Inflammatory Arthritides

Question 1

Describe a ‘swan neck deformity’

Answer 1

hyperextension at the PIP joint, flexion at the DIP joint

Question 2

Describe a ‘boutonniere deformity’

Answer 2

flexion at PIP, hyperextension at DIP joint

Question 3

What causes a swan neck deformity?

Answer 3

intrinsic hand muscle contracture (laxity of PIP joint w/ overstretched palmar plate & bow stringing of lat. band of extensor hood = hyperextension of PIP, flexion of DIP)

Question 4

What causes a boutonniere deformity?

Answer 4

rupture of the central band of extensor hood (lat band of extensor hood = slip of PIP = flexion of PIP and extension of DIP).

Question 5

What is an ‘ulnar drift deformity’?

Answer 5

ulnar deviation of the hand with subluxed MCP joints

Question 6

What is a Baker’s cyst?

Answer 6

enlargement of the posterior knee bursa (may occur in RA impacted knee joints)

Question 7

The inflammatory stage of AS usually ends by age…

Answer 7

40

Question 8

AS synovitis usually begins at what joints, and then progresses…

Answer 8

SI joints, up the spine

Question 9

90% of people diagnosed with AS have what in common?

Answer 9

HLA-B27 gene

Question 10

Severe, longstanding AS can also see inflammation of the iris, which is called…

Answer 10

uveitis (present in up to 30% with AS)

Question 11

How does AS change breathing?

Answer 11

it becomes primarily diaphragmatic as chest expansion is reduced

Question 12

What is seen in 90% of RA cases after the first year?

Answer 12

the joints initially involved are the joints ultimately affected

Question 13

True or false: in RA, joints are usually affected asymmetrically.

Answer 13

false. usually symmetrical

Question 14

What is the role of proteolytic enzymes in RA?

Answer 14

attack and erode cartilage, eventually exposing subchondral bone

Question 15

In severe cases of RA, erosion of what features in the neck can lead to cervical instability?

Answer 15

the alar ligament, transverse ligament, odontoid process

Question 16

What is seen in RA - genu varus or valgus?

Answer 16

valgus

Question 17

What commonly happens to the MCP joints in RA?

Answer 17

ulnar drift (deviation) and palmar subluxation

Question 18

The deformity of the thumb commonly seen in RA is called…

Answer 18

zig zag deformity (mm imbalances and lig. laxity lead to MCP dislocations)

*thumb becomes flexed and adducted

Question 19

What is a proteoglycan?

Answer 19

proteins that bind water and make up a major part of the ECM of cartilage (give cartilage its elasticity)

Question 20

Why is cartilage so resilient?

Answer 20

its high water content (up to 80% of the ground substance)

Question 21

The initial response of cartilage to damage is to self repair by…

Answer 21

increasing water content and number of proteoglycans (load bearing portions of articular cartilage are affected first w. OA)

Question 22

In later stages of osteoarthritis, what happens to the subchondral bone?

Answer 22

it remodels & thickens (the exposed surface becomes eburnated = bone turns into hard, ivory-like mass)

Question 23

What happens to the joint capsule and synovium in the later stages of OA?

Answer 23

they thicken in response to chronic irritation

Question 24

Describe the progression of a patient’s experience of pain as OA progresses.

Answer 24

no pain until bone on bone

pain will then follow moderate joint use

progresses to pain with minimal active motion, passive motion, and eventually even at rest

Question 25

Where are Bouchard's nodes found?

Answer 25

PIP joint (enlarge)

Question 26

Where are Heberden's nodes found?

Answer 26

DIP joints

Question 27

Osteophyte formation in the spine can lead to...

Answer 27

narrowing of the intervertebral foramen spinal stenosis ...leading to compression of nerve roots, intermittent radicular pain

Question 28

With hip OA, which two osteokinematic movements see a reduction in range?

Answer 28

IR, ext. (pain over the groin and adductors)

Question 29

What are some CI's for all inflammatory arthritides?

Answer 29

no provocative testing (except aROM) no hot hydro on areas of inflammation no tx if fever no circulatory techniq. distal to areas with swelling no lymph drainage do not mobilize unstable or ankylosed joints

Question 30

How does AS affect posture?

Answer 30

loss of lumbar curvature (lordosis) flexion contractures in the hips thoracic curvature becomes more apparent chest becomes fixed/flattened

Question 31

When should cold hydro to affected joints be used with RA?

Answer 31

during flareups

Question 32

With AS, chest expansion is reduced as a result of what joints being impacted...

Answer 32

costovertebral joint

Question 33

RA begins with activation or injury of...

Answer 33

synovial microvasculature of the endothelia cells

Question 34

What % of those with RA has an unremitting and progressive course of development?

Answer 34

3%

Question 35

These 7 joints are the most commonly involved in RA...

Answer 35

``` PIP MCP Wrist Knees MTP subtalar C1/C2 ```

Question 36

As RA progresses, synovitis occurs and the synovial membrane...

Answer 36

thickens and folds (similar to granulation which occurs with wound healing)

Question 37

define pannus:

Answer 37

vascularized membrane that extends from the synovium to involve the articular cartilage (pannus develops between the joint margins, forming adhesions which restrict ROM)

Question 38

Where do rheumatoid nodules develop?

Answer 38

where skin and subcutaneous tissue are subject to pressure (ex. extensor surface of forearm)

Question 39

Synovial joints are composed of...

Answer 39

hyaline cartilage-covered bone ends connected by a fibrous joint capsule and reinforced extra-capsular ligaments

Question 40

Hyaline cartilage is a low friction, wear resistant tissue present within joints that is designed to...

Answer 40

bare and distribute weight (strong, rubbery, flexible - like nose and ears)

Question 41

With OA, as collagen fibers continue to break, what happens?

Answer 41

proteoglycans are depleted and cartilage softens and becomes thinner.

Question 42

How do vertical clefts result in pain for people with OA?

Answer 42

they develop in the articular cartilage surface and deepen, allowing for cartilage to fragment off into the synovial fluid, eventually extending to subchondral bone underneath. subchondral bone is pain sensitive.