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MSPT > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

What are the 4 categories that make up the classification criteria for RA?

A

A. Joint Involvement
B. Serology (at least 1 is needed for classification)
C. Acute phase reactants (at least 1 test result is needed for classification)
D. Duration of Symptoms

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2
Q

What are the 3 serology classifications?

A
  1. Negative RF and negative ACPA = 0 points
  2. Low-positive RF or low-positive ACPA = 2 points
  3. High-positive RF or high-positive ACPA = 3 points
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3
Q

What 2 things does serology test for?

A
  1. Rheumatoid factor (RF)

2. Anti-citrullinated protein antibody (ACPA)

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4
Q

What are 2 acute phase reactants?

A
  1. C-reactive proteins (CPR)

2. Erythrocyte sedimentation rate (ESR)

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5
Q

The duration of symptoms must be _____ weeks to receive 1 point on the RA classifications.

A

> 6 weeks

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6
Q

What is the target population for the classification criteria for RA?

A

Patients who have at least 1 joint with definitive clinical synovitis and in whom the synovitis is not better explained by another disease

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7
Q

What total score is needed for classification of a patient as having definite RA?

A

A score of >6

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8
Q

What 2 categories from the classification criteria for RA can be observed by a PT?

A

A. Joint involvement

D. Duration of Symptoms

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9
Q

What are 4 characteristics of RA?

A
  1. Morning stiffness that lasts greater than 60 minutes
  2. Joint involvement that is bilateral and symmetrical
  3. Heat, swelling, pain and redness in joints
  4. Systemic fatigue
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10
Q

Individuals with osteoarthritis usually have morning stiffness that lasts _____ minutes

A

Less than 60 minutes

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11
Q

Is RA more common in men or women? At what age is it typically first diagnosed?

A
  1. More common in women

2. First diagnosed when the individual is aged late 30’s to mid 50’s

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12
Q

List the 13 joints that can be affected by RA. (its literally every joint in the body)

A
  1. Suboccipital joints
  2. Mid Cervical joints
  3. TMJ
  4. Shoulder joints
  5. Elbow joints
  6. IP joints
  7. Wrists
  8. First CMC joint
  9. First MCP and IP joints
  10. MCP Joints of Digits 2-5
  11. Hips
  12. Knees
  13. Toes
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13
Q

What happens as a result of RA at the suboccipital joints? Why is this a problem?

A
  1. Erosion of the transverse ligament of C1
  2. This ligament holds the dens into place.
  3. If the transverse ligament ruptures, the dens can migrate into the spinal cord and cause the patient to die or have significant neurological problems.
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14
Q

What 2 treatment interventions are contraindicated in a patient with RA?

A
  1. Upper cervical spine stretching

2. Joint mobilization /manipulation techniques

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15
Q

RA at the midcervical joints results in ______.

A

A decrease in ROM into rotation

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16
Q

True or False: The TMJ is more commonly affected by RA than with juvenile arthritis.

A

FALSE

More commonly affected by juvenile arthritis than RA

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17
Q

What 2 conditions occur at the IP joints as a result of RA?

A
  1. Boutonniere Hand: This is manifested by excessive PIP flexion and DIP extension of digits 2 through 5
  2. Swans Neck Hand: This is manifested by excessive PIP extension and DIP flexion of digits 2 through 5
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18
Q

How does RA usually manifest at the wrist?

A

Manifests itself as a subluxation into radial deviation.

19
Q

What 3 things occurs at the wrist as a result of RA?

A
  1. erosion of the ligaments on the ulnar side of the wrist and a rupture of the ECU tendon
  2. loss of restraining force causes the proximal row of carpal bones to sublux ulnarly
  3. Wrist moves into radial deviation.
20
Q

What pathology will occur as a result of RA at the first MCP and IP joints?

A
  1. Thumb Z Hand: thumb is positioned in MCP flexion and IP extension
21
Q

What pathology will occur as a result of RA at the 2nd-5th MCP joints?

A

Ulnar drift: ulnar deviation of the digits as a result of a radially deviated wrist

22
Q

True or False: OA is more common at the hip than RA.

