Rheumatoid Arthritis Flashcards
RA vs OA
RA- systemic inflammatory characterized by symmetrical poly arthritis
OA- localized degeneration
Patophysiology
Inflammation of the synovium leading to joint effusion, pain, stiffness, reduced ROM
Immune cells degrade articulated cartilage and bone erosion- leading to more uneven joint surfaces
Pannus- synovial overgrowth of vascular granulation tissue
Joint space narrowing causing pseudolaxity
Muscular imbalances resulting in deformities
Lab test
Acute phase reactants (increased ESR CRP)
Presence of autoantibodies (RF)
Complete Blood count
Synovial fluid analysis (cloudy, will clot, less viscous)
Radio graphic Findings
Joint space (uneven wearing)
Bone (erosion and peri-articular osteropenia - less bone density)
Soft tissue (rheumatoid nodules, swelling)
Diagnosis Criteria
need 4 out of 7 and 1-4 have been present for at least 6 weeks
morning stiffness lasting at least 1 hour
soft tissue swelling or fluid in at least 3 jt areas simultaneously
at least one area swollen in a wrist, MCP, or PIP jt (DIP is rarely involved)
symmetrical arthritis
rheumatoid nodules
abnormal amounts of serum rehematoud factor
erosion or bony decalcification on Radiograps of the hand and wrist
Course of disease
No cure can only manage
Cycles of exacerbation an remission
Remission is defined as <15 mins of morning stiffness
Systemic S&S
Morning stiffness
- lasting >1 generalized
- eases with movement
Extreme fatigue
- increased resting energy expenditure due to chronic immune activation leads to “rheumatoid cachexia” (loss of lean body mass as a results of RA)
Weight loss/ loss of appetite
Fever
Malaise
Articulate S&S
Bilateral and symmetrical
Effusion
Joint pain (arthralgia)
Creptus
Deformity
Loss of fxn
Pseudo-laxity
Cervical Spine RA
C1-C2 commonly effected leading to decreased ROm
Could be life threatening if transverse lig ruptures
Ankylosis (fusion) may be seen in some joints in advanced RA
TMJ RA
Commonly last joint involved
Inflammation results in pain, swelling and limited ROM
Shoulder RA
GH, SC, AC jt effected
Destination and capsule thinning
Higher risk of dislocations
Elbows Ra
Bilateral olecranon bursitis may occur
Ulnar never entrapment
Inflammation will lead to instability
Rheumatoid nodules around olecrannn (most common place to find nodules)
Wrist RA
Affected in almost all RA patients
Volar subluxation of the wrist and hand causing piano key sign
Ulnar drift of MCPs
Carpal bone erosion
Carpal tunnel common
Decreased grasp and pinch strength
Hand RA
Commonly affected in almost all RA (like wrist) index and long fingers (?) is common
Zig zag effect
Trigger finger
Gunnel-littler test for intrinic muscle tightness
PIP RA
Swan neck deformity
Boutonniere deformity
Thumb RA
Flail IP
Type 1- Most common
Type 2- least common
Type 3-
Hip RA
Pain over greater tronchatnter is often due to tronchanteric bursitis
Knee RA
Commonly involved
Knee ballottement test used to test for excess fluid
Sweep test
Accumulation of fluid may lead to a Bakers cyst
Chronic Synovitis leads to joint laxity, erosion
Ankle RA
Hind foot pronation
Forefoot planes and flattening of medial longitudinal arch
Possible instability in subtalar
Tarsal tunnel syndrome may develop
Feet RA
Synovitis of MTP joint is very common
All the usual feet deformities are seen
Muscle involvement
Atrophy
Weakness
Loss of body mass
Tendon involve
Tenosynovitis
Chronic inflammation causing damage
Rheumatoid nodules
Pressure bearing spots
Vascular complications
Vasculitis
Neurological
Peripheral neuropathy
Spinal cord compression
Cardiopulmonary complications
Increased morbidity and mortality risk
Accelerated atherosclerosis
Ma affect gas exchange
Ocular
Episcleritis
Scleritis
Pharmacological Management
NSAIDS- makes them feel better
Corticosteriods- “
Disease Modifying Anti-rheumatic Drugs (DMARDS)- reduces disease progression
PT Examination
History (fatigue, how long swelling)
Physical examination
Psychological status
Envionmental factors
History red flags
Claudication
Constitutional signs
Focal or diffuse weakness
History of significant trauma
Hot swollen joint
Neurogenic pain
Standardized assessment of joint inflammation (SAJI)
Duration of morning stiff
Bilateral grip
Number of active
Erythrocyte sedimentation rate (not us, doctors)
STOP- active joints
Swelling
Tenderness (joint line)
Over Pressure
Damaged joint
Subluxation or deformity
Bone on bone crepitus
Loss of more than 20% of passive ROM
Ligament instability
Sensory integrity
Raynaud’s disease
Nerve compression
Modalities for pain relief
Heat (not on an active joint)
-superficial and deep
Cold
Electrical agents (TENS, IFC)
Rest
Orthoses, Splints, Braces
ROM and flexibility
Education on proper resting positions
AROM daily
(No stretching active jt)
Exercise a time of day they feel the best
If exercise induced pain does not subside after 1 hour, modify parameters
Strengthening exercises
Pain free ranges, improves stability and function
Not on active jt
Cardiovascular traingin
Usual
Functional training
Assisted devices and/or environmental adaptions
Gait and balance training
Rockers or orthotics gait deviations
Wide toed shoes
Extra depth shoe
Joint protection
Decreases pain, improves function, provides support and protection for vulnerable joints
Education and self-management
Helps a lot
PT interventions
Modalities for pain relief
ROM and flexibility
Strengthening
Cardiovascular
Functional training
Gait and balance traingin
Joint protection
Education and self management
