Rheumatoid Arthritis (RA) Flashcards
Describe rheumatoid arthritis
- a chronic systemic inflammatory disease
- presents with articular & extra-articular findings
- results in gradual destruction of joint tissues
- often significant deformity & disability
- affects joints symmetrically
What are the most commonly affected joints for rheumatoid arthritis
- wrists
- fingers
- knees
- ankles
- feet
What are the risk factors for rheumatoid arthritis
- hormones
- infection
- genetics
- environment
-associated with autoimmune thyroid & rheumatic diseases
Who is the at risk population for rheumatoid arthritis
- affects all races equally
- women are 3x more likely then men
- 2nd most prevalent form of arthritis
- onset at any age but most common from 30-60 years old
Define pannus
- the thickened synovium with destructive vascular granulation tissue
- destroys collagen, cartilage, & subchondral bone
Pathogenesis of rheumatoid arthritis
- joint inflammation due to presence of immune cells in synovial fluid
- cells in synovial lining multiply, leukocytes increase causing edema & synovitis
- protein destroying enzymes are released causing articular cartilage destruction & synovial hyperplasia
- swelling, joint pain, deformity, joint instability, & altered biomechanics result
Clinical characteristics of rheumatoid arthritis & symptoms
- begins slowly, cartilage degradation, ligamentous laxity, synovial effusion, & erosion
- Symptoms: fatigue, weight loss, diffuse musculoskeletal pain, reconditioning, & depression
Joints symptoms of rheumatoid arthritis
- instability, deformity, & laxity
- MCP & IP early
- morning stiffness >1 hour
- joints may feel warm, tender, edematous, & stiff
- loss of ROM & function
Hand impairments related to rheumatoid arthritis
- swan neck deformity
- boutonniere deformity
- ulnar drift
- thumb MP flexion with IP hyperextension
Describe swan neck deformity
- MCP flexion
- PIP hyperextension
- DIP flexion
Knee impairment related to rheumatoid arthritis
- genu valgus
- baker’s cyst
Ankle/foot impairments related to rheumatoid arthritis
- pronation
- hallux valgus
- hammer toes
- claw toes
Extra-articular manifestations of rheumatoid arthritis
- synovitis, bursitis, tendonitis, fasciitis, neuritis, & vasculitis
- rheumatoid nodules: surfaces with repeated mechanical pressure
- increased risk for myocardial infarction & congested heart failure
- slogan syndrome
- depression
- sleep disorders
Diagnosis of rheumatoid arthritis
- American college of rheumatology: synovitis in at least 1 joint & a score of 6 or more
- serum rheumatoid factor
- synovial fluid analysis
- C-reactive protein
- X-ray
- MRI
- ultrasound
Synovial fluid lab testing results with rheumatoid arthritis
- decreased volume
- increased white blood cells
- increases protein & protein antibodies
What to look for in imaging for rheumatoid arthritis
- looking for periarticular swelling, cortical thinning, erosion, and joint space narrowing
What is the purpose of medical management for rheumatoid arthritis
- reduce pain
- maintain mobility
- minimize stiffness & edema
- prevent joint destruction
Pharmacology management for rheumatoid arthritis
- NSAIDs is the 1st choice (ibuprofen & naproxen)
- corticosteroids for short term only (dexamethasone & cortisone)
- DMARDS (disease modifying anti-rheumatic drugs) used to slow disease progression
Purpose of physical therapy for rheumatoid arthritis
- reduce pain
- maintain mobility
- minimize stiffness & edema
- prevent joint destruction
How do we manage rheumatoid arthritis with physical therapy
- education: joint protection, energy conservation, & assistive devices
- joint protection: avoid positions of deformity, most stable position, & avoid repetitive tasks
- therapeutic exercise: maintain ROM & focus on activities of daily living (ADL’s)
Describe stage I of rheumatoid arthritis
- represents synovitis
- synovial membrane demonstrates infiltrating small lymphocytes
- joint effusions
- no destructive changes present on X-ray
Describe stage II of rheumatoid arthritis
- inflamed synovial tissue proliferates
- encroaching within joint cavity across articular cartilage causing destruction
- narrowing of joint due to loss os articular cartilage
Describe stage III of rheumatoid arthritis
- pannus of synovium
- erosion of articular cartilage
- exposed sub-chondral bone
- X-rays shows extensive cartilage loss & erosions around the margins of joint
Describe stage IV of rheumatoid arthritis
- end stage disease
- inflammatory process is subsiding
- fibrous or bony ankylosing has occurred
- nodules
