Week 5 - Rheumatoid Arthritis Flashcards
People with RA are at risk for what 4 things?
- decreased flexibility
- muscle atrophy
- decreased muscle strength
- reduced cardiovascular endurance
one type of INFLAMMATORY polyarthritis characterized by a prolonged course of exacerbation and remission of joint pain and swelling which frequently leads to deformity and permanent disability.
RA
one type of INFLAMMATORY polyarthritis characterized by a prolonged course of exacerbation and remission of joint pain and swelling which frequently leads to deformity and permanent disability.
RA
what is RA?
a chronic inflammatory disease with symmetrical poly-articular inflammation, morning stiffness, malaise, and fatigue.
RA is a ___ disease affecting not only the ___ joints but also blood vessels, heart, lungs, eyes and other non-articular systems.
systemic, synovial
name 4 associated problems with RA.
- skeletal
- respiratory
- drugs
- other
name the 5 stages of joint changes in RA.
- healthy joint
- synovitis
- pannus
- fibrous ankylosis
- bony ankylosis
- synovial membrane inflamed and thickened
- bones and cartilage gradually eroded
synovitis
extensive cartilage loss; exposed and pitted bones
pannus
joint invaded by fibrous connective tissue
fibrous ankylosis
bones fused
bony ankylosis
inner membrane of synovial joints which secretes synovial fluid into the joint cavity.
synovial membrane
RA MUST have ___ involvement.
hand
name the criteria for an RA diagnosis.
- symmetrical polyarthritis - usually hands
- persisted more than 60 days
- systemic fatigue and malaise
self limited polyarthritis, resolves
type 1 - RA
persistent disease but does NOT lead to long term consequences
type 2 - RA
progressive disease, x-ray changes, decreased function, work disability
type III - RA
independent in ADLs, IADLs, vocation, avocation
type I - RA functional classification
able to do ADLs, IADLs, work, NO avocation
type II - RA functional classification
able to do self-care and limited work
type III - RA functional classification
all activities limited
type IV - RA functional classification
a medical strategy that sets remission or low disease activity as a goal; specific disease management targets are set.
Drug Therapy: Treat to Target (T2T)
Name 4 categories of drugs involved in RA treatment.
- non-steroidal anti-inflammatory (NSAIDs)
- disease modifying anti-rheumatic (DMARDs)
- corticosteroids
- analgesic drugs
what is the goal of drug therapy for RA?
clinical remission
remission must see 5 of these 6 things absent…
- morning stiffness
- joint pain
- fatigue
- joint tenderness
- joint or tendon sheath swelling
- elevated ESR
Describe a typical RA eval.
- review chart
- observe and interview pt.
- assessments - ADLs, ROM, hand function - typical wrist/hand deformities, finger deformities, strength, endurance, sensibility
name 4 acute stage clinical presentations of RA.
- pain
- redness
- heat
- swelling
name 4 OT goals during the acute stage of RA.
- to control inflammation
- to preserve joint mobility
- to help pt. manage pain
- to help maximize health
how should you control inflammation of RA?
- rest
- orthosis
- cold modalities
how do you preserve joint mobility with RA?
- gentle active or AAROM within pain free range 2-3 times per week
- proper positioning
how do you help pt. manage pain in acute stage of RA?
- education
- deep breathing
- relaxation
- imagery
- stress management
how do you help pt. maximize health in acute stage of RA?
- restorative sleep
- healthy nutrition
what is the primary target of RA?
synovial lining and synovium
RA leads to ___ damage and ___ erosion.
cartilage, joint
the amt of synovial fluid ___, but loses its viscosity and can no longer act as an effective lubricant.
increases
which joints are typically affected in RA?
MP, PIP, thumb and wrist joints
name 5 common RA deformities.
- MP joint ulnar deviation
- palmar subluxation
- radial deviation of the MCs (zig zag deformity)
- PIP swan neck deformity
- boutonniere deformity
radial deviation of the MCs
zig zag deformity
name 4 roles of orthotics in RA.
- decrease inflammation
- relieve pain
- improve function
- deformity prevention
name 5 clinical presentations of chronic active RA.
- synovium invades soft tissue
- decrease in ROM
- intrinsic atrophy
- nodules
- tenosynovitis
name 4 clinical presentations during the chronic inactive stage of RA.
- subluxation
- ulnar deviation
- hyperextension
- common hand deformities
what is the role of splints in the chronic inactive stage of RA?
stabilization
name 3 aspects of orthotic applications in RA.
- rest inflamed joints
- prolong joint integrity
- post surgery - provides joint alignment and safe motion, prevents stiffness during healing phase
In RA, joints are ____ bc tissue is pushed out.
hypermobile
RA can lead to ____ ____.
cartilage damage
is swan neck or boutonniere deformity more common in RA?
swan neck
describe the role of the silver ring company ring in RA.
- used to correct deformity
- holds PIP in SN deformity in slight flexion and prevents full extension.
name the 3 traditional RA categories of PAMs.
- thermal
- electrical
- aquatic (hydrotherapy)
when are heat modalities used for RA?
once inflammation and swelling are under control
why is exercise important for pts with RA?
good for maintaining tone and muscle bulk - joints will be protected and function improved
describe exercise during the acute stage of RA.
- gentle active assistive exercises 1-2 x day
- PROM
describe exercise during the chronic active stage of RA.
- AROM to maintain/improve ROM
- isometrics in different parts of range
- short arc isotonic - may use very light resistance
- 2-3 times a day
describe exercise during the chronic inactive stage of RA.
- continue AROM
- isometric strengthening
- short to full arc isotonic with light to moderate resistance
- GENTLE passive stretching as indicated
- increase reps and exercise periods per day
- low impact cardio
What is SARAH?
exercise to improve RA hand function.
tendons are at a different length
zig zag deformity (wrist)
name 4 conditions of wrist involvement in RA.
- synovitis
- instability and subluxation
- carpal tunnel syndrome
- tenosynovitis (dorsal and volar)
name 2 conditions of thumb involvement in RA.
- CMC synovitis
- MCP or IP synovitis or instability
name 3 conditions of MCP involvement in RA.
- synovitis
- ulnar deviation
- intrinsic muscle tightness
what is the most common surgery for RA?
total joint arthroplasty
what is swan neck deformity?
hyperextension of the PIP joint and flexion of the DIP joint due to an imbalance of muscle forces on the PIP.
what is boutonniere deformity?
zone III extensor tendon injury characterized by PIP flexion and DIP extension.
