Rheumatoid Arthritis Lecture - Week 6 Flashcards
1
Q
Rheumatoid Arthritis
A
- Progressive, systemic, autoimmune inflammation
- Often aggressive, devastating consequences with function
- Unknown etiology
2
Q
What is there an imbalance of with RA?
A
- Pro- inflammatory and anti-inflammatory markers
3
Q
What are the mediators of joint destruction?
A
- Cytokines, TNF
- Chemokines, IL-1, IL-6
- MMP, VEGF
4
Q
Natural course of RA
A
Undifferentiated, poly arthritis (pain and inflammation) —> early RA - mild disease —> severe RA with deformities
5
Q
Time line of function loss in RA
A
- 2 years: moderate loss of function
- 5 years: severe loss of function
- 10 years: very severe loss of function
6
Q
RA Diagnosis criteria —> 4 or more must be present
A
- Morning stiffness > 1 hr
- Arthritis of greater than or equivalent to 3 joint areas of the possible 28
- Arthritis of hand jionts
- Symmetric swelling - same joints on both sides
- Serum rheumatoid factor
- Rheumatoid nodules
- Radiographic changes
7
Q
Criteria that has to be present for 6 weeks or more for RA diagnosis
A
- Morning stiffness > 1 hr
- Arthritis of greater than or equal to 3 joint areas of the possible 28 joints
- Arthritis of hand joints (MCPs, PIPs, wrist)
- Symmetric swelling (arthritis) - same joints on both sides
8
Q
In the spine, why do you think only the Atlanto-axial joint (C1-C2) is involved or affected in RA?
A
- In the cervical spine, it’s the only purely synovial joint
- Disease process of synovial inflammation leads to joint erosion, leads to erosion in soft tissue
9
Q
RA Predictors of poor prognosis
A
- Presence of > 20 inflamed joints
- Markedly elevated ESR
- Radiographic evidence of bone erosion
- Presence of RA nodules
- High titers of RA factor and anti CCP
- Higher class of functional disability
- Persistent inflammation; comorbidities
- Advanced age of onset
- Low socio-economic status, low education level
10
Q
RA complications
A
- Carpal tunnel
- Baker’s cyst, subcutaneous nodules
- Systemic vasculitis
- Sjögren’s syndrome
- Peripheral neuropathy
- Cardiac and pulmonary involvement
- Felty’s syndrome and anemia
- Risk of lymphomas 3x greater
- Risk of infection due to disease and treatment
11
Q
Pharmacological treatment of RA
A
DMARDs
12
Q
What are DMARDs mechanism of action?
A
- General: inhibit autoimmune response underlying RA
- Inhibit production of cytokines (IL’s, IFN’s, TNF)
- Inhibit cellular activation (monocytes, T and B lymphocytes)
- Relatively non-selective .. inhibit many aspect of immune function
13
Q
DMARDs problems and rehab implications
A
- GI problems
- Pulmonary toxicity
- Hematological disorders
- Fever, rashes
14
Q
PT Management goals for RA
A
- Relief of pain
- Reduction of inflammation
- Protection of articular structures
- Maintenance of functional activity
- Control of systemic involvement
- Slow the progression of disease
- Increase the overall quality of life
15
Q
Acute exacerbation of RA PT management of exercise
A
- Respect pain and fatigue
- Grade I-II joint mobilization to inhibit pain and maintain fluid dynamics
- AROM through available ROM, NO stretching across swollen joints
- Joint protection and energy conservation
- Modify ADL’s as needed
