Arthritis

Question 1

arthrtsis

Answer 1

a chronic joint disorder characterised by degreneration of joint cartlidge causing pain and stiffness
can limit physical function

Question 2

process of osteoarthrsis

Answer 2

cells that produce collagen and proteoglycans become abnormal
initally an increase in cartlidge growth and bone dnsity - reducing joint space
soon cartlidge thins and cracks, rough cartlidge causes pain during movement
bone starts to be worn down, bone moves against bone increasing erosion and pain
spurs develop to compensate
inflammation means synovium is thickened - increase synovial fluid
joint swells
ligaments become lax and overstreatched casuing weakness

Question 3

rheumatoid arthritsis

Answer 3

an autoimmune disease affecting the wholw body
affects 1% of the population
3x more common in women

Question 4

effect of inflammatory cytokines

Answer 4

cause weakness, fatigue, loss of appetite, muscle pain and weight loss
may cause myocardial damage and pericarditis

Question 5

process of rheumatoid arthritsis

Answer 5

T cells in synovial fluid become corrupted and unable to distinguish between foreign and normal body cells
excessive production of immunoglobins and inflammatory cytokines
aggressive productinon of interleukin 6 causes persisent inflamation and joint destruction
osteoclasts stimulated
excessive Ig causes abnormal growth and division of synoival and cartlidge cells
macropahges migrate to joints - release enzymes that cause synovitis

Question 6

what is synovitis

Answer 6

increased swelling of joints
stretching of ligaments
enzymes released by macopahages attacks hyaline cartlidge

Question 7

name some immunglobins

Answer 7

IgA
IgG
IgM

Question 8

name some inflammaroty cytokines

Answer 8

Tnf alpha

Interleukins - IL6

Question 9

5 stages of RA

Answer 9

healthy
synovitis
pannus - destroyed hyaline cartlidge, pitted bone, swelling
fibrous ankylosis - joining of connective tissue and bone
bony alkylosis - fixed joint

Question 10

what can affect arthritsis

Answer 10

age 
gender
inactivity 
obesity 
overuse 
infection

Question 11

how does age affect arthritis

Answer 11

increased prevalence in older

natural decline in glucosamine and condition sulphate production

Question 12

how does gender affect arthritis

Answer 12

men have more hip OA
women have more hand/knee OA
women>men RA
oestrogen appears to be protective, with increased OA post menopause

Question 13

how does inactivity increase arthritis

Answer 13

weakness of quads increase risk of OA

Question 14

how does obesity increase arthritis

Answer 14

top 20% for BMI increases risk 7-10 times for hip and knee OA

Question 15

how does overuse affect arthritis

Answer 15

inconclusive data
but histoy of damage predisposed to OA
moderate levels of PA does not increase risk

Question 16

symptons of arthritis

Answer 16

pain and crepitation of movement 
joints become enlarged and deformed 
inflammation 
ligaments become streched - unstable 
decreased ROM

Question 17

problem activities

Answer 17

bending 
standing 
walking 
push 
climb 
carry 
sit
reach 
reduces the amount of PA they do which is detrimental

Question 18

effect of arthritis on strength

Answer 18

less muscular strength/endurance

decrease 25-50%

Question 19

effect of arthritsis on flexibitly

Answer 19

decrease flex and ROM

Question 20

effect of arthritis on peak VO2

Answer 20

lower

decrease 20-30%

Question 21

why do exercise measurments decrease

Answer 21

inactivity causes detraining
structural changes in bones and tendon
reduce co-ordination and motor control

Question 22

effect of decrease inactivity

Answer 22

increase risk of CHD, diabetes, osteoporsis

increase weigth = increase joint loading and reduces mobility further

Question 23

aim of treatment

Answer 23

easing of pain 
decrease of pain and inflammation 
improvment in joint function 
lessening in joint damage 
improvement in functional capacity 
reduce risk of co-morbid conditions

Question 24

non exercise treatment

Answer 24

balance between exercise and rest 
firm bed/chair 
heat 
massage 
drugs 
weight loss 
surgery

Question 25

drugs

Answer 25

``` asprin ibuprofen steriods diease modifying anti-rheumatic drugs cox-2 selective inhibitors ```

Question 26

benefits of exercise

Answer 26

``` increase joint mobility increase muscle strength around joint increase stability increase shock absorption increase bone density reduce swelling reduce weight reduce pain on movement ```

Question 27

how does exercise help

Answer 27

cartlidge has no direct blood vesels or nerves relies on movement to facilitate diffusion of nutients into cartlidge movement increases 'feeding' of cartlidge - increase prostagladin production - increase glucosamine and chrondrontin sulphate secretion

Question 28

benefit of muscle strength increase

Answer 28

quads strengthening acts to cushion force transmission through the muscle rather than the joint improvement in quad/hamstring ratio helps balance loads on joint

Question 29

aim of exercise

Answer 29

to preserve or increase ROM and flexibilty increase muscle strength and endurance aerobic condtioning ameliorate health risks of inactivity

Question 30

exercise considerations

Answer 30

``` decreased ROM work within pain threshold difficulty gripping balance problems reduce joint load joints stiffer when cold time of day - stiffer in morning ```

Question 31

stretching

Answer 31

``` core of program all joints static stretching - hold 10-30 secs PNF if supervised - 5 sec hols followed by 10 - 30 sec asssited stretch 3-4 times ```