EXAM #2 Autoimmune Diseases-Fibromyalgia

Question 1

An autoimmune disease is present when the body ______ to distinguish ______ from _______

Answer 1

fails; self from non-self

Question 2

What are some etiologic and risk factors of autoimmune diseases regarding genes?

Answer 2

-Genetic
-single gene not identified
-clusters are present
-gene expression by epigenetics, remember factors that can influence genes

Question 3

Who are the most affected by autoimmune diseases?

Answer 3

women (hormonal) > men

Question 4

What is pathogenesis?

Answer 4

immune mechanism attacks self antigens sytemically

Question 5

What are common S&S with MOST auto-immune conditions?

Answer 5

-GI S&S *gut largest number of immune cells
-Gradual Onset
-Inflammation
-persistent w/possible acute bouts
-local or systemic
-Myalgia/arthralgia
-Swollen lymph node(s)
-Typically affect > 1 part of the body
-Emotional changes

Question 6

What are the general PT implications for autoimmune disease? (4)

Answer 6

-infection control
-exercise Rx
-nutritional guidance
-sleep health

Question 7

What are the PT implications regarding medications for autoimmune disease:
-what medication?
-what does it do?
-side effects?

Answer 7

-corticosteroid medication
-prolonged use to suppress immune system response
-side effects: sleep/mood change, GI irritation, hyperglycemia, bone loss

Question 8

What is the MOST serious side effect of Corticosteroid medications?

Answer 8

increased susceptibility to infection

Question 9

What are the PT implications regarding the side effects of autoimmune disease medications?
-more susceptible to?
-PT should offset with?
-PT should avoid?

Answer 9

–more susceptible to fx, osteoporosis, avascular necrosis, etc.
–offset with WB and resistance exercise
–avoid JM

Question 10

Lupus is seen primarily in ____________ and more common in ______________

Answer 10

young women; minorities

Question 11

Why does Lupus have unique clinical manifestations & S&S?

Answer 11

no two people are the same

Question 12

1. What are S&S of Lupus involving skin and joints?
2. -__________ MOST common S&S and target _____ , _________and _____

Answer 12

skin lesions, butterfly rash (across nose and cheeks)

-Arthralgia (joint P!); hand wrist and knee

Question 13

What are other possible Lupus S&S?

Answer 13

Cardiopulmonary abnormalities and risk for thrombosis
Neurological including headaches, irritability, and depression
–cognitive deficits, seizures neuropathies, and even strokes
Urinary w/renal disease
Circulatortory w/anemia and amenorrhea
-Hepatitis may develop

Question 14

PT implications often intervene during exacerbations by: (4)

Answer 14

-protection w/bracing assistive or ergonomic devices
-energy conservation
-monitor symptoms to maximize movement
-gentle and regular exercise -land and aquatic based

Question 15

PT implications –exacerbations
–identify?

Answer 15

Identify triggers i.e., physical and environmental factors

Question 16

Group of diverse auto-inflammatory conditions that affects the spine > extremity joints

Answer 16

Spondyloarthropathies

Question 17

What is Sjogren syndrome?

Answer 17

spondyloarthropathies or spondyloarthritis

Question 19

Common Features & S&S of spondyloarthropathies or spondyloarthritis
(6)

Answer 19

-gradual
-multi jt. inflammation and P!
- > 30 min of P! after prolonged positions
-improved P! with easy and regular movement
-typically of smaller,extremity joints but can affect larger ones
-localized to insertions of ligaments, tension and fascia (numerous “itis”)

Question 20

If a patient tells you that it “hurts to see, pee, and bend my knee” what are they experiencing?

Answer 20

spondyloarthropathies or spondyloarthritis

Question 21

What are the risk factors of Sjogren Syndrome? (2)

Answer 21

2nd MOST common rheumatic disease but no Rh factor present in the blood test
MOST often in postmenopausal women

Question 22

Etiology and Pathogenesis of Sjogren’s Syndrome:

-_______ glands (moisture-producing), mainly _______ and _______ gland destruction

-Additional ________ and ______ gland dysfunction

Answer 22

-exocrine glands; salivary & lacrimal (tear)
-pituitary and adrenal

Question 23

This gland helps regulate growth, blood pressure, and reproduction:

Answer 23

pituitary gland

Question 24

What is the function of the adrenal gland:

Answer 24

regulate metabolism, immune system, blood pressure, and stress response

Question 25

Unique clinical manifestations and S&S of Sjogren’s Syndrome?

Answer 25

-Hallmark symptom- dry eyes/mouth but the potential effect on all systems
-Fatigue is dominating and disabling
-Sleep disturbance
-Spondyloarthritis S&S plus
-Peripheral neuropathy

Question 26

What is Fibromyalgia Syndrome: -NOT what?

Answer 26

Chronic widespread myalgia -NOT the fatigue level of chronic fatigue syndrome -Systemic and NOT the same as a more localized Myofascial P! Syndrome

Question 27

Fibromyalgia Syndrome- Incidence/Prevalence: (4) -MOST common _____________ in the US -Women _______ Men -Age? -Fitness level?

Answer 27

MOST common MSK disorder in the US Women (90%) > Men (10%) 20-55 years of age Minimal Fitness levels

Question 28

Fibromyalgia Syndrome: Risk factors/ P! Triggers (5)

Answer 28

-Prolonged anxiety and emotional stress -Trauma -Infections -Rapid steroid withdrawal -Thyroid disorders

Question 29

1. The etiology of Fibromyalgia Syndrome is often _______ but ______ and ______ are possible. 2. My be triggered by __________ conditions.

Answer 29

-unknown; risk factors & genetics -inflammatory

Question 30

Fibromyalgia Syndrome pathogenesis are:

Answer 30

not entirely understood

Question 31

Fibromyalgia Syndrome pathogenesis is misprocessing of P! which is ____________

Answer 31

sensitization/nociplastic P!

Question 32

T or F the nociplastic P! in Fibromyalgia Syndrome alters the ANS, PNS, and CNS?

Answer 32

True

Question 33

Fibromyalgia Syndrome ANS has an _________ sympathetic (flight or flight) branch and ________ parasympathetic (rest) branch? Which leads to increased ________-----> which releases ________

Answer 33

hyperactive; underactive P! ; P! neurotransmitters

Question 34

Fibromyalgia Syndrome S&S: (6)

Answer 34

Visual problems 95% Mental and physical fatigue 85% Sleep disturbance/,morning fatigue 80% Morning stiffness 75% Global Anxiety 72% Cognitive problems 71%

Question 35

All imaging and blood testing are ________ for Fibromyalgia Syndrome

Answer 35

negative (-)

Question 36

PT implication for Fibromyalgia Syndrome: What two initial approaches are strongly supported? others: (3)

Answer 36

-pt. education -exercise Rx -nutritional guidance -stress management -often minimal benefits over long-term management

Question 37

What should the exercise Rx look like for patients with fibromyalgia syndrome? -intensity -duration of sessions? -frequency? wks? you should monitor?

Answer 37

-low to moderate intensity global exercises w/aerobic and resistance activity -1hr-1.5 hr sessions -2-3x/wks -≥13 weeks -monitor vital signs to avoid hyperactive sympathetic response

Question 38

What are PT implications for Fibromyalgia Syndrome? (3)

Answer 38

-nutritional guidance -stress management -often minimal benefits over long-term management