Gout, Psoriatric, AS

Question 1

What is ankylosing spondylitis(AS)?

Answer 1

form of arthritis that mainly affects spine but can affect other joints

Question 2

What are the host factors for AS?

Answer 2

age 14-40

unknown etiology

HLA B27+

more men than women and rare in African Americans

Question 3

What is the disease process of AS?

Answer 3

1. inflammatory
2. arthropathy
3. enthesopathy- tendon to bone connection (patella tendon could lead to knee pain)

Question 4

What are the most common joints involved in AS?

Answer 4

spine, SI jt, shoulders and hips

Question 5

What are systemic features of SA?

Answer 5

acute iritis, arrthymia, pulmonary fibrosis

Question 6

What are some lab values that could indicate AS?

Answer 6

elevated CPK- muscle inflammation marker

increased ESR?

Question 7

How does RA and SA differ?

Answer 7

RA- higher in females

HLAD4 (RA) vs B27 in AS

RA- peripheral jts vs SA axial jts

No SI jt involvement in RA

Rash RH factor- over 80% in RA vs less than 15% AS

Question 8

Why is it important to know the difference between early and late symptoms with patients who have AS?

Answer 8

they are very different in their clinical manifestations

Question 9

What are the early signs and Sx in AS?

Answer 9

fever, weight loss, synovitis, pain/stiffness with inactivity,
tender SI joint, Enthesitis

Question 10

What are late signs and Sx of AS?

Answer 10

osteophytes (bone spurs)
fibrosis
Loss of ROM spine and hip
OA in hip jts
glaucoma, iritis
Bamboo Spine (fusion of spine, lack of rotation)

Question 11

What physical signs and Sx will pt present with?

Answer 11

decreased spinal rotation, increased thoracic kyphosis, decreased lumbar lordosis, gait deviations, C1-C2 subluxation

spinal stenosis- narrowing of vertebral foramen

Question 12

What symptoms will patients usually c/o?

Answer 12

back stiffness, LBP, buttox pain, feel better with activity, AM stiffness, Enthesis

Question 13

What diagnostic tests can be preformed for AS?

Answer 13

Xrays- squaring of vertebral bodies?

MRI- early on may help Dx

HLA B27 helps rule out other dx but not definite for AS

Question 14

What is medical management for AS?

Answer 14

NSAIDS- early on
DMARDS, immunosupressives

exercise- PNF and aerobic, flexibility

Surgery- usually THR

Question 15

What is PNF exercise?

Answer 15

proprioceptive neuromuscular facilitation

goal is to enhance both active and passive range of motion with the ultimate goal being to optimize motor performance and rehabilitation

Question 16

What is PT intervention for AS?

Answer 16

postural education, ROM/ Flexibility exercises, pain management, aerobic exercise, PNF strengthening exercises

Question 17

What is psoriatic arthritis (PA)?

Answer 17

repeated inflammatory synovitis results in:
hypetrophied synovial lining, eroded articular surface, inflammation and enthesis erode bone

usually affects DIP of hands and feet but can involve knee and ankles

Question 18

What is dactylitis?

Answer 18

sausage fingers which is prevalent in PA but not RA

Question 19

What are characteristics of PA?

Answer 19

can result from psoriasis (7% of PA pts)

age of onset 20-50 y/o, can be 20 yrs after onset of psoriasis

strong family association and HLA B27 but etiology unknown

slow progression and a less disabling disease

Question 20

What are Signs and Sx?

Answer 20

warmth, tenderness, swelling, sausage fingers

acne, nail changes, psoriatic plaques

painful jts, morning stiffness

Question 21

What is medical management of PA?

Answer 21

NSAIDS- mild cases

corticosteroids, immunomodulators- severe

early and aggressive treatment

Question 22

PT management of PA?

Answer 22

pain management, joint protection, maintain strength and flexibility when not in acute inflammation

Question 23

What is Reiter’s syndrome (RS)?

Answer 23

acute, aseptic inflammatory arthroplasty (inside joint) arising after infectious process at site remote primary infxn

can affect anyone

Question 24

Who is more likely to get RS?

Answer 24

most common in young, sexually active adults, esp men infected with chlamydia

post-enteric ear infection can be cause

Question 25

What are characteristics of RS?

Answer 25

most common type of reactive arthritis

follows 2-4 weeks post infection

oligo, asymmetric, enthesitis involving L.E

autoimmune disease whose trigger is infection

usually self limiting and last under year but predisposed for OA

Question 26

What are the signs and Sx of Reiter’s?

Answer 26

conjuctivitis/uveitis (can’t see), urethritis (can’t pee), arthritis (can’t climb a tree)

Question 27

What is medical management of RS?

Answer 27

NSAIDS, DMARDS, biologics, corticosteroids

to control progression

Question 28

What is goal of PT with RS pts?

Answer 28

focus on joint protection, maintenance of function

Question 29

What is gout?

Answer 29

a metabolic disorder resulting from a deposition of urate crystals in jts, soft tissues and kidneys

stuck bc your body is having a hard time metabolizing them (hyperuricemia)

crystals aggregate and trigger inflammatory response

Question 30

What are risk factors that predispose someone to gout?

Answer 30

tends to happen in males more age 40-50

obesity (increased UA), excessive alcohol consumption, diuretic, HTN, kidney disease (decrease UA excretion)

Question 31

What is the course of the disease?

Answer 31

1. hyperuricemia
2. acute gout arthritis- 1st attack can look like RA or sepsis, big toe, very painful can last days hours or weeks
3. inter critical gout- recurence of acute gout but now polyarticular
4. chronic tophaceous stage- destructive disease, build up of tophi- can be crippling

Question 32

What is medical management of gout?

Answer 32

acute- NSAIDS ( never aspirin)
corticosteroids if cant take NSAIDS

if 2-3 attacks in year then start taking preventative meds

Question 33

What are clinical manifestations of gout?

Answer 33

warmth, extreme tenderness, hypersensitivity (blanket on area hurts), fever/chills?

bad pain mostly at night, inability to bear weight

feels like walking on glass

Question 34

What is role of PT with gout?

Answer 34

modify treatments during attack, prescribe AD to decrease jt stress

educate PT