Rheumatoid arthritis

Question 1

Describe rheumatoid arthritis

Answer 1

• Immune mediated disorder
• Systemic inflammation disease
• women are 2-3 x’s more likely to develop RA
• age of onset is 40 – 60 yrs (possibly 20-50 yrs)

Question 2

What is the pathology/etiology of RA?

Answer 2

1. Current Theory: viruses may trigger the disease
2. Hydrolytic enzymes re released into the joint fluid causing inflammation, proliferation of synovium and tissue damage
3. antigen/antibody process
4. Immunoglobulin molecules and RA (reheumatoid) factor present in blood test (this is how diagnosis made)
5. Pannus: granulation tissue that causes destruction of the articular cartilage, tendons and ligament attachments.
6. In chronic RA there is destruction of articular cartilage, ligaments, tendons and bone.
   - ruptured tendons
   - decreased movement in joints
   - capsular adhesions

Question 3

What are S/S of RA?

Answer 3

1. malaise, fatigue and diffuse musculoskeletal pain.
2. symmetry of symptoms
3. hands, wrists, knees, feet most frequently involved.
4. biomechanical dysfunction causes the typical deformities of RA (ulnar deviation at MCP’s, swan neck deformities, boutonniere deformities, claw toes, etc.)
5. As the disease progresses, knees, shoulders, hips, C-spine becomes more involved making movement very difficult.
6. ADL’s become difficult to perform secondary to deformities and loss of AROM.

Question 4

What is the treatment of RA?

Answer 4

1. Medications
   - aspirin
   - NSAID’s
   - corticosteroids
   - Other meds (p. 689): DEMARs–> slow disease process; Biologics- newer drugs, super expensive
2. Therapy
   - energy conservation
   - ambulatory assistive devices
   - orthosis
3. surgeries
4. joint conservation

Question 5

Describe juvenile RA

Answer 5

30,000 – 50,000 children in the USA
Onset is at any age
affects females more than males in general

Question 6

What are the types of juvenile RA?

Answer 6

1. Systemic JRA (Still’s Disease- not used a lot)
2. Polyarticular JRA
3. Pauciarticular JRA

Question 7

Describe systemic JRA (Still’s Disease)

Answer 7

1. 20% of children with JRA
2. any age onset
3. sex distribution is equal.
4. chronic polyarthritis develops within weeks to months of disease onset
5. 25% of these patients wind up with severe chronic arthritis

Question 8

What are the S/S of systemic JRA (Still’s Disease)

Answer 8

1. rash
2. general lymphadenopathy
3. hepatosplenomegaly
4. pericardial or plural effusions
5. fatigue
6. weight loss
7. muscle atrophy; growth retardation–> pretty dramatic decrease in strength
   - can see them fall out of no where

Question 9

Describe polyarticular JRA

Answer 9

1. 40% of cases
2. no dramatic systemic manifestations
3. malaise, growth retardation, wt loss, low-grade fever, modest organomegaly, adenopathy and anemia
4. onset is at any age girl:boy ratio 2:1
5. disabling arthritis occurs in 50% of children with +RA factor; only 10-15 without factor.

Question 10

Describe Pauciarticular JRA

Answer 10

1. 40% of cases
2. 4 or fewer joints affected
3. systemic feature do not occur
4. 10-50% children will have vision complications

Question 11

What is the treatment for JRA?

Answer 11

1. 75% of children enter a long term remission or disease quiescence
2. Goals of Therapy:
   - relief of symptoms
   - maintain jt position/joint preservation
   - muscle function / strength
   - Teach energy conservation
3. Medical Treatment
   - Aspirin
   - NSAID’s - nonsteroidal antiinflammatory drugs (naproxin, tolmetin, etc.)
   - systemic corticosteroids
   - intraarticular corticosteroid injections