RA, OA, OP Flashcards
What is Rheumatoid Arthritis?
It is an inflammatory autoimmune disease where our immune system attacks our own joints, causing bilateral and symmetrical symptoms since it is autoimmune
Explain the mechanism of the disease
- It is an ongoing immunological response attacking the synovial membranes of our joints.
- Antibodies are sent out causing inflammation
- Membranes become sore and chemicals are released causing damage to nearby tissues
What cause and risk factors of RA?
- Cause is unknown
Risk factors:
- Smoking which inhibits RA medication and worsens the disease
- Gender – more common in middle aged women
- Genetics, environmental factors, lifestyle, and immunology
How does RA progress?
- Inflammation of the synovial membrane (synovitis) affecting joints only and no other structures. Stiffness and swelling occur.
- Eventually damage to cartilage occurs causing muscle weakness surrounding the joint.
- Damage to bones within the joint which can cause joint deformity and further muscle weakness resulting in loss of mobility
- “End stage”, where inflammation has stopped, and joints have lost their function meaning that they are severely damaged, and bones may fuse together.
What can be the consequences of RA?
- Malalignments (displacement of bones in relation to joints)
- Cervical spine problems are common, like dislocated vertebra that compresses nerve causing neurological symptoms
- Genu Varum/Genu Valgus which is outward/inward position of knee
- Rheumatic foot that causes pain and problems with footwear:
1. Claw toe, hammer toe, and hallux valgus
2. Ulcers due to deformities of foot causing pressure spots resulting in lesions of skin that does not heal naturally
3. Hyper pronation which is foot tilted inwards
What are the symptoms of RA?
- Inflammation symptoms: pain, heat, swelling, redness
- Stiffness
- Tiredness
- Loss of apatite
- Weight loss
How to you treat and rehabilitate RA?
- Surgical: Reconstruction of joints/tendons, fixation of joints and removal of synovial membrane
- Medications: Painkiller – paracetamol; NSAIDs – Ibuprofen to reduce inflammation and pain; DMARDs – inhibits activity of immune system; Cortisone
- Conservative treatments: Physiotherapy to improve strength and ROM, and reduce inflammation; Orthotics to support and enable physiotherapy and activity and ease pain
Rehabilitation:
- Education
- Psychological and social support
- Aids and physical activity
Chractiristic symptoms of RA
- Morning stiffness of joints in hands and feet
- Three or more joints affected
- Symmetrical symptoms
What is OA?
It is a mechanical degenarative disease of the joints
- Asymmetrical
- Common in weight bearing joints and those exposed to mechanical trauma (knees, hips, fingers)
Explain the mechanism of OA
- Core mechanism is a imblanace of degeneration and regeneration of cartilage
- Proteocglycans’ ability to bind water decreases/disappears causing unevenly distributed pressure resulting in that degeneration exceeds regenration of cartilage
- Joint space shrinks eventually
What risk factors are associated with OA?
- Result of RA
- Smoking, inactivity, anorexia
- Overweight causing too much load on joints
- Muscle weakness
- Genetics and gender (more common in women)
- Not enough rest of joint after injury/surgery
How does the progression of OA look?
Grade 1: Cartilage gets thinner and clinical symptoms are rare
- Feeling of stiffness and discomfort in joints
- Hard to move after inactivity
- Symptoms disappear during physical activity
Grade 2: Joint space shrinks and clinical symptoms are common
- Pain when moving joint
- Difficulties with daily activities
Grade 3: Almost complete degeneration of cartilage, joint space is no longer visible on X-rays, and bone ends start to rub on each other
- Constant symptoms with limited mobility
What does the progression rate in OA depend on?
- Severity of symptoms when diagnosed
- Overall health
- Use of the affected joints
For knees progression is faster in:
- Older people
- Overweight people
- People with OA in more joints
Name 3 consequences of OA
- Pain due to bones rubbing onto each other - cartilage usually protects since it has no free nerve endings
- Skeleration = bone growth causing more dense bone
- Subchondral cyst (mass of dense bone) causing pain from surrounding tissue or pinched nerve
What are common symptoms of OA?
- Morning stiffness lasting no longer than 30 min
- Pain getting worse after physical activity
- Swelling
- Restricted ROM
- Crepitations - joint ckracking
