Arthritis Quiz: Symptoms and Risk Factors
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Questions and Answers

Which of the following cytokines is overproduced in rheumatoid arthritis?

  • IL-1
  • TNF (correct)
  • IL-6 (correct)
  • IL-10

    • Rheumatoid arthritis typically has an abrupt onset of symptoms.

    False

    What is the increased risk factor for first-degree relatives in relation to rheumatoid arthritis?

    2- to 3-fold increased risk

    Pregnancy and breastfeeding for 24 months __________ the risk of rheumatoid arthritis.

    <p>lowers</p> Signup and view all the answers

    Match the following symptoms or features with their corresponding categories:

    <p>Fever = General sign Articular symptoms = Symmetric polyarthritis Synovitis = Articular manifestation Fatigue = General symptom</p> Signup and view all the answers

    Which of the following is NOT a clinical sign of an inflamed joint?

    <p>Weight gain</p> Signup and view all the answers

    Osteoarthritis primarily affects the underlying bone structure.

    <p>False</p> Signup and view all the answers

    List one risk factor associated with osteoarthritis.

    <p>Obesity</p> Signup and view all the answers

    Osteoarthritis is characterized by pain and __________ in the affected joints.

    <p>capsular laxity</p> Signup and view all the answers

    Which of the following is a common location for osteoarthritis to occur?

    <p>Hips</p> Signup and view all the answers

    Match the type of arthritis with its characteristic:

    <p>Osteoarthritis = Chronic degenerative disorder affecting articular cartilage Rheumatoid arthritis = Autoimmune disorder causing joint inflammation Both = Can cause joint swelling and impaired mobility None = Primarily affects ligaments and tendons</p> Signup and view all the answers

    Rheumatoid arthritis is primarily caused by mechanical injuries to the joint.

    <p>False</p> Signup and view all the answers

    Name one factor that can lead to cartilage thinning in osteoarthritis.

    <p>Mechanical injury</p> Signup and view all the answers

    Which joint has the highest percentage involvement in rheumatoid arthritis?

    <p>MCP</p> Signup and view all the answers

    The DIP joint is most commonly affected by rheumatoid arthritis.

    <p>False</p> Signup and view all the answers

    What type of joint manifestation is characterized by fusiform or spindle-shaped swelling?

    <p>Swelling in rheumatoid arthritis</p> Signup and view all the answers

    The primary aim of treatment for rheumatoid arthritis is to achieve _____ or minimize disease activity.

    <p>remission</p> Signup and view all the answers

    Match the following extra-articular manifestations of rheumatoid arthritis with their categories:

    <p>Palmer erythema = Dermatological Pericarditis = Cardiac Lymphoma = Haematologic Osteoporosis = Others</p> Signup and view all the answers

    Which of the following is NOT a common extra-articular manifestation of rheumatoid arthritis?

    <p>Asthma</p> Signup and view all the answers

    What radiological finding helps in establishing a diagnosis of rheumatoid arthritis?

    <p>Radiographic findings</p> Signup and view all the answers

    A _____ score is used to assess radiographic changes in rheumatoid arthritis.

    <p>Larsen</p> Signup and view all the answers

    Which of the following tests is used to assess the medial collateral ligament (MCL)?

    <p>Valgus Test</p> Signup and view all the answers

    Rheumatoid arthritis is characterized by unilateral joint inflammation.

    <p>False</p> Signup and view all the answers

    What is the primary symptom used to diagnose knee osteoarthritis (OA)?

    <p>knee pain</p> Signup and view all the answers

    The age group with the peak incidence of rheumatoid arthritis is between _____ years.

    <p>35 to 50</p> Signup and view all the answers

    Which of the following is NOT one of the classic clinical criteria for knee OA diagnosis?

    <p>Positive Varus Test</p> Signup and view all the answers

    Match the types of knee pain with their possible causes:

    <p>Medial Pain = MCL Lateral Pain = LCL Diffuse Pain = Infectious arthritis Anterior Pain = Patellofemoral syndrome</p> Signup and view all the answers

    A common test to measure the degree of knee flexion is known as _____ assessment.

