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PCE - Multisystem conditions > Rheumatic Diseases > Flashcards

Rheumatic Diseases Flashcards

1
Q

Characteristics of inflammatory conditions:

  • AM vs PM
  • Swelling?
  • Erythema?
  • Warmth?
  • Morning stiffness?
  • Systemic features?
  • Increase in ESR?
  • Ex:
A 
Yes, worse in AM
Moderate to severe swelling
Sometimes present erythema
Warmth sometimes present
Morning stiffness usually =/> 1 hr
Systemic features are sometimes present
Frequent inc ESR (erythrocyte sedimentation rate)
Ex RA
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2
Q

Characteristics of non-inflammatory conditions:

  • AM vs PM
  • Swelling?
  • Erythema?
  • Warmth?
  • Morning stiffness?
  • Systemic features?
  • Increase in ESR?
  • Ex:
A 
Pain worse after use
Mild swelling
Erythema: Often absent
Warmth: Absent
Morning stiffness usually less than 30 minutes
Systemic features: Very rare/absent
Uncommon
Ex OA
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3
Q

Main feature of rheumatoid arthritis

A

Synovitis - symmetrical pattern

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4
Q

What is the sequence of events that occurs with synovitis in RA

A
  1. Synovium becomes swollen and cells proliferate
  2. dense cellular membrane (pannus) spreads over articular cartilage
  3. erodes underlying cartilage and bone
  4. w/ time: pannus may extend to the opposite articular surface creating:
    • fibrous scar tissue
    • adhesions
    • bony ankylosing`
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5
Q

Synovitis leads to…

A
  • immobility + consolidation (bones form a single unit) of a joint
  • bones can become osteopenic
  • ligaments/tendons become damaged or ruptured
  • surrounding mm deteriorate à joint instability + deformity prone
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6
Q

RA Criteria

A
  • morning stiffness >1hr (6 weeks)
  • arthritis of ≥ 3 joints (6weeks)
  • arthritis of hand joints
  • symmetric arthritis (6weeks)
  • rheumatoid nodules
  • serum rheumatoid factor
  • radiographic changes
  • abnormal antibody HLA-DR4 (80% those w/ RA)
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7
Q

Abnormal antibody HLA-DR4 is also found in which populations

A

Pts with interstitial lung disease, chronic hepatitis, idiopathic pulmonary fibrosis, normal aging adults, SLE

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8
Q

Increased risk of RA w/

A

o giving birth
o cigarette smoking
o pollution

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9
Q

RA S&S

A
  • pain, fatigue, stiffness (decreased ROM)

- swelling, joint deformity, mm atrophy, extra-articular features

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10
Q

RA Management: Meds

A
  • DMARDs/biologics: stop disease process
  • Methotrexate: prevent permanent joint damage/premature death - educate patient on effects on liver and reproductive organs
  • NSAIDs, Tylenol, cortisone - don;t stop disease process but reduce inflamm/pain and increase ROM
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11
Q

RA Rehab Acute phase

A
  • energy conservation
  • ice
  • splints
  • gentle ROM
  • NO STRETCHING (may stretch the synovial membrane & cause irreversible damage)
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12
Q

RA Rehab Chronic phase

A
  • relieve pain, i.e. modalities, heat
  • splints, exercise (gentle ROM)
  • relaxation/rest
  • Decrease stiffness: gentle ROM
  • aquatic ex (endurance exercise)
  • functional ex’s
  • prevent deformity
  • fall prevention
  • moderate intensity physical activity
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13
Q

RA lifestyle modifications/self management

A
  • need to be informed, problem solve, self-monitor, and communicate
  • education: what the drugs do, what health care team does, resources, exercise and physical activity
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14
Q

RA Surgery

A 
4 R’s 
• remove (MTP resection)
• re-align (tendon rupture)
• rest (arthrodesis)
• replace (arthroplasty)
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15
Q

