Week 9: Arthritis Flashcards
chronic, systemic inflammatory condition that affects approx. 1.3 million people in US
b. Peak incidence between 40 and 60 with rate 2 to 3 times higher in females
c. Autoimmune disease involving synovial cells (normally meant to lubricate joints) producing
matrix degrading enzymes that destroy cartilage and bone. Scar tissue may form, causing joint
to become immobile
Rheumatic Arthritis
Other features may include fatigue, vasculitis, and rheumatoid nodules. Patients with
RA may die 10-15 years earlier due to infection, GI bleeding, and cardiovascular disease
h. Clinical features: characterized by symmetric polyarticular pain and swelling, malaise, fatigue,
low-grade fever, and prolonged morning stiffness. Even though joint involvement is bilateral, one
side may progress quicker than the other due to use.
Rheumatic Arthritis
Inflammatory process of ____: 4 stages, including acute, subacute, chronic active, and chronic
inactive. In acute stage, may see limited movement, stiffness, weakness, tingling, and hot, red
joints. In subacute stage, limited movement and tingling remain. Stiffness is limited to morning and joints appear pink and warm. In chronic active stage, there is less tingling and pain and more endurance/tolerance of activity
Rheumatic Arthritis
Joint deformities will develop in around 1/3rd of patients with ____, including wrist radial deviation, MP ulnar deviation, swan neck, boutonniere deformities. Also can cause tendon rupture, nerve compression, and trigger finger
Rheumatic Arthritis
diagnosis is based on clinical eval, lab findings, and radiologic findings.
Rheumatoid factor is an antibody found in blood of 85% of patients with RA.
Rheumatic Arthritis
Medical management: has no known cure, so main goals are pain, swelling, and fatigue reduction, improvement of joint function, prevention of disability, and maintaining physical, social, and emotional function while minimizing toxicity from meds. Drug types include NSAIDs and DMARDs. It is important for OT to know specific meds and what adverse reactions may arise
Rheumatic Arthritis
Surgical management: often used because of extensive joint damage caused by ____. Surgeries include synovectomy (removal of diseased synovium) and tenosynovectomy (removal of diseased tendons). They relieve symptoms but do not slow disease progression. Tendon transfers and peripheral nerve decompression may also be used.
Rheumatic Arthritis
most common rheumatic disease and affects approx. 27 million people in US
b. Past age of 50, women more likely to develop RA. In addition to age and gender, other factors
include heredity, obesity, anatomic joint abnormality, injury, and occupation leading to joint
overuse
c. OA characterized as primary or secondary. Primary has no known cause and may be
localized or generalized (3 or more joints)
Osteoarthritis
characterized as primary or secondary. Primary has no known cause and may be
localized or generalized (3 or more joints)
d. Secondary ___ can be related to identifiable cause such as trauma or infection
e. ___ causes cartilage of joints to break down with resultant joint pain/stiffness.
___ is limitedto specific joints, unlike RA which is systematic.
Osteoarthritis
A healthy joint is lined by articular cartilage that is thin, durable, and designed to distribute loads and to reduce stress on bone. ____ destabilizes this normal balance and is a two part process that includes deterioration of articular cartilage and reactive new bone formation
Osteoarthritis
Clinical features: joint pain, stiffness, tenderness, limited movement, variable degrees of local inflammation. Symptoms are gradual and usually begin with minor ache. Pain and stiffness typically with activity and relieved by rest but eventually will not be relieved by rest.
Osteoarthritis
diagnosis of ____ initially made on basis of history and physical. Main features are use-related pain and stiffness or gelling after inactivity. MRIs may be used
Osteoarthritis
Medical management: ____ has no cure so goal is to relieve symptoms, improve function, limit disability, and avoid drug toxicity. Anti-inflammatory drugs may be used as well as analgesic agents. Cortisone injections may also be provided. Some nutritional supplements may be used such as glucosamine sulfate.
Surgical management: operative intervention may be used to slow joint deterioration, improve integrity, restore stability, or reduce pain
Osteoarthritis
OT Eval for arthritis
Priority of evaluation will be primarily driven by reason for eval., whether that is a
preoperative hand assessment, postoperative hip replacement, education after diagnosis,
splinting during flare up, or decline in functional status
d. Close collaboration with client, family, therapist, and other team members is crucial
e. OT eval. process consists of client history, occupational profile, occupational performance
status, cognitive, psychologic, and social status, and clinical status
Occupational performance training for arthritis
An effective means of maintaining functional motion and strength with arthritis is to have clients perform daily occupations.
During active stages of the disease, occupations may be limited to just a few (i.e. Feeding & hygiene).
As the client’s condition improves, usual life activities should be resumed because this will help promote physical status and psychological well-being.
An important (but sometimes neglected) aspect of ADL training is sexual counseling.
Analysis of activity demands and activity contexts is a critical component in helping clients maintain, restore, or enhance their engagement in desired activities and occupations.
Environmental modifications, alternative methods, or assistive devices often make a difference by increasing clients’ independence, ease, and safety in completely meaningful occupations with less pain and stress on their joints.
