RA and related hand deformities Flashcards
________ is the inflammatory, systemic (total body), connective tissue , and autoimmune characterized by bilater symmetrical arthritis. It is 3:1 ratio females to male ratio, effects many jt’s and organs, can been mild to severe, and the onset is teen to 60’s.
RA
In 60% of people with __________ in the US, a genetic trait called HLA-DR4 is present that may predispose people to develope the disease.
RA
_______ affects the synovitis, immune complexes, thickening of synovium, excess synovial fluid
RA
______ consists of many types of cells which cause degredation of cartilage and bone
Pannus
what are these signs and symptoms:
synovitis, pannus, ankylosing, destroyed ligaments, (early signs of inflammation) cardinal signs of inflammation,Rheumatoid Factor, (early stages) affects the PIP, MCP,MTP, and PIP, (later stages) hips, knees, shoulders, elbows, C-spine, TMj, pain is both acute and severe, pain in the am (2 hrs), spindle fingers, muscle atrophy, and jt stiffness.
RA
_______ is a painful condition caused by finger flexor tenosynovitis and results in snapping type motions when attempting to flex or extend the finger.
trigger finger
________ of the finger involves hyperextension of the DIP jt, flexion of the PIP and hyperextension of the MCP
boutonniere’s deformity
________ of the finger involves flexion of the DIP jt and hyperextension of the PIP jt. It is usually caused by adhesions and the associated shortening of the finger extensor tendons and the jt capsule.
swan-neck deformity
________ deformities in the hand are the result of disruption of the collateral ligaments of the MCP jt. The fingers drift to the _______ side. Arthroplasty may be performed to fix the deformities.
ulnar drift
The _______ involvement in RA is perhaps the most dangerous aspect of the articular disease process.
C-spine
These are other problems of what disease?
- radial-ulnar jt damage (affects supinatiopn/pronation and damages ligaments),
- carpal tunel, foot damage (Hallux valgus,
- hammer toes, mallet toes, and knee damage (genu valgus, genu varus, and fexion deformity)
some other problems associated with RA
what is the most common jt affected in the cervical spine form RA?
atlantoaxial jt
The use of ____________ medications increases the risk of atlantoaxial jt inflammation and instability.
corticosteroid
If the ligamnets of the cervical spine are affected by the disease process, an increased risk of the odontoid process of the axis vertebra becoming detached and may exist, which leads ot compression of the spinal cord. In severe cases, this can result in ________
quadriparesis, tetraplegia, and death
these are some non-jt pathology changes from what disease?
- severe fatigue
- anemia,
- skin nodes,
- sjogrens syndrom,
- lung problems,
- raynauds phenomenon,
- amyloidosis(deff on pg 221)
RA
_________ show jt abnormalities including reduced jt space and bony changes in people with RA
radiographs
at least four of these criteria must be presesnt for a person to be diagnosed with RA. What does the criteria include?
- morning stiffness of 1 hr or more,
- symmetrical arthritis of at least 3 jts associated with soft tissue swelling of more than 6 weeks,
- arthritis of hands,
- rheumatoid skin nodes, and
- positive test for rheumatoid factor.
some examples of medications taken for RA are_________
NSAIDS, DMARDs, corticosteroids, and biological drugs.
why are splints worn for RA?
to preserve jt intergrity
what are some things a PT intervention will include with a pt with RA?
- improve function,
- increase jt motion,
- decrease jt deformity,
- decrease pain,
- strengthening,
- adapt ADLs,
- gait training with assistive device as needed
what PT modalities can be used with a RA pt?
Hydrotherapy Passive stretch Active exercise Electrical modalities Orthotics Pain reduction Psychosocial aspects nutrition
what are some precautions and contraindications that are importatnt for PTinterventions
Traction Spinal flex ex with osteoporosis Forced stretching Rolls beneath knees Hot modalities Pain may increase easily Skin care Adaptive equipment (pg 228)
JRA is called _________ when systemic manifestations are found.
stills disease
what is the etiology of JRA?
unknown
what are some signs and symptoms of JRA?
starts acute Children under 16 Connective tissue (CT) and autoimmune Affects larger, peripheral joints Bone growth retardation Skin rash, pericarditis
stills disease may have lasting damage to the _______ and ________.
heart and lungs
what are included in the PT intervention of a pt with JRA
reduce pain, preserve ROM, functional activities, family involvement, joint protection
__% of all children with JRA have a remission of the dissease by the time they are adolescent with minimal loss of function. The remaining ___% of children will continue to have arthritis asociated diseases throughout their adult life.
75, 25
what meds are given to pts with JRA?
NSAIDS, corticosteroids, DMARDS
_________ is a progressive, inflammatory, rhuematoid-related disease, affecting the jt and ligaments of the spine and occasionally peripheral jts as well as internal organs.
ankylosing spondylitis
AS(ankylosing spondylitis) is more common in __________ and 3 times more common in ______ than in ________
caucasions, men, women
________ is a symptom/sign of AS, which affects maily the spine and sacroiliac jt but can also involve the shoulders, hips, and knees.
anklosis
what are the symptomatical S/S of AS?
Pain, stiffness, fatigue, initially: worse in am
in a person with ankylosing spondylitis what are these symptoms of?
Starts in lower spine
Difficulty with chest expansion
bambo spine
AS in most people includes periods of exacerbations and remissions. The condition does not reduce life expectency but __________ will happen over time.
immobilliy
what are the criteria used to diagnos AS and what are used to assist in the diagnosis?
unilateral or bilateral sacroiliitis, low back pain experienced for at least 3 months that is relieved by exercise, limitatonof spinal motion in more than one plain and chest expansion; MIR, CAT scans, and Xrays assist
what are some meds used to treat AS?