    <p>ROM</p> Signup and view all the answers

    What imaging technique is used to visualize the patella in the knee during an examination?

    <p>Tangential Patellar (Sunrise) view</p> Signup and view all the answers

    What should be done if joint pain develops and persists for more than 1 hour after activity?

    <p>Decrease level of activities or omit provoking activities</p> Signup and view all the answers

    Therapeutic exercises can positively alter the pathological process of rheumatoid arthritis (RA).

    <p>False</p> Signup and view all the answers

    Name one precaution to take when exercising individuals with rheumatoid arthritis.

    <p>Avoid stretching swollen joints.</p> Signup and view all the answers

    It is important to avoid deforming ______ during activity.

    <p>positions</p> Signup and view all the answers

    Match the following stages of rheumatoid arthritis with their characteristics:

    <p>Subacute = Intensity of pain and swelling diminishes Chronic = Occurs between exacerbations Acute = Characterized by increased pain and swelling Remission = Symptoms are absent or minimal</p> Signup and view all the answers

    Which of the following is NOT a recommended strategy for someone with RA?

    <p>Perform heavy resistance exercises on swollen joints</p> Signup and view all the answers

    Ligamentous laxity can be a secondary effect of steroidal medications.

    <p>True</p> Signup and view all the answers

    What is a recommended approach for managing RA during its chronic stage?

    <p>Respect fatigue and avoid overstressing tissues.</p> Signup and view all the answers

    What type of exercises are recommended for improving cardiopulmonary endurance in individuals with RA?

    <p>Aquatic exercise</p> Signup and view all the answers

    Individuals with RA should engage in vigorous stretching exercises without any precautions.

    <p>False</p> Signup and view all the answers

    What is the primary focus of exercises for individuals with rheumatoid arthritis?

    <p>Improving flexibility, muscle strength, and muscle endurance.</p> Signup and view all the answers

    To protect the joints, it is important to use __________ and environmental adaptations.

    <p>assistive devices</p> Signup and view all the answers

    Match the following types of exercises with their characteristics:

    <p>Aquatic exercise = Non-impact conditioning exercise Isometric exercises = Strength training at maximum voluntary contraction Aerobic dancing = Low-impact cardiovascular exercise Cycling = Aerobic exercise performed on a stationary bike</p> Signup and view all the answers

    Which exercise was NOT mentioned as part of the intensive exercise program for patients with RA?

    <p>Pilates</p> Signup and view all the answers

    Patients with medically controlled RA can participate in an intensive exercise program safely.

    <p>True</p> Signup and view all the answers

    What was the significant outcome of the randomized review on aerobic training for patients with RA?

    <p>Positive impact on cardiovascular status.</p> Signup and view all the answers

    Study Notes

    Joint Diseases Overview

    • Joint diseases are characterized by inflammation of a joint.
    • Common types include osteoarthritis and rheumatoid arthritis.

    Objective of Study

    • Define osteoarthritis and rheumatoid arthritis.
    • Identify the different signs, symptoms of osteoarthritis and rheumatoid arthritis, and the problems affecting patient functions.
    • Recognize various risk factors associated with osteoarthritis.
    • Design physical therapy programs for osteoarthritis and rheumatoid arthritis to help patients return to active function without impairments.
    • Describe surgical procedures for treating joint arthritis.
    • Design treatment programs after surgery, ensuring no side effects to quickly restore normal function.

    Arthritis

    • Arthritis is inflammation of a joint.
    • Common types are rheumatoid arthritis and osteoarthritis.

