Ankylosing Spondylitis and Fibromyalgia Flashcards
Ankylosing Spondylitis - Definition
Systemic rheumatic disease affecting entire body. Inflammatory arthropathy of axial skeleton.
Ankylosing Spondylitis - Cause (3) and Risk Factors (2)
Unclear, genetics, environmental factors.
Men, older age.
Ankylosing Spondylitis - Pathogenesis
Progressive fusion of zygapophyseal joints and disc spaces resulting in a stiff, rigid spine with Tx forward posture.
Spine vulnerable to injury -> fractures.
Enthesitis/inflammation of ligaments, tendons and cartilage attachments.
Reactive bone formation.
Ankylosing Spondylitis - Signs and Symptoms (6)
- Gradual onset of LBP an stiffness > 3 months.
- Morning stiffness > 1hþ
- Pain and stiffness with rest, gets better with movement.
- Bowel irritation.
- Fatigue, eye inflammation.
- Loss of chest wall expansion (costovertebral ligaments ossified -> kyphosis) -> decreased lung volumes.
Ankylosing Spondylitis - Joints commonly involved (5)
Spine, SIJ, heels, hips, shoulder.
Ankylosing Spondylitis - Red Flags (2)
Sudden onset of LBP, SIJ or hip pain with no trauma or over-use, non-mechanical cause of back pain.
Signs and symptoms of systemic disease (fever, fatigue, respiratory)
Ankylosing Spondylitis - Assessments (3) and Outcome Measures (3)
Assess ROM and strength of spine and peripheral joints (schober test).
Chest expansion
Hip flexion contractions - hip deformities - IR ROM.
- BASMI: severity of AS
- BASFI: functional index
- BASDAI: activity index (severity of symptoms)
Ankylosing Spondylitis - Exercise Prescription (4)
Avoid high impact/contact sports, high velocity trunk flexion/rotation -> high risk of fracture.
- Spinal mobility and peripheral joint mobility!*
- Stretching, strength, cardiopulmonary, functional.
- Hydrotherapy, modified Pilates and Tai Chi.
Fibromyalgia - Definition
Syndrome characterized by chronic widespread pain at multiple tender points, joint stiffness and systemic symptoms.
Fibromyalgia - Onset and Etiology (4)
20-55 years old, female > male.
Multifactorial etiology: CNS, ANS, genetics, neuroendocrine dysfunction.
Fibromyalgia - Risk Factors (5)
RA!* or Lupus
Age
Smoking
Stress and anxiety
Fibromyalgia - Pathogenesis
Malfunction of CNS.
Central sensitization -> greater perception of pain + ineffective pain inhibition. Low pain threshold.
Abnormal pain modulation -> hyperalgesia and allodynia.
Fibromyalgia - Signs and Symptoms (7)
- Muscle pain!
- Tender points bilaterally
- Diffuse pain
- Sleep disturbance, fatigue.
- Diaphragm significantly affected (accessory muscles take over).
- Wind up response (central sensitization)
- High level of muscle activity during ADLs.
Fibromyalgia - Tender Points (9)
Bilateral
- Occiput
- Low cervical
- Trapezium
- Supraspinatus
- 2nd rib
- Lateral epicondyle (elbow)
- Gluteal
- Greater trochanter
- Knee
Fibromyalgia - Management
Multidisciplinary approach, PA 150 min per week, education, self management and coping strategies, exercise.