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39 Cards in this Set
- Front
- Back
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Is Inflammation the Primary Pathological Process in Arthritis?
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No
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Secondary Factors
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- trauma
- repetitive use - obesity - developmental diseases |
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Diagnostic Method of OA
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- x-rays
- no changes in synovium, urine, or blood noted |
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Early Features of Degenerative Joint Disease/OA
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- cartilage degenerates
- focal swelling/softening of cartilage - loss of proteoglycans |
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Late Features of Degenerative Joint Disease/OA
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- fibrillations in the surface of deepen into fissures
- subchondral bony ebernation - margins of the cartilage develop spurs |
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What Does OA Normally Affect?
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- affects weight bearing joints
- particularly 1st carpometacarpal and MP joints - Heberden's Nodes - generally affects one side at a time - not systemic - causes a decreased shock absorption affect |
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What are Heberden's Nodes?
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where OA affect the distal IP joints
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Symptoms of OA
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- may be bilateral
- pain - ROM limited to extreme positions such as IR with hip flexion - muscle weakness, atrophy, and fatigue - joint instability is NOT seen in OA |
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Non-surgical Options in OA
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- combinations of NSAIDS, weight reduction, exercise for strength, joint protection, and flexibility
- assistive devices for weight bearing |
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Surgical Options in OA
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- joint arthroplasties
- total joint replacements - cartilage repairs - muscle transfers are NOT a suitable rx option |
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Spondylosis
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narrowing of the intervertebral space, degenerative joint disease typically in cervical spine
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Charcot's Joint
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- any of the tarsal joints loss of sensory modalities due to repetitive micro-fractures of tarsal bones = loss of nocioceptors - has an inflammatory component
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Incidence of RA
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- affects 1% of the population = 2.1 million Americans
- mostly women - occurs middle age with sometimes happening in the 20s/30s |
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RA Factor and 6 Criteria for Dx
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occurs in approximately 75% of the population in the adult form
1. >1 hr morning stiffness 2. 3 or more joints involved (wrist jts, PIP, MP) 3. joint swelling 4. RA Nodules 5. ulnar drift 6. Serum RA+ Factor |
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Pain Patterns in RA
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- periods of pain remissions possible
- bilateral upper and lower joint symptoms - systemic in contrast to OA - Felty's Syndrome |
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Symptoms of Felty's Syndrome
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- Anemia
- Thrombocytopenis - Neutropenia |
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Causes of RA
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- process triggered when synovial vascular lining cells are activated by some process not yet understood
- cells proliferate developing a "pannus" - erosion of bone and cartilage - muscles and ligaments rupture in response |
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Lab & Imaging Studies
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- elevated ESR
- anemia - joint swelling - bone resorption in later stages - high titer of RA factor |
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What Are Some of the Clinical Manifestations of RA?
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- severe inflammation joints
- more likely to be systemic - juvenile and adult forms - small joints/ generally bilateral and symmetrical - excaberations and remissions |
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Classifications of RA
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- class I: completely able to perform usual ADLs
- class II: able to perform usual self-care and vocational activities, but limited in avocational activities - class III: able to perform usual self-care activities, but limited in vocational and avocational activities - class IV: limited in ability to perform usual self-care, vocational, and avocational activities |
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Additional Forms of RA
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- Ankylosing Spondylitis
- Psoriatic Arthritis - Juvenile RA - Systemic Lupus - Gout |
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Symptoms of Psoriatic Arthritis
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- dry skin lesions and finger nail bed changes identified
- distal IP joints of fingers most commonly affected |
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Epidemiology of Psoriatic Arthritis
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- 1/3 of patients with psoriasis have arthritis with delay of joint involvement for as long as 20 years
- both sexes affected equally - SI joint commonly involved |
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Juvenile RA: Forms and Twin Peaks of Age For Onset?
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Forms:
- Systemic - Polyarticular - Pauciacticular (most common) Peaks: - between 1-3 and again at 8-12 - females affected 2x more then males |
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Lab Findings for JRA
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- leukocytosis in systemic and polyarticular forms
- increase WBC levels - 50% of cases have + antinuclear antibodies - imaging studies show joint erosion, pannus (soft tissue swelling) |
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Disease Progressions for JRA For the 3 Forms
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systemic
- episodic high fevers, rashes, lymphadenopathy, slenomegaly - 1/2 of cases resolve in adolescence/teenage years polyarticular - lower grade fevers, synovitis in 4 or more joints pauciarticular - no systemic signs - increased incidence of iridocyclitis |
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What is Lupus?
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- inflammatory connective tissue disorder of unknown etiology occurring predominately in women
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Symptoms of Lupus
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- butterfly rash
- episodic fever & malaise - utericarial plaques (blisters) - thrombocytopenia - increased antinuclear antibodies |
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Progression of Lupus
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- intermittent arthalgias leading to acute polyarthritis
- pneumonitis and pleurisy - diffuse myocarditis - congestive heart failure - splenomegaly - renal involvement |
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Gout
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metabolic disease in which deposition of monosodium urate crystals in the joints produce inflammatory changes
- affects 1st MP joint of the foot - also seen in ankle, wrist, fingers, and elbows |
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Gout Incidence
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- hereditary incidence of 6-18%
- serum urate concentration likely controlled by multiple genes - differential diagnosis is the presence of urate crystals in the WBC in synovial fluid |
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Tophi
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- actual calcified crystals in the joint spaces
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Exercises for Prevention and Wellness
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- maintain proper body weight
- sustain good postural alignment - use joints for ADLs |
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Goals of Rx For OA
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- decrease inflammation
- restore flexibility - educate on proper body mechanics |
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Goals of Rx for RA
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- energy conservation
- joint protection - maintenance of cardiovascular levels - decrease inflammation |
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Methods For Protecting the Joints
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- using a straight cane
- viscoelastic insoles and foot orthosis to decrease impact vibration and disperse weight - aquatic therapy |
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Restoring Muscle Balance
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- isometric exercises
- stretching muscles - resistive exercises of joints - joint mobilization |
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Restoring Functional Activities
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- closed kinetic chain exercises (in midrange)
- balance and equilibrium exercises - energy conservation education |
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To Normalize Specific Joint Movement Patterns
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use splints and braces
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