    Clinical Signs and Symptoms of Inflamed Joints

    • Impaired mobility (capsular pattern)
    • Decreased and painful joint play
    • Joint swelling (effusion)
    • Muscular contractures limiting range of motion (ROM)
    • Impaired muscle performance
    • Joint malalignment
    • Muscle inhibition
    • Impaired balance
    • Functional limitations

    Osteoarthritis (OA)

    • A chronic degenerative disorder primarily affecting articular cartilage in synovial joints.
    • Characterized by bony remodeling and overgrowth at joint margins (spurs and lipping).
    • Includes thickening of synovial and capsular tissues and joint effusion.
    • Weight-bearing joints (hips, knees), cervical and lumbar spine, distal interphalangeal joints (DIPJs) of fingers, and carpometacarpal joints (CMCJ) of the thumb are commonly involved.
    • OA often results from a complex interplay of joint integrity, biochemical processes, genetics, and mechanical forces.
    • Mechanical injuries, repeated minor stresses, joint deformity, and soft tissue injuries (e.g., ACL, MCL, LCL) can contribute to OA development.
    • Poor synovial fluid movement is problematic during joint immobilization.

    OA Characteristics

    • Pain in weight-bearing joints is typical.
    • Capsular laxity is observable.

    Risk Factors for OA

    • Genetics
    • Obesity
    • Weakness of the quadriceps muscles
    • Repetitive microtrauma
    • Occupational activities (e.g., jobs requiring kneeling, squatting, heavy lifting)

    Pathophysiology of OA

    • Cartilage splits and thins out.
    • Subchondral bone becomes exposed with increased density and cystic bone loss along the joint line (sclerosis).
    • Capsular laxity results from bone remodeling, leading to some joint motion instability or hypermobility.
    • Affected joints may enlarge in later stages.

    Radiological Features of Knee Osteoarthritis

    • Radiographs display progressive stages of OA in the knee.
    • Stages are often graded from 0-4, with higher stages showing more significant cartilage loss and bone changes.

    OA of the Knee: Overview

    • Knee OA is a primary cause of disability among adults.
    • It causes decreased work productivity and frequent sick days.
    • It incurs the highest medical expenses among all arthritis conditions.
    • Over 10 million Americans suffer from symptomatic knee OA.
    • The prevalence is elevated in people over 64.

    OA of the Knee: Definition

    • OA involves a gradual loss of articular cartilage within the knee's three articulations: the lateral and medial femoral condyles with the tibia, and the patellofemoral joint.
    • Damage results from a combination of joint integrity, biochemical processes, genetics, and mechanical force interplay.

    Anatomy of the Knee

    • The knee is a complex joint with multiple ligaments (LCL, MCL, ACL, PCL) and cartilage (menisci) that stabilize and cushion the joint.
    • Ligaments limit sideways and rotational movements, while also controlling forward movement of the tibia.

    Risk Factors for Knee OA

    • Age
    • Female gender
    • Obesity
    • Previous knee injury
    • Lower extremity malalignment
    • Repetitive knee bending
    • High-impact activities
    • Muscle weakness

    Clinical Approach to Knee Pain

    • Comprehensive patient history assessment using SOCRATES pain questions.
    • Examination of inflammatory indicators (e.g., fever, hot joint).
    • Assessment of past trauma or surgical history.
    • Evaluation of knee instability.
    • Evaluation of functional loss.

    Knee Pain Assessment

    • Physical exam includes observing patient vitals and Body Mass Index (BMI).
    • Knee palpation for tenderness, effusion, and crepitus.
    • Range of motion (ROM) measurement.
    • Assessment of ligament, meniscus, and overall alignment.
    • Observation of gait or movement patterns (e.g., duck waddle).

    Tests for Knee Pain or Arthritis

    • Complete blood count (CBC)
    • Erythrocyte sedimentation rate (ESR)
    • Rheumatoid factor (RF)
    • Arthroscopy
    • X-rays (3 views - weight bearing and tangential patellar views)
    • MRI

    Differential Diagnoses for Knee Pain

    • Differentiating knee pain necessitates considering various conditions, including osteoarthritis (OA), medial collateral ligament (MCL) issues, meniscus tears, and bursitis. Considerations also include possible iliotibial band syndrome, patellofemoral syndrome, prepatellar bursitis, quadriceps mechanism issues, infectious arthritis, gout, or pseudogout.

