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T2 MSK > Topic 10 - Inflammatory Arthritides > Flashcards

Topic 10 - Inflammatory Arthritides Flashcards

1
Q

Ther are over 100 different types of ____________ ___________, and they affect all age groups. All cause inflammatory and degenerative changes in connective tissue and joints.

A

Inflammatory Arthritides

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2
Q

Inflammatory arthritides can develop as a _______ disorder or as a _________ disorder.

A

Primary
Secondary

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3
Q

Common ____________ ___________ include:
- Rheumatoid arthritis
- Lupus
- Sjögren’s syndrome
- Juvenile rheumatoid arthritis
- Scleroderma
- Ankylosing spondylitis
- Gout
- Lyme disease infectious arthritis
- Reiter’s syndrome

A

Inflammatory Arthritides

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4
Q

A chronic, systemic inflammatory disease of joints and connective tissue that affects females more than males. The disease can occur at any stage in life, but prevalence increases with age.

A

Rheumatoid Arthritis (RA)

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5
Q

Peak incidence of RA is _______ aged ___ to ___ years.

A

Females
40-60 years

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6
Q

While idiopathic, RA is thought to be __________ in origin. 70-80% of RA sufferers test positive for an auto-antibody called __________ factor.

A

Autoimmune
Rheumatoid (RH)

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7
Q

RH factor combines with ____ to form ______ complexes. Along with complement components, these are found in synovium, synovial fluid and extra-articular lesions of person with RA.

A

IgG
Immune

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8
Q

With RA, the ______ system attacks the immune complexes and releases _______ that destroy articular cartilage.

A

Immune
Enzymes

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9
Q

Characteristics of ______________ include:
- Age of onset usually after age 40
- Usually develops slowly over many years in response to mechanical stress
- Cartilage degeneration, altered joint architecture & osteophyte formation
- Can affect any joint (usually weight bearing joints & usually asymmetrical)
- Morning stiffness (< 30 mins), increased joint pain with weight bearing/after periods of immobility & crepitus/loss of ROM
- No systemic S/S

A

Osteoarthritis

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10
Q

Characteristics of __________ _________ include:
- Age of onset between 15-50 years
- May develop suddenly, within weeks/months
- Inflammatory synovitis & irreversible structural damage to cartilage/bone
- Usually affects many joints bilaterally (e.g. MCPs, PIPs of hands, wrist, elbow, shoulder, c-spine, MTPs, talonavicular, ankles)
- Redness, warmth, swelling, prolonged morning stiffness (> 1 hour)
- General feeling of sickness, fatigue, myalgias, arthralgias, weight loss, rheumatoid nodules
- May have ocular, respiratory, hematological and cardiac symptoms

A

Rheumatoid Arthritis

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11
Q

What are the 4 stages of RA?

A

1) Synovitis
2) Pannus Formation
3) Fibrosis
4) Bony Ankylosis

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12
Q

A stage of RA where there is inflammation of the synovial membrane and joint effusion.

A

Synovitis

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13
Q

A stage of RA characterized by an abnormal form of granulation tissue in which as extensive network of new blood vessels forms in the synovium, which contributes to inflammation. ______ _________ extends to the joint margins and enzymes are released that destroy articular cartilage/bone.

A

Pannus Formation

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14
Q

A stage of RA where intra-articular adhesions form as a result of the inflammation. These will lead to decreased ROM of the associated joints.

A

Fibrosis

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15
Q

A stage of RA characterized by calcification of the panni and fibrous tissue. This leads to joint fusion which further leads to deformity and disuse atrophy.

A

Bony Ankylosis

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16
Q

T/F - Flare up and remission are not common with RA.

A

False - Flare up and remission ARE common with RA.

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17
Q

During an RA flare up, there will be generalized __________, fatigue and associated weight loss.

A

Arthralgia

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18
Q

T/F - RA presentation is usually bilateral and symmetrical, involving more than one joint.

A

True

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19
Q

RA patients often feel _________ in the morning that lasts for about an hour or more.

A

Stiffness

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20
Q

Progressive joint destruction with RA may lead to ___________ and possible subluxation.

A

Instability

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21
Q

Rheumatoid _______ may appear with RA, as well as fibrosis of muscles with associated weakness and atrophy.

A

Nodules

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22
Q

_________ in muscle strength and alterations in line of pull of muscles/tendons add to deforming forces associated with RA.

A

Asymmetry

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23
Q

What are the 3 most commonly affected joints with RA?

A

1) Hands
2) Feet
3) Knees

24
Q

Some joint deformities associated with __________ _________ include:
- Boutonniere deformity
- Swan neck deformity
- Zig zag deformity
- Joint thickening
- Rheumatoid nodules

A

Rheumatoid Arthritis

25
Q

A joint deformity characterized by PIP flexion and DIP hyperextension.

A

Boutonniere Deformity

26
Q

A joint deformity characterized by PIP hyperextension and DIP flexion.

A

Swan Neck Deformity

27
Q

A joint deformity characterized by MCP ulnar deviation and PIP radial deviation.

A

Zig Zag Deformity

28
Q

A joint deformity characterized by large, swollen and thickened joints.

A

Joint Thickening

29
Q

Subcutaneous nodules formed by collagenous tissue that are found around the joint affected by RA.

A

Rheumatoid Nodules

30
Q

Rheumatoid nodules are not ______ themselves, however they are typically adhered to tendons and ______ and can therefore reduce ROM at joints and cause tenderness as a result.