What does a joint count assessment tell you

A

Indicator of RA Disease activity

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16
Q

3 steps to a RA Joint count

A
  1. Joint effusion
  2. Joint line tenderness
  3. Stress pain
17
Q

What 3 joints may get a flexion deformity in RA

A

Elbow
Hip
Knee

18
Q

10 common deformities seen with RA

A
  • Hallux valgus
  • MTP Subluxation
  • Claw toe
  • Hammer toe
  • mallet toe
  • Swan neck
  • Boutenniere
  • ulnar drift
  • Thumb deformities (BD thumb or swan neck)
  • DRUJ instability
19
Q

Features of hallux valgus

A
  • 1st MTP synovitis
  • big toe is lateral
  • ligament laxity
  • erosion
20
Q

Series of events leading to MTP subluxation

A

o synovitis, displacement of the flexors, unopposed extensors pull the prox phalanx into hyperext, metatarsal head prolapses and get dislocation and lateral drift of toes

21
Q

Sign of MTP subluxation

A

Callouses

22
Q

Features of claw toe

A
  • MTP synovitis
  • MTP ext
  • PIP+DIP flex
  • often all toes except big toe
23
Q

Features of hammer toe

A

MTP and PIP synovitis

  • usually involves 2nd toe
  • flex of PIP and hyperext of DIP (similar to boutonniere)
24
Q

Features of mallet toe

A
  • Flex of DIP

- affects longest toe

25
Q

features of Swan neck

A
  • Contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons
  • flexion of MCP (not always), hyperextension of PIP, flexion of DIP
26
Q

Swan neck Ax and Rx

A

Ax: Bunnel Littler’s
Rx: able to actively flex & extend deformed joints, stretch interosseous muscles

27
Q

Features of boutonniere deformity

A

o Rupture of central tendinous slip of extensor hood

o zig zag deformity à extension of MCP (not always), flexion of PIP, hyperextension of DIP

28
Q

Boutonniere deformity Ax and Rx

A

Ax: central slip tenodesis

RX: able to flex and extend deformed joints

29
Q

Features of ulnar drift

A

involves synovitis of MCP + structural differences: cause volar subluxation/laxity of MCP in radial collateral ligaments

30
Q

Ulnar drift Ax and Rx

A

Ax: radial collateral ligament test, extensor tendon subluxation test

Rx: radial finger walking, joint protection: prevent ulnar deviation forces in getting up from chair, turn on/off taps, holding a book

31
Q

What is BD thumb

A

90/90 position

32
Q

Ax and Rx for BD thumb and thumb swan neck

A

Ax: grind & crank test

Rx: web space massage/stretch, opposition and abduction exercises

33
Q

Features of DRUJ Instability

A

Synovitis at joint, stretches ulnar carpal ligaments, ulnar head will sublux dorsally, ECU is displaced and more becomes a flexor tendon

34
Q

DRUJ instability test

A

Ballottement test

Piano key test

35
Q

What are 4 other deformities not associated with RA

A

Dupuytren’s contracture
Ape hand
Mallet finger
Gamekeeper’s thumb

36
Q

What is Dupurtren’s contracture

A
  • Contraction of the palmar fascia

* MCP’s + PIP’s of 4th and 5th digits

37
Q

What is Ape hand? What is it the result of?

A
  • Thenar muscle wasting with first digit moving dorsally until in line with second
  • Results from median nerve dysfunction
38
Q

What is Mallet finger

A
  • Rupture or avulsion of extensor tendon at its insertion into distal phalanx (generally with trauma)
  • Causes flexion of DIP
39
Q

What is gamekeeper’s thumb? What is it caused by?

A

AKA skiers thumb
• Sprain/rupture of ulnar collateral ligament of MCP of first digit leading to medial instability
• Caused by falls (ie. while skiing when pole increases forces on thumb)

PCE - Multisystem conditions (12 decks)

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