    Diagnosis of Knee OA

    • Diagnostic criteria include age >50, presence of morning stiffness (<30 minutes), crepitus, bony tenderness/enlargement and absence of palpable warmth.

    Knee OA Classification Tree

    • Classifies symptoms or findings as presenting with or without OA.
    • Determines existence of synovial fluid issues (WBC, color, and viscosity).
    • Radiographic analysis to determine bone spurs, loss of joint space, subchondral sclerosis, or subchondral cysts.

    Treatment of Knee OA Overview

    • Management modalities include home exercises, physical aids, pain management, and medical interventions including medication (analgesics or steroids).

    Management Guidelines for Knee OA

    • Home programs and patient education.
    • Pain management.
    • Supportive devices (e.g., canes, walkers).
    • Joint realignment.
    • Mobilization.
    • Aerobic exercises and balance training.

    Recommendations for Knee OA Management

    • Weight management (5-7% loss).
    • Land-based exercises (e.g., walking, strengthening).
    • Recommend against specific procedures (e.g., debridement, repair, meniscectomy, stem cell injections, viscosupplements).

    Moderate Knee OA Management Recommendations

    • Hydrotherapy
    • Manual therapy
    • Stationary bicycles
    • NSAIDs and corticosteroid injections (short-term)
    • Heat therapy
    • Assistive walking aids

    Moderate Knee OA Management Recommendations Contraindicated

    • Acupuncture
    • Kinesiotaping
    • Vitamin D
    • Omega-3 fatty acids
    • Lateral wedge or rocker shoes
    • Valgus unloading braces
    • Cold therapy, laser, or shockwaves

    Knee OA Lifestyle Management

    • Weight loss.
    • Nutritional guidance.
    • Exercise programs with physical therapy referral.
    • Quadriceps strengthening.
    • Range-of-motion (ROM) exercises.
    • Low-impact activities (e.g., swimming, cycling).
    • Ambulatory aids (e.g., canes, walkers).
    • Insoles.
    • Knee braces for unloading.

    Knee OA Medical Management

    • Analgesics (e.g., acetaminophen).
    • Nonsteroidal anti-inflammatory drugs (NSAIDs).
    • Intraarticular injections (corticosteroids or hyaluronans).

    Surgical Management of Knee OA

    • Procedures include arthroscopic irrigation, debridement, high tibial osteotomy, partial knee arthroplasty, or total knee arthroplasty.
    • Specific surgical approaches (e.g., high tibial osteotomy) are appropriate for certain OA-related conditions. Surgical steps, recovery durations, and post-operative care vary based on the chosen procedure.

    Rheumatoid Arthritis (RA)

    • Chronic, systemic, autoimmune inflammatory disease,
    • Characterized by symmetric polyarthritis and synovitis.
    • Progressive inflammation leads to joint destruction, deformity, reduced function, and increased morbidity/mortality rates.
    • Systems affected include musculoskeletal, skin, hematologic, lymphatic, immunologic, muscular, renal, cardiovascular, neurologic, and pulmonary.
    • Disease course is fluctuating, exhibiting periods of active disease and remission.

    RA: Epidemiology

    • Incidence is 25-30 cases per 100,000 for males, and 50-60 per 100,000 for females.
    • Peak age of onset is 35-50 years of age.
    • Prevalence in the general population is 0.3-1%.

    RA: The Rheumatoid Joint

    • Key features include inflamed synovial membrane, pannus formation (invading tissue), cartilage thinning, and possible inflammatory synovial fluid.

    RA: Etiology and Pathophysiology

    • RA is presumed to result from an initial autoimmune reaction precipitated by an insult (infection, smoking, trauma)
    • Marked by abnormal B-cell and T-cell interactions and elevated cytokine production (e.g TNF, IL-6).
    • RA is a multifactorial disease resulting from genetic, hormonal, immunologic, and environmental (e.g., socioeconomic, smoking) factors interacting to cause an autoimmune response.