A

Tender
Fascia

31
Q

T/F - Rheumatoid nodules can also occur on the heel or elbow.

A

True

32
Q

T/F - Everyone with RA will develop rheumatoid nodules.

A

False - NOT everyone with RA will develop rheumatoid nodules.

33
Q

T/F - Dislocations are not possible at joints with RA.

A

False - Dislocations ARE possible at joints with RA.

34
Q

Treatment for __________ _________ includes:
- Joint & tissue health maintenance via soft tissue work & exercise
- NSAIDs
- DMARDs (disease modifying anti-rheumatic drugs)
- Corticosteroid injection
- Prednisone/other immune suppressants (drugs used in cancer treatment)
- Potential to have a joint replacement prior to late stage joint deformity

A

Rheumatoid Arthritis

35
Q

During flare ups of __________ _________, the massage therapist’s job is to provide support by:
- Treating inflammation (e.g. cryotherapy, LD)
- Normalize sympathetic firing

A

Rheumatoid Arthritis

36
Q

Between flare ups of __________ _________, maintaining ROM is important and can be done by:
- Treating TrPs, spasm & UMRT
- Being careful with joint play, as the joint capsule will be fragile
- Lengthening & strengthening should be considered for self-care
- Postural education & consultation on sleeping position may be necessary

A

Rheumatoid Arthritis

37
Q

If ___-___ is involved with RA, overpressure/tractioning of the upper quadrant is _______________. High MRT in the _____________ will stabilize the region, so tone should not be reduced by very much. Keep the head in a _______ position while treating.

A

C1-C2
Contraindicated
Suboccipitals
Neutral

38
Q

In later stages of __________ _________, other organ systems may be involved so consider:
- Nerve compressions
- Nodular development in the pleural tissue of the lungs, pulmonary effusion & fibrosis of the lungs
- Vasculitis, vascular occlusion & thrombi
- Nodular development in the chordae tendonae of the heart
- Conjunctivitis & scleritis

A

Rheumatoid Arthritis

39
Q

A chronic inflammatory disease that can affect any organ system. It is an autoimmune disease and an idiopathic type III sensitivity disorder. Sufferers have auto-antibodies and immune complexes.

A

Systemic Lupus Erythematosus (SLE)

40
Q

There may be a _______ factor involved in developing SLE as well as a ________ component, as females are much more likely to develop lupus than males.

A

Genetic
Hormonal

41
Q

Some potential clinical manifestations of ________ _____ _____________ are:
- Flare up & remission pattern
- Malar (butterfly) rash
- Sensitivity to light (especially UVB light)
- Inflammation of the pericardium & pleura of lungs
- Reduced circulation to fingers & toes with cold exposure (aka. Raynaud’s phenomenon)
- Hair loss & oral ulcers
- Arthralgias & inflammation
- Seizures, psychosis, & nerve transmission abnormalities that can cause parathesias & muscle weakness

A

Systemic Lupus Erythematosus (SLE)

42
Q

T/F - Most patients with SLE have mild cases with only a few symptoms. However, some have more serious illnesses.

A

True

43
Q

Treatment during flare ups of SLE are generally oriented to control ____________.

A

Inflammation

44
Q

If there is a _____ with SLE, all massage is contraindicated.

A

Fever

45
Q

Treatments between flare ups of SLE often involve goals of maintaining _____ of ______ and addressing ____________ impairments like spasm and TrPs.

A

Range of Motion
Compensatory

46
Q

With SLE, be careful of any modalities that may provoke an ____________ response (e.g. frictions). Use caution with stretching techniques and joint play, as there may be joint _____________.

A

Inflammatory
Hypermobility

47
Q

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.

A

Sjögren’s Syndrome

48
Q

_________ syndrome may exist on its own, or along with SLE and RA (15% of RA patients). It can occur among either sex and at any age. However, 90% of patients are ______ with average age of onset being post __________.

A

Sjögren’s
Female
Menopausal

49
Q

Patients with Sjögren’s syndrome will have dry ____ and ______. The disease may affect other organs (e.g. liver, kidneys, pancreas, lungs, NS).

A

Eyes
Mouths

50
Q

An inflammatory arthritis that occurs in children, usually between ages 9 and 12. It may be self-limiting or become chronic and flare up/remission periods are common.

A

Juvenile RA (aka. Still’s Disease, Juvenile Idiopathic Arthritis)

51
Q

Some S/S of ________ RA include:
- Lethargy, poor appetite & possible limp
- Flu like symptoms & spiking fever
- Inflamed joints (e.g. knee, wrist, ankle)

A

Juvenile

52
Q

T/F - There is never lasting damage to the affected joints with juvenile RA.

A

False - There MAY BE lasting damage to the affected joints with juvenile RA.

53
Q

___________ is common with juvenile RA and treatment is deigned to restore ROM and to address compensatory impairments.

A

Contracture

54
Q

Occurs in 5-7% of people with psoriasis. Its etiology is unknown and it appears to be an autoimmune disorder.

A

Psoriatic Arthritis

55
Q

Symptoms of psoriatic arthritis usually present _____________ and it does have periods of flare up/remission.

A

Symmetrically

56
Q

T/F - Typically psoriasis develops before arthritis when it comes to psoriatic arthritis.

A

True

57
Q

A rare autoimmune disease that is characterized by fibrosing and thickening of the skin, which can then stick to underlying structures (e.g. fascia, tendon sheaths).

A

Scleroderma

T2 MSK (12 decks)

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