
Rx
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
prognosis
the course varies w/ cause, complete permanent disability possible
risk factors
nonmodifiable=build, age, race
modifiable=coffee, alcohol, smoking
prevention
calcium & protein rich diet, daily exercise, early screening: all F//M over age 50
problems/safety concerns
- risk of falls
- respiratory problems, ribs tou
- MT considerations
