rheumatoid arthritis Flashcards
what is rheumatoid arthritis?
a chronic inflammatory systemic, autoimmune disorder
what is the aetiology?
unknown
what is the pathology?
Genetic susceptibility
Unknown pathogen initiation the autoimmune reaction within the synovial membrane
Synovial hypertrophy
Key cytokines involved are TNF ALPHA AND INTERLUKIN 1
Abnormal synovium
treatments
- NSAIDS, ANALEGSICS: paracetamol, ibuprofen, NSAIDS
- cortical steroids: orals, subcutaneous, interarticular injections
- DMARDS: CONVENTIAL: METHOTREXATE (COMMON), GOLD, SULFASALAZINE
- Combination therapy: combination of DMARDS
- BIOLOGICAL DRUGS AND BIOSIMILARs: (BIOLGOCIAL = DISEASE MODIFYING)
how does it affects the lower limb?
- Not common in the hips
- More common in the knee
- Fixed flexion deformity (can’t have fixed flexion at rest, loss of knee extension)
- Valgus knee deformity
- Popliteal (BAKER’S) cysts: fluid filled swelling on the posterior aspect of the knee and when the knee is extended it causes fullness in the popliteal regions.
podiatry treatment main aims
- Relieve pain
- Control inflammation
- Prevent joint destruction
How does this have an impact on a person’s life?
- Very painful
- Stiffness, deformities
- Impact their quality of life
- Have an effect on their mental health and can lead to depression.
basic observation of RA
symmetrical and tends to start in the hands and feet
Clinical presentations
Onset: can start with articular or non-articular presentation. Non articular= tenosynovitis, bursitis
General weakness, feeling unwell, weight loss, joint stiffness in the morning, general aching
Slow mono-articular
Sever joint pain, swelling, limitation
Acute monoarthritic ( rare looks like gout or septic arthritis)
Palindromic
Single joint may be affected for some other people it’s many joints affected
podiatry dealing with management from onset to late years
Disease onset:
Very early RA: 12 to 6 weeks: DMARDS, BIOLOGICS, SELf management
EARLY RA: Target Therapy: customised orthoses, Intra- articular injections, intra lesions injections. Try to get the inflammation under control
ESTABLSIHED RA: podiatric rehabilitation: footwear, semi-rigid/accommodative orthotics, debridement of lesions prefabricated devices.
5years and plus: if considered as chronic then foot surgery
Rehabilitation is done with the help of the multi-disciplinary team
key features of foot disease in RA
- Pes Plano valgus deformity
- Tibialis posterior/ peroneal tenosynovitis
- Achilles’ tendinitis
- Retrocalcaneal bursitis
- Plantar fasciitis
- Daylight sign
- Morton’s neuroma
- Severe HAV (hallux abductor valgus)
- Claw, hammer, retracted lesser toes
- Plantar metatarsal callosities, bursitis and ulceration
how do we detect active disease
Clinical examination of swollen joints
Lateral squeeze test
Swollen joint count
Examination and palpation of tendons and bursae
MSK assessment approach LFM
LOOK: swelling of structures as an indication of acute inflammation, we can look for existing foot and ankle deformities and any changes to these and foot posture, indicating previous or active inflammation.
FEEL: different structures, feeling for swelling in joints, tendons and other structures, where swelling, pain and tenderness on palpation are also indicators of acute inflammation.
MOVE: joints through their range of motion, assess muscle strength and assess dynamic joint function through gait.