A

TRUE

23
Q

What 3 pathologies does RA manifest at the toes?

A
  1. Hallux valgus at 1st MTP
  2. Hammer toes
  3. Claw toes
24
Q

What is systemic lupus erythematosus? Characteristics?

A
  1. Progressive systemic inflammatory disease that may affect body organs in addition to synovial joints
  2. Characterized by a red rash resembling the shape of a butterfly across the nose and cheeks
25
Q

How can PT manage systemic lupus erythematosus, gout and psoriatic arthritis?

A
  1. Joint protection
  2. Education,
  3. Maintenance / restoration of functional strength/ ROM
26
Q

What is gout? How can it be treated?

A
  1. disorder of purine metabolism characterized by elevated blood levels of uric acid. The uric acid changes into crystals, and deposits into peripheral joints, most often the MTP joint of the big toe.
  2. Treated pharmacologically with medication to dissolve the crystals, and with NSAID’s
27
Q

What is the major focus of medical management RA?

A

Aggressively controlling the inflammation through medications

Early and aggressive medical management is crucial, because once the joint is destroyed, there is little that can be done to restore the patient to the premorbid status

28
Q

In general, physical therapy is considered ______ for the rheumatoid arthritis patient

A

Adjunct therapy

29
Q

What 2 ways is RA managed surgically?

A
  1. Synovectomies may be performed to minimize joint destruction
  2. Once the joint is destroyed, a joint replacement is considered
30
Q

What 7 things should be assessed in the PT examination for patients with RA?

A
  1. History
  2. Functional Status
  3. Gait
  4. Alignment
  5. Joint stability
  6. Endurance
  7. General description of strength and ROM
31
Q

List 4 general PT interventions for treating RA.

A
  1. Provide patient with assistive device if needed
  2. Restore functional strength/ROM
  3. Instruction in activity regulation
  4. Instruction in a strengthening exercise program to manage the condition
32
Q

True of false: Regular physical activity is not detrimental to patients with RA, and should be incorporated into their lifestyle

A

TRUE

33
Q

An individually tailored supervised program of ___________ exercises can be beneficial to patients with RA, unless there is extensive _________ in large joints

A
  1. High Intensity

2. Joint damage

34
Q

What 2 exercises are included in the optimal exercise program for RA patients?

A

Strengthening and endurance type of exercises

35
Q

Why might aquatic therapy be beneficial for patients with RA?

A

Provide the pt. with joint impairments a means of performing high intensity exercise without accelerating damage to the involved joints

36
Q

What should the therapist be aware of regarding exercise and RA?

A

Exercise often temporarily increases pain, and treat any pain that occurs during or after exercise

37
Q

True or False: Intensity of exercise should be decreased when the patient is experiencing a flare

A

FALSE

Intensity of exercise should not be decreased simply because the patient is experiencing a flare

38
Q

When joint damage and/or structural impairments are present, the involved joints should be provided with ____________ while exercising the involved joints.

A

External support

External support can be provided through the use of equipment such as braces, tape, assistive devices and parallel bars

39
Q

If pain persists more than ______ after an activity, then that activity is generally considered to be too aggressive for the patient

A
  1. One hour
40
Q

How many hours of sleep should a patient with RA get per day?

A

10 hours per day, including a nap as needed

41
Q

PTs should provide instructions to RA patients regarding what 2 things?

A
  1. Instruction in good posture and body mechanics

2. Energy and joint sparing techniques

42
Q

What are 3 things PTs should teach RA patients?

A
  1. Teach the patient about pacing oneself, so that the patient rests in between the activities
  2. Teach them to avoid being in the same position for more than 20 minutes at a time while awake
  3. Teach them to use the larger joints to do the work whenever possible, to avoid torsional stresses to the joints, and to avoid putting the joint in an end range position
43
Q

What 2 modalities can be used to control swelling?

A
  1. Superficial heat

2. Ice

44
Q

What 2 modalities should not be performed on patients with RA? Why?

A

Deep heating treatments

  1. Ultrasound
  2. Diathermy

Can exacerbate inflammatory symptoms

MSPT (12 decks)

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