Arthritis

Question 1

T/F: Arthritis affects women > men?

Answer 1

True.

Question 2

There are two main classifications of arthritis: monoarticular and polyarticular. Describe each.

Answer 2

MONOARTICULAR

• infection
• trauma
• crystal induced (gout)

POLYARTICULAR

• Inflammatory (RA or RA-like)
• Degenerative (OA or OA-like)
  
  • 1*
  • 2* (to 1* injury; abn align)
• Metabolic (gout, hyperlipidemia)

Question 3

RA is described as a red, hot inflamed joint with reduced motion due to systemic inflammation. What group is mostly affected by RA and what are the 3 main factors in its pathogenesis?

Answer 3

Women, 3:1, 30-50

1. Genetics
2. Intrasynovial immune response (self-perpetuating)
3. Damage from pro-inflammatory cells

Question 4

In what way is RA most different from OA?

Answer 4

RA is symmetric (erosive synotivits)
-OA is degenerative and is not necessarily symmetrical

SYSTEMIC FEATURES

• Fatigue
• Fever
• Weight loss
• Malaise

Question 5

By what process does RA destroy the joints?

Answer 5

Inflammation destroys joint synovium, creating synovitis. Cartilage and bone are affected as the disease progresses.

Question 6

Where is RA most commonly seen?

Answer 6

HANDS
-MCP, PIP

WRIST
-ulnar drift is a common phenomenon

Question 7

To have a clinical diagnosis of RA, >4/7 signs / symptoms must be present. What are they?

Answer 7

1. Morning stiffness (prolonged)
2. Swelling or fluid >= 3 joints
3. Arthritis in hands
4. Symmetric involvement –both sides
5. Subcutaneous nodules
6. Abnormal serum RF (rheumatoid factor)
7. Radiographic changes

Fewer than 10% ever exp prolonged remission

Question 8

What part of the body is most affected in patients with synotivits? How soon does radiological evidence show?

Answer 8

HANDS (90%)

• wrist rotary sublux
• ulnar drift
• swan neck (MCP flexed, PIP hyperextended, DIP flexed) and boutonneire’s deformities

RADIOLOGICAL EVIDENCE
-2 years

Question 9

What can happen in the spine due to RA?

Answer 9

C1 transverse ligament laxity

• subluxation of C1/C2
• causes compression caudally

Question 10

T/F: RA symptoms do not include nodules.

Where are they seen?

Answer 10

False.

Seen in areas of repeated friction (elbows)

Question 11

What are 3 frequent RA lab findings?

Answer 11

1. < RBC
2. > ESR (when active)
   - acute phase response = > fibrinogen & globulins
   - due to anemia
   - CRP can also correlate
3. • Rheumatoid factor

Question 12

Why would you want to pursue aggressive RA intervention with polytherapy?

Answer 12

Little evidence of disease modification with conservative rx.
-disease progression modifiable in first few years

Question 13

What types of meds are good for RA?

Answer 13

NSAIDS & COX-2 inhibitors
DMARDS
-Methotrexate = gold standard
-reduce or prevent disease
-start no later than 3 months s/p diagnosis

Question 14

What are the benefits of glucocorticoids?

Answer 14

Highly effective, especially when injected
-< synovitis

e.g. cortisone

Question 15

What is important to remember about conditioning patients with RA?

Answer 15

They have decreased aerobic capacity.

Question 16

What is a typical intervention plan for someone with RA?

Answer 16

ACUTE

• inflammation
• rest, splints, modalities, isometrics, ROM

SUBACUTE
-Dynamic ROM ther ex

CHRONIC

• aerobic exer
• work accomodations

Question 17

Cartilage a subchondral substance that is composed of water, collagen and proteoglycans and internally remodels. What happens to this with OA?

Answer 17

Progressive cartilage loss, subchondral thickening and marginal osteophytes
-remodelling disrupted

Question 18

How is secondary OA different from primary?

Answer 18

I follows joint injury

Question 19

What are the OA demos? How does it occur?

Answer 19

> 60
M=W

Mechanical, cellular and biomechanical.
-subchondral pain evident late

Question 20

What role does synovial fluid play in the joint?

Answer 20

Permeates and influence nature of intercelluar environment around chondrocytes, nociceptors and synovial cells
-elastic and viscous combo

Question 21

How does OA present?

Answer 21

Use pain
-gets worse through day

Morning stiffness (< ROM

Bony enlargement, joint instability, crepitus

Question 22

What is the most common OA deformity?

Answer 22

Medial knee (varus deformity)

• decreased medial joint space due to loss of cartilage
• osteophytes

Question 23

What features are evident in spinal OA?

Answer 23

Asymmetrical joint space
-if space is not preserved, facet joints fall down on each other and can trap nerve roots (stenosis)
Traction osteophytes

Question 24

What two nutritional supplements can be used for OA?

Answer 24

Glucosamine
-cartilage formation
Chondroitin Sulfate
-proteoglycan related for elasticity

Can slow OA and have analgesic effect.

Question 25

What types of conversvative management are available for OA?

Answer 25

Preserve ROM and strength

Reduce joint load
-assistive device

Question 26

What is sero-negative spondyloarthopathy (ankylosing spondylitis)?

Answer 26

Non-RA of the spine

• Sacro-iliitis
• erosion
• fuzziness of SI joint
• other vertebra start to fuse after

PRESENTATION

• tender SI
• fever
• synovitis
• inactivity

Question 27

How is Reiter’s syndrome different than Psoriatic arthritis?

Answer 27

Reiter’s is spine, hip, knee ankle and toes.

Psoriatic is spine, fingers and toes.

Question 28

What type of exercise would you use in AS?

Answer 28

Extension exer
-spine tend to fuse flexed
PNF
Aerobic and flexibility