Topic 10: Inflammatory Arthritides Flashcards
T/F: Inflammatory Arthritides may develop as a primary disorder, and some develop as a secondary disorder.
True
__________ _________ is a chronic, systemic inflammatory disease of joints and connective tissue.
Rheumatoid Arthritis (RA)
Peak incidence of Rheumatoid Arthritis is among _____ aged __-__
Women aged 40 - 60
While idiopathic, RA is thought to be autoimmune in origin. 70% to 80% of RA sufferers test
positive for ___________ ________ - an auto-antibody
Rheumatoid (RH) factor
RH factor combines with IgG to form ________ ________, which are found in the synovium,
synovial fluid, and extra-articular lesions of persons with RA.
Immune complexes
T/F: Osteoarthritis is more prevalent than rheumatoid arthritis with young people.
False
T/F: Osteoarthritis is more prevalent than rheumatoid arthritis with young people.
False
What type of arthritis is associated with inflammatory synovitis and irreversible structural damage to cartilage and bone?
Rheumatoid arthritis
What type of arthritis can affect any joint, usually weight bearing joints, usually asymmetrical?
Osteoarthritis
What type of arthritis is associated with morning stiffness for 1 hour or more (as opposed to ~30 minutes)?
Rheumatoid arthritis
True or false: Rheumatoid arthritis has a variety of systemic signs and symptoms (sickness, fatigue, weight loss) whereas Osteoarthritis has none.
True
Stage _ of RA is __________ - Inflammation of the synovial membrane and joint effusion
Stage 1- Synovitis
Stage _ of RA is _________ ___________ - an abnormal form of granulation tissue - an extensive network of new blood vessels forms in the synovium which contributes to the inflammation. Enzymes are released that destroy articular cartilage and bone.
Stage 2 is Pannus Formation
Stage _ of RA is __________ - Intra-articular adhesions form as a result of the inflammation. These will lead to decreased ROM of associated joints.
Stage 3 is Fibrosis
Stage _ of RA is _____ _________ - Calcification of the panni and fibrous tissue. This leads to joint fusion, which leads to deformity, and disuse atrophy.
Stage 4 is Bony Ankylosis
T/F: Flare up and remission are common with Rheumatoid arthritis.
True
T/F: Presentation of Rheumatoid arthritis is usually bi-lateral, though typically not symmetrical.
False: presentation is usually bi-lateral and symmetrical.
With rheumatoid arthritis, the most commonly affected joints are in the ______, ____ and _____.
Hands, feet and knees.
_____________ deformity: PIP flexion, DIP hyperextension.
Boutonniere deformity
___________ deformity: PIP hyperextension, DIP flexion.
Swan neck deformity
__________ deformity: MCP ulnar deviation, PIP radial deviation
Zig Zag deformity
Rheumatoid nodules are subcutaneous nodules formed by collagenous tissue. They are not tender themselves, however they are typically adhered to _______ and ________ and can therefore reduce ROM at joints and cause tenderness as a result.
Tendons and fascia
During flare-ups of RA, the massage therapists job is to provide support by (2 points):
- Treat inflammation (cryotherapy, LD)
- Normalize sympathetic firing
Between flare-ups of RA, maintaining ________ is important
Range of Motion
If _____ - ____ is involved in a patient’s Rheumatoid Arthritis, overpressure, tractioning of the upper quadrant is CI’d (high MRT in the suboccipitals will stabilize the region, so tone should not be reduced by very much. Keep the head in a neutral position while treating).
C1-C2
_______________ is a chronic inflammatory disease that can affect any organ system. It is an autoimmune disease – an idiopathic type III sensitivity disorder. Sufferers have auto-antibodies, and immune complexes. There may be a genetic factor involved in developing the disease. There may be a hormonal component, as women are much more likely to develop it than men (8:1 ratio).
Systemic Lupus Erythematosus (SLE)
Patients with SLE will often have a _____ (_______) rash.
Malar (butterfly) rash
Massage treatments of SLE during flare-up are generally oriented to control ___________.
Inflammation
T/F: If there is fever with SLE, it is up to the patient’s pain tolerance whether massage is continued.
False: If there is a fever, all massage is contraindicated.
Treatments goals between flare ups of SLE often involve maintaining ROM, and addressing compensatory impairments like ______ and ______.
Spasm and TrP’s
_________ __________ is an autoimmune disease in which the immune system attacks exocrine glands that produce mucous and tears. There may be excessive dryness of the eyes and mucosal membranes of the body. It may exist on its own, or along with SLE and RA (15% of RA Pt’s). It can occur among either sex, and at any age. However, 90% of patients are female, with average age of onset being post menopausal.
Sjögren’s Syndrome
An inflammatory arthritis that occurs in children - usually between ages 9 and 12.
Juvenile RA (aka Still’s disease, aka Juvenile Ideopathic Arthritis)
_______ _______ occurs in 5 - 7% of people with psoriasis. Its etiology is unknown. It appears to be an autoimmune disorder.
Psoriatic Arthritis
__________ is a rare autoimmune disease. It is characterized by fibrosing and thickening of the skin. This can then stick to underlying structures like fascia, and tendon sheathes.
Scleroderma
For which condition would we want to modify techniques because skin is thin and fragile. I.e. caution with fascial work, frictions and other techniques that torque the skin?
Scleroderma
_________ _________ is an inflammatory disease that can eventually cause fusion of the vertebrae. Etiology is not entirely understood. It is thought to be a genetically determined autoimmune response.
Ankylosing Spondylitis (AS)
AKA for Ankylosing Spondylitis
Bamboo Spine
Loss of flexibility in the lumbar spine is an early sign of Ankylosing Spondylitis. Pain usually starts bilaterally in the ______ joints, and ______ spine.
SI joints and lumbar spine
With Ankylosing Spondylitis, ___________s (vertically oriented bony outgrowths) replace IVDs, followed by bony fusion.
Syndesmophytes
T/F: patients with Ankylosing Spondylitis will find rest alleviates the pain.
False!
Aggravating: rest
Alleviating: walking and hot showers may relieve pain
Gout occurs when there is an over production of uric acid which can lead to ____________. Urate crystals form in the synovial fluid - it generally affects peripheral joints.
Hyperuricemia
Most commonly affected joint with Gout is the _____ _____ joint. Tarsal joints, ankles, heels, knees, wrists, fingers and elbows may also be affected.
First MTP
T/F: Lack of exercise may trigger a Gout flare-up.
False: Attacks may be precipitated by excessive exercise and also certain medications, alcohol, or certain foods (like offal, sardines and anchovies).
T/F: Cold hydrotherapy is indicated as a treatment for Gour.
False: Cold hydrotherapy is CI’d with gout as it can exacerbate the pain caused by the urate crystals.
______ ______ is characterized by joint inflammation resulting from a bacterial, viral, or fungal infection.
Septic Arthritis (aka infectious arthritis)
Results from infection with Borelli burgdorferi bacteria (spread by deer ticks). Characterized by bulls-eye rash.
Lyme’s Disease
_________ _________ is classified as an autoimmune condition that develops in response to an infection (often Chlamydia) in another part of the body. Coming into contact with bacteria and developing an infection can trigger the disease. By the time symptoms present, the initial trigger has resolved itself – making determination of the initial cause difficult.
Reiter’s Syndrome aka Reactive arthritis
