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Musculoskeletal Pathophysiology > Arthritis > Flashcards

Flashcards in Arthritis Deck (61):
1

Which gender is affected more by general arthritis?

women

2

Monoarticular arthritis examples:

infection
trauma
crystal induced gout or pseudo-gout

3

Inflammatory polyarticular arthritis example(s):

RA
spndylarthropathy

4

Degenerative polyarticular arthritis example(s):

OA (primary or secondary)

5

Metabolic polyarticular arthritis examples:

gout
amyloid
hyperlipidemia
CPPD

6

Classic RA affects ___% of the US population.

1%

7

Classic RA female:male ratio?

3:1

8

Classic RA age of onset is:

30-50 years

9

RA is an autoimmune disease influenced by these 3 main factors:

1. genetics
2. intrasynovial immune response
3. damage from pro-inflammatory cells and enzymes

10

RA is a ________ inflammatory response.

systemic

11

The course of RA is a chronic ______ course.

fluctuating

12

RA manifestations:

symmetric, erosive synovitis
extra-articular involvement
progressive joint destruction and deformity
premature death possible

13

Diagnostic classification of RA: (7 Sxs)

1. morning stiffness
2. swelling/fluid > 3 joints
3. hand arthritis
4. symmetric involvement
5. subcutaneous nodules
6. abnormal serum RF
7. radiolographic changes

14

What is RF?

rheumatoid factor

15

Hand/wrist conformation changes can be described as:

ulnar drift at MCPs
rotary subluxation at wrist
swan-neck deformities
boutonneire's deformity

16

To be classified, you need ___ out of the 7 sxs.

4

17

What is a sign of greater disease activity and erosions?

more swollen and involved joints at onset

18

What are the systemic features of RA?

fatigue
malaise
weakness
fever
weight loss

19

How soon do RA patients show radiographic evidence of disease?

70% of patients - evidence appears within 2 years
(Early radiographic evidence does not correlate strongly with outcomes)

20

Arthritic radiological changes with RA include:

marginal erosions at joints
osteopenia
joint subluxation

21

What cervical changes can occur with RA?

laxity of transverse ligament at C1 allows subluxation of C1/C2 causing SC compression
(dens translates backwards toward SC)

22

______ is a non-specific marker of inflammation that rises and falls with inflammation.

CRP = C-Reactive Protein

23

Extra-articular rheumatoid nodules are associated with

low dose methotrexate

24

Areas of repeated friction and viscera of heart and lungs are susceptible to

Extra-articular rheumatoid nodules

25

Increased ESR is a finding that frequently leads to RA diagnosis when it is active. What is ESR?

Acute phase response, elevated fibrinogens & globulins -> increases ESR
(erythrocyte sedimentation rate)

26

What is the pharmacologic intervention for RA?

NSAIDS and COX II
DMARDS and Biologics
Glucocorticoids

27

Patients with RA are 2 x more likely as those with OA to have serious _____ complications.

NSAID

28

What is the initial pharmacologic intervention for RA?

NSAIDs, salicylates or COX-2s
Analgesic and anti-inflammatory properties
(don't alter disease course or prevent joint destruction)

29

RA rehab goals:

Muscular strength
Flexibility
Endurance
Mobility
Patient independence and self-management skills

30

RA Acute inflammation interventions:

rest, splints, modalities, isometrics, ROM, energy conservation

31

RA subacute interventions:

dynamic and ROM exercises, ergonomic interventions

32

RA inactive/chronic interventions:

aerobic exercises, work accommodations

33

OA is a disease of the ____.

CARTILAGE

34

A disrupted ________ process leads to increased degenerative changes in OA.

remodeling

--> progressive loss of cartilage, subchondral thickening, marginal osteophytes

35

Primary OA:

no preceding injury

36

Secondary OA:

after an injure to the joint (ex: fx or congenital abnormalities)

37

______ pain is a late event in OA.

subchondral

38

What are the primary sources of pain early on in OA?

synovial and capsular tissues

39

Sxs/Symptoms of OA:

pain related to use
morning stiffness
stiff after inactivity (gelling)
decreased ROM
swelling
joint instability
bony enlargement
restricted movement
crepitus

40

OA joint involvement:

hips
knees
spine
DIP (heberdon's nodes)
shoulders
elbow

41

OA radiological changes:

bone proliferation
joint space narrowing
subchondral sclerosis (hardening of tissue/compacted)
osteophytes
subchondral cysts
malalignment and subluxations

42

Severe OA at knee often presents as genu _____.

Genu Varus
greater compression moment medially

43

Spine radiological features of OA:

asymmetrical disc spaces
traction osteophytes

44

Early pharmacological management of OA:

NSAIDs and Tylenol - early medications for pain relief

45

Name 2 nutrient management "nutraceuticals" for OA:

glucosamine and chondroitin sulfate

46

Chondroitin sulfate:

part of a large protein molecule (proteoglycan) that gives cartilage elasticity
(animal cartilage, such as tracheas or shark cartilage)

47

Glucosamine:

a form of amino sugar believed to play a role in cartilage formation and repair.
(crab, lobster or shrimp shells)

48

What is the goal for use of glucosamine and chondroitin sulfate?

goal: pain relief, slow cartilage damage in people with OA

49

Non-invasive OA management:

preserve motion and strength
reduce load on joint (decrease WB loads, use assistive device)

50

Invasive OA management:

experimental: cartilage replacement
surgical: arthroplasty (usually hips/knees)

51

What is a viscosupplement injection?

KNEE only – injection of Synvisc or Hyalgan which are substances intended to substitute for hyaluronic acid

52

Ank Spond is defined as:

sero-negative (no RF)
spondyloarthropathy

53

Ank Spond begins usually as:

sacro-iliitis (fuzzy on radiograph)

54

Due to fibrosis, ank spond is called "______ spine"

Bamboo spine due to fibrosis (syndesmophytes)

55

Ank Spond most commonly affects which gender?

male

56

Early ank spond Sxs:

inactivity (am stiffness prominent)
Tenderness SI jt Early
Fever
Weight loss, fatigue
Synovitis
Pain/stiffness with
Enthesitis- achilles, patellar(men)

57

Late ank spond Sxs:

Osteophytes
Fibrosis
Loss ROM spine, hips
OA hip jts
Glaucoma, iritis
Bamboo spine

58

Complications of ank spond include: ___% aortic insufficiency, ___% pulmonary fibrosis

10% aortic
5% pulmonary

59

Ank Spond rehab:

exercise is very important
(PNF, aerobic, flexibility, spinal extension especially)

60

Ank Spond pharmacologic management:

NSAIDs- early stages: Indomethecin (75 mg)
DMARDS – sulfasalazine
Immunosupressives – Inflixamib

61

What is the most common surgical technique for ann spond?

total hip replacement (TKR)