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
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
3
Q
Main feature of rheumatoid arthritis
A
Synovitis - symmetrical pattern
4
Q
What is the sequence of events that occurs with synovitis in RA
A
- Synovium becomes swollen and cells proliferate
- dense cellular membrane (pannus) spreads over articular cartilage
- erodes underlying cartilage and bone
- w/ time: pannus may extend to the opposite articular surface creating:
• fibrous scar tissue
• adhesions
• bony ankylosing`
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
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)
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
8
Q
Increased risk of RA w/
A
o giving birth
o cigarette smoking
o pollution
9
Q
RA S&S
A
- pain, fatigue, stiffness (decreased ROM)
- swelling, joint deformity, mm atrophy, extra-articular features
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
11
Q
RA Rehab Acute phase
A
- energy conservation
- ice
- splints
- gentle ROM
- NO STRETCHING (may stretch the synovial membrane & cause irreversible damage)
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
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
14
Q
RA Surgery
A
4 R’s • remove (MTP resection) • re-align (tendon rupture) • rest (arthrodesis) • replace (arthroplasty)
15
Q
What does a joint count assessment tell you
A
Indicator of RA Disease activity
16
Q
3 steps to a RA Joint count
A
- Joint effusion
- Joint line tenderness
- 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
features of Swan neck
- Contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons
- flexion of MCP (not always), hyperextension of PIP, flexion of DIP
26
Swan neck Ax and Rx
Ax: Bunnel Littler's
Rx: able to actively flex & extend deformed joints, stretch interosseous muscles
27
Features of boutonniere deformity
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
Boutonniere deformity Ax and Rx
Ax: central slip tenodesis
RX: able to flex and extend deformed joints
29
Features of ulnar drift
involves synovitis of MCP + structural differences: cause volar subluxation/laxity of MCP in radial collateral ligaments
30
Ulnar drift Ax and Rx
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
What is BD thumb
90/90 position
32
Ax and Rx for BD thumb and thumb swan neck
Ax: grind & crank test
Rx: web space massage/stretch, opposition and abduction exercises
33
Features of DRUJ Instability
Synovitis at joint, stretches ulnar carpal ligaments, ulnar head will sublux dorsally, ECU is displaced and more becomes a flexor tendon
34
DRUJ instability test
Ballottement test
| Piano key test
35
What are 4 other deformities not associated with RA
Dupuytren's contracture
Ape hand
Mallet finger
Gamekeeper's thumb
36
What is Dupurtren's contracture
* Contraction of the palmar fascia
| * MCP’s + PIP’s of 4th and 5th digits
37
What is Ape hand? What is it the result of?
* Thenar muscle wasting with first digit moving dorsally until in line with second
* Results from median nerve dysfunction
38
What is Mallet finger
* Rupture or avulsion of extensor tendon at its insertion into distal phalanx (generally with trauma)
* Causes flexion of DIP
39
What is gamekeeper's thumb? What is it caused by?
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)
