MODULE 11 - CHRONIC MUSCULOSKELETAL CONDITIONS

Question 1

What is rheumatoid arthritis?

Answer 1

A progressive chronic inflammatory autoimmune condition of unknown aetiology that can occur at any age.
In RA the body’s immune system attacks the joints, causing pain, fatigue, joint swelling and stiffness.
The inflammatory response can also affect the circulatory and pulmonary systems.

Question 2

What are the early manifestations of RA?

Answer 2

Early manifestations include swelling, stiffness and pain in the joints however patients may note signs of inflammation in the preceding period.

Question 3

What are the late manifestations of RA and the impacts it has on a person?

Answer 3

Late manifestations include deformity of the joints as they are slowly destroyed.

Impacts include changes to motor function, quality of life and life expectancy

Question 4

What systems are affected by rheumatoid arthritis?

Answer 4

Respiratory 
Musculoskeletal
Sensory
Exocrine glands
Cardiovascular
Integumentary

Question 5

What are the drug classes used for the pharmacological treatment of RA?

Answer 5

Medication therapy includes a multifaceted approach.

• Non steroidal medications are used to decrease the inflammation and management symptoms but do not halt the progress of RA.
• Corticosteroids may impact on disease progression

Question 6

Provide some examples of the drugs used to manage RA

Answer 6

Aspirin
Ibuprofen
Naproxen

Question 7

What are the non-pharmacological management strategies for RA?

Answer 7

• Fatigue management
• Use of mobility aids
• management of chronic pain through encouraging the monitoring and pacing of activity to match pain levels and judicious use of heat and cold
• emotional and self-management support for patient and family/carers

Question 8

What is juvenile arthritis?

Answer 8

Juvenile arthritis (also known as juvenile idiopathic arthritis, (JIA) is a general term used to describe inflammatory arthritis in children that begins before the 16th birthday and lasts at least 6 weeks.
- Development of JIA and pathogenesis is complex and may be related to factors such as autoimmune, genetic and environment.

Question 9

What are the types/modes of onset for juvenile arthritis?

Answer 9

Oligoarthritis
- up to 4 joints may be involved are affected
- uveitis (inflammation of eye) may occur
Polyarthritis
- 5 or more joints
Systemic onset JIA
- includes generalised inflammation with fevers, rashes, aching limbs and fatigue

Question 10

What are the signs and symptoms of JIA?

Answer 10

• stiffness and pain and this depends on the day and the joints involved. eg. stiffness may be noted predominantly in the morning.
• The child may be irritable and refuse to mobile or may favour or guard a joint.
• Low grade fever, rash, fatigue and weight loss may be reported.
• Changes in growth and development.

Question 11

What does the management of JIA include?

Answer 11

• managing pain, maintaining mobility and joint movement whilst decreasing the risk of further joint destruction and promoting age appropriate growth and development
• pharmacological management such as pain medications, anti-inflammatory and immunosuppressant’s
• non- pharmacological include: splints to protect and rest the joints, relaxation, deep breathing, distraction from pain, and education regarding strategies for dealing with and thinking about pain.

Question 12

What is osteoarthritis? (OA)

Answer 12

A progressive condition that affects the ability of synovial joints to move freely

Pathophysiology: Enzymatic changes to the cartilage results in loss of collagen and proteoglycans. This is an inflammatory response and has the potential to involve all parts of the joint.

Ongoing loss of the articular cartilage causes the surface to soften and thin, resulting in painful bone-on-bone contact in the joints, synovial inflammation and joint deformity.

Question 13

What are the manifestations of OA?

Answer 13

Pain, decreased range of motion and stiffness and varies depending upon the joint involved

Question 14

What are the pharmacological interventions for OA?

Answer 14

Medications for pain relief for example Paracetamol and Ibuprofen or anti-inflammatories. Topical medications include counterirritants, salicylates and capsaicin.

Question 15

What are the non -pharmacological interventions for OA?

Answer 15

Exercises, weight loss or surgical interventions such as arthroscopy, osteotomy or joint arthroscopy

Question 16

What is osteoporosis? (OP)

Answer 16

A chronic, systemic musculoskeletal condition associated with increased risk of fractures.
It is characterised by low bone mass, micro-architectural deterioration of bone tissue which leads to bone fragility.
Pathophysiology is unclear however there is noted to be imbalances between bone formation and bone reabsorption.

Question 17

What are the manifestations of OP?

Answer 17

Fractures, curvature of the spine and a decrease in height

Question 18

What are the pharmacological interventions for OP?

Answer 18

Include medications that reduce bone loss or increase bone density such as oestrogen replacement therapy, Bisphosphonates, calcium, sodium fluoride

Question 19

What are some of the risk factors for musculoskeletal conditions?

Answer 19

BEHAVIOURAL: repetitive stress on joints, cigarette, smoking, alcohol intake
NON-MODIFIABLE: gender, previous family history
BIO-MEDICAL: obesity, previous joint injury, certain medical conditions such as hormonal factors
PHYSICAL ENVIRONMENTAL DETERMINANTS: employment, limitations in accessing services
SOCIAL: cultural factors

Question 20

What is the self management for musculoskeletal conditions?

Answer 20

• identification and self-management of co-morbidities
• learning about their disease
• being an active participant in making health decisions
• understanding medications
  utilising both pharmacological and non pharmacological interventions
• knowing how to deal with health emergencies specific to muscle-skeletal conditions, such as uncontrolled pain or a fall