Topic 10 - Inflammatory Arthritides Flashcards by Taylor Brown

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

Inflammatory Arthritides

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

Primary
Secondary

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

Inflammatory Arthritides

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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.

Rheumatoid Arthritis (RA)

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

Females
40-60 years

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

Autoimmune
Rheumatoid (RH)

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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.

IgG
Immune

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

Immune
Enzymes

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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

Osteoarthritis

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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

Rheumatoid Arthritis

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What are the 4 stages of RA?

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

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

Synovitis

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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.

Pannus Formation

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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.

Fibrosis

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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.

Bony Ankylosis

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

False - Flare up and remission ARE common with RA.

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

Arthralgia

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

True

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

Stiffness

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

Instability

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

Nodules

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

Asymmetry

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What are the 3 most commonly affected joints with RA?

1) Hands
2) Feet
3) Knees

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

Rheumatoid Arthritis

A joint deformity characterized by PIP flexion and DIP hyperextension.

Boutonniere Deformity

A joint deformity characterized by PIP hyperextension and DIP flexion.

Swan Neck Deformity

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

Zig Zag Deformity

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

Joint Thickening

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

Rheumatoid Nodules

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.

Tender Fascia

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

True

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

False - NOT everyone with RA will develop rheumatoid nodules.

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

False - Dislocations ARE possible at joints with RA.

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

Rheumatoid Arthritis

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

Rheumatoid Arthritis

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

Rheumatoid Arthritis

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.

C1-C2 Contraindicated Suboccipitals Neutral

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

Rheumatoid Arthritis

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.

Systemic Lupus Erythematosus (SLE)

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.

Genetic Hormonal

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

Systemic Lupus Erythematosus (SLE)

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

True

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

Inflammation

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

Fever

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

Range of Motion Compensatory

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 _____________.

Inflammatory Hypermobility

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.

Sjögren's Syndrome

_________ 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 __________.

Sjögren's Female Menopausal

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

Eyes Mouths

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.

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

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

Juvenile

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

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

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

Contracture

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

Psoriatic Arthritis

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

Symmetrically

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

True

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).

Scleroderma