Chapter 1: Arthritic Conditions

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dmshaw9
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296549
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Chapter 1: Arthritic Conditions
Updated:
2015-02-22 18:47:24
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Arthritic Conditions
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NPTE Review
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NPTE: Chapter 1
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  1. Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Definition and Characteristics
    • Definition: a degenerative process of varied etiology, which includes mechanical changes, diseases, and/or joint trauma
    • Characteristics: degeneration of articular cartilage, with hypertrophy of subchondral bone and joint capsule of weight-bearing joints
  2. Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Medications
    • Corticosteroids
    • NSAIDs
    • Glucocorticoid injections (unresponsive to NSAIDs) 
    • Acetaminophen (mild pain without inflammation)
  3. Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Diagnostic Tests
    • Plain film imaging: diminished joint space, decreased height of articular cartilage, presence of osteophytes
    • Lab tests: rule out other disorders (RA)
  4. Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Physical Therapy Goals, Outcomes and Interventions
    • Joint protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Implementation of aerobic capacity, endurance conditioning or reconditioning (i.e. aquatic programs)
  5. Rheumatoid Conditions: Subtypes
    • Ankylosing Spondylitis (Marie-Strumpell disease, Bechterew's disease, rheumatoid spondylitis) 
    • Gout
    • Psoriatic Arthritis
    • Rheumatoid Arthritis
  6. Ankylosing Spondylitis: Definition and Characteristics
    • Progressive inflammatory disorder of unknown etiology
    • Initially affects axial skeleton
    • Initial onset (mid and low back pain for 3 months or greater) before 4th decade of life
    • 1st symptoms include mid and low back pain, morning stiffness, and sacroiliitis 
    • Results in kyphotic deformity of vertical and thoracic spine and decease in lumbar lordosis 
    • Degeneration of peripheral and costovertebral joints may be observed in advanced stages 
    • Affects men 3x more than women
  7. Ankylosing Spondylitis: Medications
    • NSAIDs (aspirin): reduce inflammation and pain
    • Corticosteroid therapy
    • Medications to suppress immune system
    • Cytotoxic drugs: block cell growth; for those who don't respond well to corticosteroids
    • Tumor necrosis factors (TNF) inhibitors: shown to improve some symptoms
  8. Ankylosing Spondylitis: Diagnostic Tests
    HLA-B27 antigen (helpful, but not diagnostic by itself)
  9. Ankylosing Spondylitis: PT Goals, Outcomes, and Interventions
    • Implementation of flexibility exercises for trunk to maintain/improve normal joint motion and length of muscles in all directions (especially ext)
    • Implementation of aerobic capacity/endurance conditioning or reconditioning (aquatic programs)
    • Implementation of relaxation activities to maintain/improve respiratory function (breathing strategies to maintain/improve VC)
  10. Gout: Definition and Characteristics
    • Genetic disorder of purine metabolism
    • Characterized by elevated serum uric acid (hyperuricemia)
    • Uric acid changes into crystals and deposits into peripheral joints and other tissues (i.e. kidneys)
    • Most frequently seen at knee and great toe
  11. Gout: Medications
    • NSAIDs (indomethacin)
    • COX-2 Inhibitors (cardiac side effects may limit use)
    • Colchichine
    • Corticosteroids
    • Adrenocorticotropic hormone (ACTH)
    • Allopurinol
    • Probenecid
    • Sulfinpryazone
  12. Gout: Diagnostic Tests
    Lab tests: identify monosodium urate crystals in synovial fluid and/or connective tissue samples
  13. Gout: PT Goals, Outcomes, and Interventiosn
    • Pt/client education for injury prevention and reduction of involved joints
    • Early identification of condition, with fast implementation of intervention is very important
  14. Psoriatic Arthritis: Definition and Characteristics
    • Chronic, erosive inflammatory disorder of unknown etiology (associated with psoriasis)
    • Erosive degeneration usually occurs in joints of digits as well as axial skeleton
    • Both sexes equally affected
  15. Psoriatic Arthritis: Medications
    • Acetaminophen (pain)
    • NSAIDs
    • Corticosteroids 
    • Disease-modifying antirheumatic drugs (DMARDs): can slow progression of psoriatic arthritis
    • Biological response modifiers (BRMs) (i.e. Enbrel (etanercept)
  16. Psoriatic Arthritis: Diagnostic Tests
    Lab tests - not useful except to rule out RA
  17. Psoriatic Arthritis: PT Goals, Outcomes, and Interventions
    • Joint protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Implementation of aerobic capacity/endurance conditioning or reconditioning (aquatic programs)
  18. Rheumatoid Arthritis: Definition and Characteristics
    • Chronic systemic disorder of unknown etiology
    • Involves symmetrical pattern of dysfunction in synovial tissues and articular cartilage of joints of hands, wrists, elbows, shoulders, knees, ankles, and feet
    • MCP and PIP joints usually affected
    • Characteristic pannus formation (inflammatory granulation tissue that covers joint surface)
    • Ulnar drift (observed at PIPs in severe forms) 
    • Volar subluxation of MCP joints
    • DIP joints usually spared
    • Other deformities = swan neck and boutonniere deformities and Bouchard's nodes (excessive bone formation on dorsal PIP joints)
    • Women 2-3x greater incidence than men
    • Juvenile RA onset prior to age 16 with complete remission in 75% of children
  19. Rheumatoid Arthritis: Medication
    • Varies with disease progression
    • May include gold compounds and anti rheumatic drugs (DMARDs) early
    • NSAIDs, immunosuppressive agents, or cortocosteroids are commonly prescribed for long-term management
  20. Rheumatoid Arthritis: Diagnostic Tests
    • Plain film imaging 
    • Laboratory testing (positive test findings include increased WBC count and erythrocyte sedimentation rate; hematocrit and hemoglobin tests will show anemia; rheumatoid factor will be elevated)
  21. Rheumatoid Arthritis: PT Goals, Outcomes, and Interventions
    • Joint protection strategies
    • Maintain/improve joint mechanics and connective tissue functions
    • Implementation of aerobic capacity and endurance conditioning or reconditioning (aquatic programs)

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