NSAIDs, Biologics, TNFa blockers
PT interventions for AS
to maintain mobility
Emphasize extension of spine
Modalities and postural awareness
Exercise to reduce deformity
_________ is a group of seronegative spondyloarthropathy disease and is characterized by inflammation of the jts, skin psoriasis, and occasipnal systemic symptoms.
psoriatic arthritis
what is the etiology of psoriatic arthritis?
it is unknown but evidence points to a combination of factors including an autoimmune factor, genetic tendency for development of the disease, and environmental factors.
what are the S/S of psoriatic arthritis?
distal jts of hands and feet, sacroilitis, spondylitis, iritis, aortic valve disease, colitis, urethritis, mouth ulcers, DIP damage, pitting of fingernails
what are the 2 S/S of psoriatc arthritis that (per Dr C) are specific to this disease?
iritis, pitting of the fingernails
the prognosis for people with psoriatic arthritis is ________
good (the disease progresses slowly)
what are involved in the PT interventions?
modalities(parafin, MHP, cold pack), exercises to improve hand and spine function
________ also know as systemic sclerosis, circumscribed scleroderma, dermatoclerosis, and morphea, is a systemic autoimmune, commective tissue disease.
scleroderma
scleroderma effects approx _______ people per yr in the US, effects women more than men in a ______ ratio or more, and has an unknow etiology.
20 per million, 3:1
what are the S/S of scleroderma?
inflammatory progress to thickening and loss of elasticity of skin and body organs, HA, fatigue Hardening of the skin, edema in fingers, tight skin in hands, feet and face
the mild form of scleroderma is characterized by CREST. what does the acronym CREST stand for?
Calcinosis, Raynauds, Esophageal hypomotility, Sclerodactyly, and Telangiectases
what are the long term affects of scleroderma?
70% lung complications, heart problems, kidney(scleroderma renal crisis)
what is involved in the PT intervention for scleroderma?
minimize contractures, massage, increase aerobic fitness, ADL’s, keep skin moist, stretching mouth
________ is classified as a rheumatoid-related, systemic, chronic, autoimmune, inflammatory, connective tissua, and collagen disorder.
systemic lupus erthematosus
systemic lupus erythematosus affects apporx 1 in 2000 people in the US, ages ________, and the etiology is unknown
14-64
what are the S/S of systemic lupus erythematosus?
malar rash (butterfly), discoid rash, fatigue, weight loss/gain, fever, alopecia, Raynauds, arthritis, anemia, renal disease, CNS, many other symptoms
_________ is a chronic pain syndrome characterized by multiple areas of muscle tenderness and frequently jt pain.
fibromyalgia
fibromyalgia is considered a __________ while RA is classified as a _________.
syndrome, disease
fibromyalgia is more commonly diagnosed in _____________ and in people with _________ or other ____________ diseases.
middle aged women, RA, autoimmune
_______ is found more in women and 2-4% of the US population.
fibromyalgia
people with fibromyalgia have an increase level of __________.
substance P
what are some S/S of fibromyalgia?
11 of 18 tender points, HA, fatigue, chest pain, IBS, restless leg, anxiety, depression, dizziness, raynauds
what can be part of a PT intervention for a pt with fibromyalgia?
stress reduction, adaption of workplace, aerobic ex: moderate activity, modalities
________ is a chronic and systemic condition often associated with giant cell arthritis.
PMR(this was red in the slides) polymyalgia rheumatica
PMR usually affects people over the age of ____ and is occurs in approx _______ per 100,000 people world wide.
60, 20-50
what are the S/S of PMR?
ache, stiffness, pain: worse proximal, sudden onset, night pain, pain in am
is PMR life threatening?
No
PMR is treated with ________ ?
sterids and methotrexate
what does a PT intervention include for PMR pts?
maximize function, modalities for pain and stiffness, ex to mobilize joints, adapt work/home
wha disease is often confussed with PMR and fibromyalgia?
Myofascial pain syndrome
what is myofacial pain syndrome associated with?
repeditive stress
_________ is localized to 1 or few areas, can cause severe mm pain, and dry needling has been shown to be effective to trigger points.
myofascial pain syndrome
__________ is a chronic pain syndrome involving a disturbance of the vasomotor control of affected limbs.
complex regional pain syndrome, aka RSD(this is red in the notes)
________ occurs in either the UE or LE, more common in women, ages 25-55 and the etiology is unknown.
RSD
RSD is most common in people with _________, peripheral nerve injury, colles fracture, trauma, not associated with severity of injury
CAD (this was red in notes)
what are the S/S of RSD?
severe pain, edema, skin changes: thinning, shinning, sweating , acute sensitivity, excess hair growth (this last one is red in the notes)
is there a cure for RSD?
no
if a pt is doing well with interventions then suddenly has severe pain in hand or foot what should a PT/PTA be suspicious of?
RSD
what are some medications given for RSD?
steroids, opiates, antidepressants, nerve blocks
what can be part of the PT intervention of a pt with RSD?
early mobilization, modalities, exercised, desensitization, contrast baths
_________ can either be a primary diagnosis with no other disease process or a secondary group of signs and symptoms found as part of a diagnosis from many pathologica conditions like autoimmune disease or a connective tissue disease
sjogren’s syndrome
what are the S/S of sjogren’s syndrom
dry eyes, dry mouth (inflamm of salivary glands and lacrimal glands. Dental/gum problems, severe fatigue, depression, arthralgia
with __________ the etiology is unknown although genetic tendency, there is no cure and it will impair the quality of life.
sjogren’s syndrome
