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Canadian Exam > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

RA vs OA

A

RA- systemic inflammatory characterized by symmetrical poly arthritis
OA- localized degeneration

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2
Q

Patophysiology

A

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

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3
Q

Lab test

A

Acute phase reactants (increased ESR CRP)
Presence of autoantibodies (RF)
Complete Blood count
Synovial fluid analysis (cloudy, will clot, less viscous)

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4
Q

Radio graphic Findings

A

Joint space (uneven wearing)
Bone (erosion and peri-articular osteropenia - less bone density)
Soft tissue (rheumatoid nodules, swelling)

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5
Q

Diagnosis Criteria

A

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

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6
Q

Course of disease

A

No cure can only manage
Cycles of exacerbation an remission
Remission is defined as <15 mins of morning stiffness

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7
Q

Systemic S&S

A

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

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8
Q

Articulate S&S

A

Bilateral and symmetrical
Effusion
Joint pain (arthralgia)
Creptus
Deformity
Loss of fxn
Pseudo-laxity

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9
Q

Cervical Spine RA

A

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

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10
Q

TMJ RA

A

Commonly last joint involved
Inflammation results in pain, swelling and limited ROM

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11
Q

Shoulder RA

A

GH, SC, AC jt effected
Destination and capsule thinning
Higher risk of dislocations

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12
Q

Elbows Ra

A

Bilateral olecranon bursitis may occur
Ulnar never entrapment
Inflammation will lead to instability
Rheumatoid nodules around olecrannn (most common place to find nodules)

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13
Q

Wrist RA

A

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

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14
Q

Hand RA

A

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

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15
Q

PIP RA

A

Swan neck deformity
Boutonniere deformity

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16
Q

Thumb RA

A

Flail IP
Type 1- Most common
Type 2- least common
Type 3-

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17
Q

Hip RA

A

Pain over greater tronchatnter is often due to tronchanteric bursitis

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18
Q

Knee RA

A

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

19
Q

Ankle RA

A

Hind foot pronation
Forefoot planes and flattening of medial longitudinal arch
Possible instability in subtalar
Tarsal tunnel syndrome may develop

20
Q

Feet RA

A

Synovitis of MTP joint is very common
All the usual feet deformities are seen

21
Q

Muscle involvement

A

Atrophy
Weakness
Loss of body mass

22
Q

Tendon involve

A

Tenosynovitis
Chronic inflammation causing damage

23
Q

Rheumatoid nodules

A

Pressure bearing spots

24
Q

Vascular complications

A

Vasculitis

25
Q

Neurological

A

Peripheral neuropathy
Spinal cord compression

26
Q

Cardiopulmonary complications

A

Increased morbidity and mortality risk
Accelerated atherosclerosis
Ma affect gas exchange

27
Q

Ocular

A

Episcleritis
Scleritis

28
Q

Pharmacological Management

A

NSAIDS- makes them feel better
Corticosteriods- “
Disease Modifying Anti-rheumatic Drugs (DMARDS)- reduces disease progression

29
Q

PT Examination

A

History (fatigue, how long swelling)
Physical examination
Psychological status
Envionmental factors

30
Q

History red flags

A

Claudication
Constitutional signs
Focal or diffuse weakness
History of significant trauma
Hot swollen joint
Neurogenic pain

31
Q

Standardized assessment of joint inflammation (SAJI)

A

Duration of morning stiff
Bilateral grip
Number of active
Erythrocyte sedimentation rate (not us, doctors)

32
Q

STOP- active joints

A

Swelling
Tenderness (joint line)
Over Pressure

33
Q

Damaged joint

A

Subluxation or deformity
Bone on bone crepitus
Loss of more than 20% of passive ROM
Ligament instability

34
Q

Sensory integrity

A

Raynaud’s disease
Nerve compression

35
Q

Modalities for pain relief

A

Heat (not on an active joint)
-superficial and deep
Cold
Electrical agents (TENS, IFC)
Rest
Orthoses, Splints, Braces

36
Q

ROM and flexibility

A

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

37
Q

Strengthening exercises

A

Pain free ranges, improves stability and function
Not on active jt

38
Q

Cardiovascular traingin

A

Usual

39
Q

Functional training

A

Assisted devices and/or environmental adaptions

40
Q

Gait and balance training

A

Rockers or orthotics gait deviations
Wide toed shoes
Extra depth shoe

41
Q

Joint protection

A

Decreases pain, improves function, provides support and protection for vulnerable joints

42
Q

Education and self-management

A

Helps a lot

43
Q

PT interventions

A

Modalities for pain relief
ROM and flexibility
Strengthening
Cardiovascular
Functional training
Gait and balance traingin
Joint protection
Education and self management

Canadian Exam (55 decks)

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