8. Musculoskeletal Conditions Flashcards
Arthritis can be classified as:
Give example of each
= inflammatory or non-inflammatory
- Rheumatoid arthritis (inflammatory) is caused by an autoimmune disease, so the body attacks itself causing increased inflammation which causes the joint pain,
- osteoarthritis (non-inflammatory) is caused by mechanical stress on the joints
Difference between inflammatory and non-inflammatory
Inflammatory
- symptoms aer prominent, including fatigue
- Onset: Insidious, usually affecting multiple joints
- morning stiffness: more than an hour
- Effect on activity: lessen with activity, worse after periods of rest
Non-inflammatory
- Symptoms: unusual
- Onset: Gradual, one joint or a few
- Morning stiffness: less than 30 mins
- Effect on activity: worsen with activity, lessen with rest
What is Osteoarthritis?
= Flexible tissue at the end of bones wears down - progressive
Due to: excessive wear and tear OR non-specific inflammatory change (trauma)
Affects- - synovial joints in hands, hips, knees
-Causes:
loss of cartilage , joint space narrowing, painful, stiff bones, decreased weight baring abilities
Risk factors for OA
- increased age
- female gender
- genetic susceptibility
- nutrition
- previous damage
- increasing bone density
- obesity
Two types of clinical presentation of OA
Primary: = most commonly affects all of:
• DIPS and PIP joints of fingers
• Carpometacarpal joint of thumb
• The hip, knee and metatarsophalangeal (MTP) joint of the big toe, and the cervical and lumber spine
Secondary. = occurs in any joint as a sequel to articular injury either
• Acute e.g fracture
• Chronic e.g. occupational overuse of a joint, metabolic disease, hyperparathyroidism or neurologic disorders
Management of OA –> risk Reduction
- Rest inflamed joint, reduce loading, time in use & repetition
- Use largest muscles and joints to do the job (ie. standing with hips and knees rather than pushing up with hands)
- Use proper movement and handling techniques
- Modify home equipment and use gadgets
- Make exercise part of your every day life
OA management goals
- Pt education about disease and management
- Pain control
- Improved function and decreased disability
- Altering disease process and its consequences
Management Techniques of OA Non pharmacological (3)
- Exercise and physical therapy
- Weight reduction
- Thermotherapy -
- ice packs for acute flares to reduce swelling and inflammation
- Heat may promote relaxation, joint flexibility and blood flow however it may contribute to inflammation and oedema
Management of OA pharmacotherapy
- Paracetamol (ensure max dose per day, SR-formulations)
- NSAIDs (relieve pain associated with tissue damage and inflammation, may cause significant GI, renal and CVS issues)
- Opioids if paracetamol and NSAIDs ineffective
- Intra-articular corticosteroids (betamethasone, methylprednisolone, triamcinolone in Aus; injected into specific joints to minimise systemic adverse effects)
What is Rheumatoid arthritis?
- Chronic systemic inflammatory autoimmune disorder characterised by inflammation and deformity of synovial joints & inflammations of surrounding tissues such as tendons, ligaments and muscles
Risk factors for RA
- Genetic vulnerability
- Family history
- Pregnancy: postpartum period is most common for symptom development
- Smoking
Early and late presentation of RA?
Early
- Joint pain and stiffness
- Weakness, fatigue, anorexia and weight loss
- Low grade fever
- Soft tissue swelling or effusion of affected joint
- Accompanying warmth and redness
- Most commonly affected joints - MCP in hand, Proximal interphalangeal (PIP), Wrist, MTP, Knee, Shoulder
Late stage
- Joint and tendon destruction
- Deformity and loss of function (ie. ulnar deviation, boutonniere, swan-neck deformities and hammer toes)
- Multiple effects of pain, reduced mobility, fatigue and depression
Aim for Management of RA
- Ultimately want to reduce remission, though this may be difficult to achieve
- Reduce joint swelling, stiffness and pain
- Preserve range of motion and joint function
- Improve quality of life
- Prevent systemic complications
- Slow destructive joint changes
RA management Non-pharmacological
- Diet PUFA rich diet, Standard changes to help reduce CV risk factors, limit alcohol intake
- Weight If overweight, try and lose weight
- Smoking cessation
- Multidisciplinary team management (OT, PT)
RA management Pharmacological management - 3 main drug groups used
- Analgesics (important to educate pt that analgesia is not an alternative to DMARDs)
o Paracetamol
o NSAIDs mainly in early stages of disease
o Sometimes opioids - Corticosteroids
- Used to rapidly and effectively control severe inflammation in early disease or active flares
- Oral (mainly prednisolone) used in 3 ways:
i. Initial ‘bridging therapy’ until DMARDs take effect
ii. Management of acute flares
iii. Combination with DMARDs when DMARD is suboptimal - Disease modification anti-rheumatic drugs (DMARDs) including biological DMARDs
- Mainstay therapy in RA due to ability to limit disease progression and relatively favourable toxicity profile
- Preserve joint function, reduce symptoms, induce clinical remission while maintaining reasonable long-term safety
- Response should be apparent in 12 weeks
- Early DMARD use decreases rates of joint damage and appears to make disease easier to control compared to delayed DMARD use
- Well tolerated and very safe when used correctly
