Topic 10: Inflammatory Arthritides

Question 1

T/F: Inflammatory Arthritides may develop as a primary disorder, and some develop as a secondary disorder.

Answer 1

True

Question 2

__________ _________ is a chronic, systemic inflammatory disease of joints and connective tissue.

Answer 2

Rheumatoid Arthritis (RA)

Question 3

Peak incidence of Rheumatoid Arthritis is among _____ aged __-__

Answer 3

Women aged 40 - 60

Question 4

While idiopathic, RA is thought to be autoimmune in origin. 70% to 80% of RA sufferers test
positive for ___________ ________ - an auto-antibody

Answer 4

Rheumatoid (RH) factor

Question 5

RH factor combines with IgG to form ________ ________, which are found in the synovium,
synovial fluid, and extra-articular lesions of persons with RA.

Answer 5

Immune complexes

Question 6

T/F: Osteoarthritis is more prevalent than rheumatoid arthritis with young people.

Answer 6

False

Question 6

T/F: Osteoarthritis is more prevalent than rheumatoid arthritis with young people.

Answer 6

False

Question 7

What type of arthritis is associated with inflammatory synovitis and irreversible structural damage to cartilage and bone?

Answer 7

Rheumatoid arthritis

Question 8

What type of arthritis can affect any joint, usually weight bearing joints, usually asymmetrical?

Answer 8

Osteoarthritis

Question 9

What type of arthritis is associated with morning stiffness for 1 hour or more (as opposed to ~30 minutes)?

Answer 9

Rheumatoid arthritis

Question 10

True or false: Rheumatoid arthritis has a variety of systemic signs and symptoms (sickness, fatigue, weight loss) whereas Osteoarthritis has none.

Answer 10

True

Question 11

Stage _ of RA is __________ - Inflammation of the synovial membrane and joint effusion

Answer 11

Stage 1- Synovitis

Question 12

Stage _ of RA is _________ ___________ - an abnormal form of granulation tissue - an extensive network of new blood vessels forms in the synovium which contributes to the inflammation. Enzymes are released that destroy articular cartilage and bone.

Answer 12

Stage 2 is Pannus Formation

Question 13

Stage _ of RA is __________ - Intra-articular adhesions form as a result of the inflammation. These will lead to decreased ROM of associated joints.

Answer 13

Stage 3 is Fibrosis

Question 14

Stage _ of RA is _____ _________ - Calcification of the panni and fibrous tissue. This leads to joint fusion, which leads to deformity, and disuse atrophy.

Answer 14

Stage 4 is Bony Ankylosis

Question 15

T/F: Flare up and remission are common with Rheumatoid arthritis.

Answer 15

True

Question 16

T/F: Presentation of Rheumatoid arthritis is usually bi-lateral, though typically not symmetrical.

Answer 16

False: presentation is usually bi-lateral and symmetrical.

Question 17

With rheumatoid arthritis, the most commonly affected joints are in the ______, ____ and _____.

Answer 17

Hands, feet and knees.

Question 18

_____________ deformity: PIP flexion, DIP hyperextension.

Answer 18

Boutonniere deformity

Question 19

___________ deformity: PIP hyperextension, DIP flexion.

Answer 19

Swan neck deformity

Question 20

__________ deformity: MCP ulnar deviation, PIP radial deviation

Answer 20

Zig Zag deformity

Question 21

Rheumatoid nodules are subcutaneous nodules formed by collagenous tissue. They are not tender themselves, however they are typically adhered to _______ and ________ and can therefore reduce ROM at joints and cause tenderness as a result.

Answer 21

Tendons and fascia

Question 22

During flare-ups of RA, the massage therapists job is to provide support by (2 points):

Answer 22

• Treat inflammation (cryotherapy, LD)

- Normalize sympathetic firing

Question 23

Between flare-ups of RA, maintaining ________ is important

Answer 23

Range of Motion

Question 24

If _____ - ____ is involved in a patient’s Rheumatoid Arthritis, overpressure, tractioning of the upper quadrant is CI’d (high MRT in the suboccipitals will stabilize the region, so tone should not be reduced by very much. Keep the head in a neutral position while treating).

Answer 24

C1-C2

Question 25

_______________ is a chronic inflammatory disease that can affect any organ system. It is an autoimmune disease – an idiopathic type III sensitivity disorder. Sufferers have auto-antibodies, and immune complexes. There may be a genetic factor involved in developing the disease. There may be a hormonal component, as women are much more likely to develop it than men (8:1 ratio).

