Rheumatoid Arthritis Flashcards
1
Q
Autoimmune, chronic, inflammatory, systemic disease affecting synovial joints and other connective tissues
A
Rheumatoid Arthritis (RA)
2
Q
- Unknown
- Genetic predisposition
- Compromised immune system possible contributing factor
A
Causes of RA
3
Q
- Women:men 3:1
- As early as 25 – 50 commonly affected
- Smoker
A
Risk Factors of RA
4
Q
- May develop suddenly within weeks or months
- MCP, PIP, wrists, elbows, GH, C-sp, MTP, ankle, talonavicular jts commonly affected
- Bilateral, symmetrical and at least 3 jts swollen at one time (MD dx)
nodules - AM stiffness lasting more than 1 hr
- Early: ROM is limited by pain
- Onset of condition starts with fever and fatigue
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Clinical Manifestations of RA
5
Q
- Malaise
- Vague mm aches and pains
- Gradual worsening becoming jt specific
- Low-grade fever
- Appetite Loss
- Anemia
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Early Stage of RA
6
Q
- Stiffness after long periods of immobility
- Stiff, often deformed swollen bilateral joints
- Shiny, tightly stretched skin over affected joints
- Puffy joints
- Affected extremity is achy
- Malaise
- Anemia
A
Remission (Subacute) Stage of RA
7
Q
- Red, Hot, Painful and swollen Joints
- Restricted, painful ROM
- Anemia
A
Flare (Acute) Stage of RA
8
Q
- Late: ROM limited by capsule, muscle contracture, rupture of tendons/ligamentous laxity, bony/fibrous ankylosing
- Instability
- Swan neck, boutonnieres, ulnar deviation, valgus deviation in hands
- C1 C2 involvement (transverse ligament, alar ligaments, odontoid deterioration)
- CTS and bursitis may be complications
- Nodules
- Ocular, respiratory, cardiac involvement
A
Late Manifestations of RA
9
Q
- Same as Lupus
- Test according to joint/s affected and according to state of inflammation
- Flare up: AROM
- Non-flared: test based on symptoms
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Assessments for RA
10
Q
- Improve relaxation
- ↓ pain and muscle guarding
- ↓ local inflammation
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RA Treatment Aims for Flare-Up
11
Q
- Assess jt integrity prior to tx
- ↓ pain/stiffness
- → ROM of affected joint(s)
- ↓ adhesions
- Minimize atrophy
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RA Treatment Aims for Remission
12
Q
- Respect fatigue and increased pain
- Do not overstress osteoporotic bone or lax ligaments
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Precautions for RA
13
Q
CI’s pertaining to inflammation:
- Avoid general circulatory intent during a flair – local lymph drainage only, proximal to inflammation
- No passive or O/P in advanced cases especially at C1 C2
- See specific precautions for prescribed medications
- No stretching swollen joints
- No vigorous stretching
- AV jostling or excitatory tech’s
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Contraindications for RA
14
Q
- Flare-ups: cool towels
- Remission: contrast to maintain tissue health
- Deep moist heat/wax bath to affected jts
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Hydrotherapy for RA
15
Q
- Tx proximally to site of inflammation
- Position and bolster for comfort
- HNS massage as well as foot massage if feet not affected
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Massage Techniques During RA Flare-up
16
Q
- TP therapy, petrissage
- Joint play, rhythmic mobilizations depending on stage and degree of mobilization
- Frictions
A
Massage Techniques Between Flare-up
17
Q
- Active ROM to affected jts
- Active assisted in severe cases
- Gentle isometrics to maintain muscle strength
- Avoidance of activities that stress joints
- Improve cardiopulmonary function
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Remedial Exercise for RA
18
Q
- DMARDs: disease-modifying antirheumatic drugs-Imuran, Ridaura
- Corticosteroids
- NSAIDs
- Salicylate Analgesics
- Nonopioid analgesics
- BRM Biologic Response Modifiers
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Medications for RA
19
Q
- Stress reduction techniques
- Use of supportive devices for jts ie. Splints, braces
- Good bed positioning while resting
self-massage - Low impact aerobics such as swimming, water aerobics, cycling
- Support groups
- Rheuminfo.com, arthritis.ca, arthritisnetwork.ca
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Homecare for RA
