Arthritis

Question 1

Definitions

Osteoarthritis:

Answer 1

degeneration of joint cartilage and the underlying bone, most common from middle age onwards

Question 2

Definitions

Rheumatoid arthritis:

Answer 2

a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.

Question 3

Types of Osteoarthritis and their pathophysiology

Answer 3

Osteoarthritis
PRIMARY
 Considered “wear and tear” osteoarthritis
 15%
 Mostly post-menopausal women

Question 4

Types of Osteoarthritis and their pathophysiology

Answer 4

SECONDARY
 Has a specific cause, such as an injury, an effect of obesity, genetics, 
inactivity, or other diseases
 85%
 Dependent on load
❑ Endemic
Cont…
 Mainly affects the elderly
 Due to wear and tear
 With genetic predisposition
 Its progressive
 Both destructive and progressive
 Not curable but manageable

Question 5

OSTEOARTHRITIS

Predisposing factors of Secondary Osteoarthritis

Answer 5

 Abnormal mechanical forces
 Increased bone rigidity
 Chrondrocyte dysfunction
 (Chrondrocyte: a cell which has secreted the matrix of cartilage and become embedded in it)

Question 6

Causes of secondary osteoarthritis

Answer 6

 Congenital/developmental
 Inflammatory
 Infective
 Metabolic
 Traumatic
 Neuropathic 
 Obesity
 Repetitive joint use
 Physical inactivity
 Genetics

Question 7

OSTEOARTHRITIS

Biomechanical risks

Answer 7

 Injury
 Obesity
 Deformity
 Instability 
 Muscle weakness

Question 8

Cardinal Features of Osteoarthritis

Answer 8

 Progressive cartilage destruction
 Subarticular cyst formation
 Remodelling of bone ends with osteophytes
 Capsular fibrosis
 More changes with age
 ↓ in water content
 ↓ in tensile strength
 Stiffness of collagen
 ↓ glycosaminoglycan length and fragmentation (glycosaminoglycan: long unbranched polysaccharides consisting of a repeating disaccharide unit)
 Damage to the chondrocytes (a cell which has secreted the matrix of cartilage and become embedded in it)
 Changes similar to OA may occur in immobilization

Question 9

Radiological features of Osteoarthritis

Answer 9

 Joint space narrowing
 Subchondral bone sclerosis
 Subchrondral cysts
 Osteophytes

Question 10

Signs & symptoms of Osteoarthritis

Answer 10

 Pain
 Stiffness
 Tenderness
 Deformity
 Limp
 Instability
 Grating Sensation
 Swelling

Question 11

With the Kellgren-Lawrence rating scale what i s the Grading of Osteoarthritis

Answer 11

Grades
 Grade 1: Doubtful narrowing of the joint space and possible osteophytic lipping
 Grade 2: definite osteophytes and possible narrowing of the joint space
 Grade 3: Moderate multiple osteophytes, definite narrowing of the joint space, some sclerosis and possible deformity of bone contour
 Grade 4: large osteophytes, marked narrowing of the joint space, severe sclerosis, definite deformity of the bone contour

Question 12

Medical management of Osteoarthritis

Answer 12

Aims is to control pain and improve function and health related quality of life.
Analgesics
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Rx of co-morbidities

Question 13

Nonpharmacological therapy of Osteoarthritis

Answer 13

 Patient education
 Prophylactic (a medicine or course of action used to prevent disease)
 Self-management programs (e.g., Arthritis Foundation SelfManagement Program)
 Personalized social support e.g. weight loss programme (if overweight)
 Aerobic exercise programs