Answer 25

Systemic Lupus Erythematosus (SLE)

Question 26

Patients with SLE will often have a _____ (_______) rash.

Answer 26

Malar (butterfly) rash

Question 27

Massage treatments of SLE during flare-up are generally oriented to control ___________.

Answer 27

Inflammation

Question 28

T/F: If there is fever with SLE, it is up to the patient’s pain tolerance whether massage is continued.

Answer 28

False: If there is a fever, all massage is contraindicated.

Question 29

Treatments goals between flare ups of SLE often involve maintaining ROM, and addressing compensatory impairments like ______ and ______.

Answer 29

Spasm and TrP’s

Question 30

_________ __________ is an autoimmune disease in which the immune system attacks exocrine glands that produce mucous and tears. There may be excessive dryness of the eyes and mucosal membranes of the body. It may exist on its own, or along with SLE and RA (15% of RA Pt’s). It can occur among either sex, and at any age. However, 90% of patients are female, with average age of onset being post menopausal.

Answer 30

Sjögren’s Syndrome

Question 31

An inflammatory arthritis that occurs in children - usually between ages 9 and 12.

Answer 31

Juvenile RA (aka Still’s disease, aka Juvenile Ideopathic Arthritis)

Question 32

_______ _______ occurs in 5 - 7% of people with psoriasis. Its etiology is unknown. It appears to be an autoimmune disorder.

Answer 32

Psoriatic Arthritis

Question 33

__________ is a rare autoimmune disease. It is characterized by fibrosing and thickening of the skin. This can then stick to underlying structures like fascia, and tendon sheathes.

Answer 33

Scleroderma

Question 34

For which condition would we want to modify techniques because skin is thin and fragile. I.e. caution with fascial work, frictions and other techniques that torque the skin?

Answer 34

Scleroderma

Question 35

_________ _________ is an inflammatory disease that can eventually cause fusion of the vertebrae. Etiology is not entirely understood. It is thought to be a genetically determined autoimmune response.

Answer 35

Ankylosing Spondylitis (AS)

Question 36

AKA for Ankylosing Spondylitis

Answer 36

Bamboo Spine

Question 37

Loss of flexibility in the lumbar spine is an early sign of Ankylosing Spondylitis. Pain usually starts bilaterally in the ______ joints, and ______ spine.

Answer 37

SI joints and lumbar spine

Question 38

With Ankylosing Spondylitis, ___________s (vertically oriented bony outgrowths) replace IVDs, followed by bony fusion.

Answer 38

Syndesmophytes

Question 39

T/F: patients with Ankylosing Spondylitis will find rest alleviates the pain.

Answer 39

False!
Aggravating: rest
Alleviating: walking and hot showers may relieve pain

Question 40

Gout occurs when there is an over production of uric acid which can lead to ____________. Urate crystals form in the synovial fluid - it generally affects peripheral joints.

Answer 40

Hyperuricemia

Question 41

Most commonly affected joint with Gout is the _____ _____ joint. Tarsal joints, ankles, heels, knees, wrists, fingers and elbows may also be affected.

Answer 41

First MTP

Question 42

T/F: Lack of exercise may trigger a Gout flare-up.

Answer 42

False: Attacks may be precipitated by excessive exercise and also certain medications, alcohol, or certain foods (like offal, sardines and anchovies).

Question 43

T/F: Cold hydrotherapy is indicated as a treatment for Gour.

Answer 43

False: Cold hydrotherapy is CI’d with gout as it can exacerbate the pain caused by the urate crystals.

Question 44

______ ______ is characterized by joint inflammation resulting from a bacterial, viral, or fungal infection.

Answer 44

Septic Arthritis (aka infectious arthritis)

Question 45

Results from infection with Borelli burgdorferi bacteria (spread by deer ticks). Characterized by bulls-eye rash.

Answer 45

Lyme’s Disease

Question 46

_________ _________ is classified as an autoimmune condition that develops in response to an infection (often Chlamydia) in another part of the body. Coming into contact with bacteria and developing an infection can trigger the disease. By the time symptoms present, the initial trigger has resolved itself – making determination of the initial cause difficult.

Answer 46

Reiter’s Syndrome aka Reactive arthritis