Ankylosing Spondylitis and Fibromyalgia Flashcards

1
Q

Ankylosing Spondylitis - Definition

A

Systemic rheumatic disease affecting entire body. Inflammatory arthropathy of axial skeleton.

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2
Q

Ankylosing Spondylitis - Cause (3) and Risk Factors (2)

A

Unclear, genetics, environmental factors.
Men, older age.

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3
Q

Ankylosing Spondylitis - Pathogenesis

A

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.

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4
Q

Ankylosing Spondylitis - Signs and Symptoms (6)

A
  • 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.
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5
Q

Ankylosing Spondylitis - Joints commonly involved (5)

A

Spine, SIJ, heels, hips, shoulder.

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6
Q

Ankylosing Spondylitis - Red Flags (2)

A

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)

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7
Q

Ankylosing Spondylitis - Assessments (3) and Outcome Measures (3)

A

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)

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8
Q

Ankylosing Spondylitis - Exercise Prescription (4)

A

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.

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9
Q

Fibromyalgia - Definition

A

Syndrome characterized by chronic widespread pain at multiple tender points, joint stiffness and systemic symptoms.

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10
Q

Fibromyalgia - Onset and Etiology (4)

A

20-55 years old, female > male.
Multifactorial etiology: CNS, ANS, genetics, neuroendocrine dysfunction.

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11
Q

Fibromyalgia - Risk Factors (5)

A

RA!* or Lupus
Age
Smoking
Stress and anxiety

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12
Q

Fibromyalgia - Pathogenesis

A

Malfunction of CNS.
Central sensitization -> greater perception of pain + ineffective pain inhibition. Low pain threshold.
Abnormal pain modulation -> hyperalgesia and allodynia.

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13
Q

Fibromyalgia - Signs and Symptoms (7)

A
  • 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.
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14
Q

Fibromyalgia - Tender Points (9)

A

Bilateral
- Occiput
- Low cervical
- Trapezium
- Supraspinatus
- 2nd rib
- Lateral epicondyle (elbow)
- Gluteal
- Greater trochanter
- Knee

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15
Q

Fibromyalgia - Management

A

Multidisciplinary approach, PA 150 min per week, education, self management and coping strategies, exercise.

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16
Q

Fibromyalgia - Exercise

A
  • Strength and aerobic: reduce symptoms, improve sleep and function.
  • Tai Chi, yoga, Nordic walking, hydrotherapy (pain relief).
    Intensity: gradual progression to moderate intensity for aerobic. Low resistance with 10% increase after 2 weeks without symptom exacerbation for strengthening.
17
Q
A