Question 14

Physiotherapy guidelines for Osteoarthritis

Answer 14

 Range-of-motion exercises 
 Muscle-strengthening exercises 
 Hydrotherapy 
 Assistive devices for ambulation
 Taping/strapping
 Appropriate footwear 
 Lateral-wedged insoles (for genu varum) 
 Bracing
 Home exercise programme
 Assistive devices, bracing, and footwear
 In OA Knee management- Hemiarthroplasty (HEP) or TKR important in assisting manual therapy.
 Pre operative exercise programme 8/52
- Aerobic exercises, balance exercises
- LL strengthening & stretching
- ↑functional outcome post TKR
 In OA Hip – HEP vs. Manual therapy
- Manual therapy is better for ↓pain, ↑ROM, ↑hip function
 Multidisciplinary team approach

Question 15

RHEUMATOID ARTHRITIS

etiology

Answer 15

 Systemic inflammatory disorder
 Affects connective tissue throughout the body
 Thought to be auto immune (the normal immune response is directed against an individual’s own tissue, including the joints, tendons, and bones)
 The cause of Rheumatoid arthritis is not known (Investigating possibilities of a foreign antigen, such as a virus)
 Response may be genetically determined
 3% of population

Question 16

RHEUMATOID ARTHRITIS

The American College of Rheumatology classification

Answer 16

 Morning stiffness
 Arthritis of 3 or more joint areas
 Arthritis of hand joints
 Systemic Arthritis
 Rheumatoid nodules
 Serum rheumatoid factor
 Radiological changes

Question 17

RHEUMATOID ARTHRITIS

Onset of action

Answer 17

 Rheumatoid arthritis usually has a slow, insidious onset over weeks to months
 About 15-20% of individuals have a more rapid onset that develops over days to weeks
 About 8-15% actually have acute onset of symptoms that develop over days

Question 18

RHEUMATOID ARTHRITIS

Functional Presentation and Disability of RA

Answer 18

 In the initial stages of each joint involvement, there is warmth, pain, and redness, with corresponding decrease of range of motion of the affected joint
 Mainly affects small joints (hands), wrists, elbows, and ankles
 Progression of the disease results in reducible and later fixed deformities
 Muscle weakness and atrophy develop early in the course of the disease in many people

Question 19

Pathology of Rheumatoid Arthritis

Answer 19

 Synovitis
 Destruction
 Deformity

Question 20

Sign and Symptoms of RHEUMATOID ARTHRITIS

Answer 20

 Synovitis

• Swelling
• Warmth
• Tenderness

 Destruction

• Limitation of joint movement
• Isolated tendon ruptures start to appear

 Deformity

• Ulnar drift of fingers
• Subluxation of MCPs
• Clawed toes
• Contractures and muscle wasting
• Genu Valgus

Question 21

RADIOLOGICAL FEATURES OF RHEUMATOID ARTHRITIS

Answer 21

 Soft tissue swelling
 Periarticular osteoporosis
 Narrowing of the joint space by stage 2
 Marginal bony erosions by stage 2
 Articular destruction 
 Joint deformity are obvious by stage 3

Question 22

RHEUMATOID ARTHRITIS

Extra-articular manifestations

Answer 22

 Tenosynovitis
 Eye
 Lung
 Cardiac
 Vascular
 CNS
 Haematological
 Renal
 Fever

Question 23

Complications of Rheumatoid Arthritis

Answer 23

Complications include:
Carpal tunnel syndrome, Baker’s cyst, vasculitis, subcutaneous nodules, Sjögren’s syndrome, peripheral neuropathy, cardiac and pulmonary involvement, Felty’s syndrome, and anemia

Question 24

Management of RHEUMATOID ARTHRITIS

Answer 24

Medical
 Surgical
Physio

Question 25

Vocational Implications of Rheumatoid Arthritis

Answer 25

 Need to make frequent assessments of the person’s functional ability as the disease progresses in order to provide realistic goals and support
 Motor coordination, finger and hand dexterity, and eye-hand-foot coordination are adversely affected
 Vocational goals dependent on fine, dexterous, or coordinated movement of the hand are not ideal
 Most jobs requiring medium to heavy lifting are not desirable
 Activities such as climbing, balancing, stooping, kneeling, standing, or walking are hampered
 Extremes of weather or abrupt changes in temperature should be avoided – indoor controlled climate better