    RA: Risk Factors

    • Family history (2-to 3-fold increased risk)
    • Smoking (elevated risk, 1.4-2.2%)
    • Pregnancy and breastfeeding (reduced risk)
    • Female gender predominance (3:1, diminishes with age)

    RA: Diagnosis

    • History of symmetric polyarthritis (primarily in hands and feet).
    • Constitutional symptoms (e.g., fatigue, malaise, low-grade fevers, weight loss).
    • Articular symptoms (e.g., tender/swollen joints, early morning stiffness lasting at least 60 minutes, and impact on daily living activities).
    • Extra-articular involvement (e.g., skin, pulmonary, cardiovascular, and ocular symptoms).
    • Insidious onset is common.
    • Typically there's no abrupt onset of symptoms or extra-articular manifestations.

    RA: Clinical Pictures

    • Patients may experience signs and symptoms such as fever, weakness, fatigue, and tiredness.
    • Articular manifestations include conditions such as arthralgia or arthritis, synovitis, swollen joints, and tenderness.

    RA: Joints Commonly Involved

    • 90-95% of patients have issues with MCP joints, 75-90% PIP joints, 70-80% wrists, 60-80% knees, 50-70% shoulders, and 50-60% metatarsophalangeal (MTP) joints.
    • Distal interphalangeal (DIP) joints are often spared.
    • Swelling in RA is frequently fusiform (spindle-shaped).

    RA: Deformities

    • Boutonniere deformity.
    • Ulnar deviation of metacarpophalangeal joints.
    • Swan-neck deformities.
    • Z-shaped thumb deformities.
    • Hammer toes.
    • Hallux valgus.
    • Knuckle Subluxation (partial dislocation).
    • Wrist Subluxation

    RA: Extra-Articular Manifestations

    • General manifestations include fever, lymphadenopathy, weight loss, fatigue, dermatologic issues (e.g., palmer erythema, subcutaneous nodules).
    • Vasculitis, related ocular conditions (e.g., episcleritis, scleritis), pulmonary conditions (e.g., pleuritis, nodules, interstitial lung disease), cardiac involvement (e.g., pericarditis, myocarditis), and neuromuscular conditions (e.g., entrapment neuropathy are potential problems.
    • Patients may also have hematologic issues (e.g., lymphoma), and possible osteoporosis or atherosclerosis among others.
    • Possible differential diagnoses include Sjögren's syndrome, systemic lupus erythematosus (SLE), systemic sclerosis, psoriatic arthritis, polymyalgia rheumatica, crystal arthropathy (gout, pseudogout), and viral-induced arthritis (e.g., parvovirus B19, hepatitis C).

    RA: Investigation & Radiographic Findings

    • Radiographic findings help establish and monitor RA.
    • MRI (hands/wrists) detects erosions, pannus, and synovitis.
    • Diagnostic ultrasound assesses synovial thickening/erosion.
    • Plain film radiographs are preferred for initial evaluation of RA.
    • Initial radiographs generally encompass hands, wrists, and feet.
    • Larsen score assesses radiographic changes in RA (grades 0 to 5).

    RA: Treatment

    • General measures focus on minimizing disease activity and preventing structural damage/disabilities, via early, aggressive treatment.
    • Periodic evaluation of disease activity and synovitis is important.
    • Arthritis self-management education is vital.
    • Treatments should address chronic or subacute phases with similar approaches to other musculoskeletal disorders, with specific precautions applied.

    RA: Physical Therapy

    • Careful grading of stretching and joint mobilization is crucial since steroids can cause joint laxity.
    • Therapeutic exercise helps prevent, retard, or correct mechanical limitations/deforming forces and maintain function.

    RA: Surgical Interventions

    • Surgical procedures (e.g., synovectomy, tendon reconstruction, joint fusion, or arthroplasty) are often considered for cases unresponsive to other treatments.
    • Specific joint choices for synovectomy or arthrodesis procedures are important to consider.

    RA: Subacute/Chronic Stage Management

    • As the severity of symptoms (pain, swelling) diminishes, the acute stage transitions to subacute.
    • Drugs can alleviate symptoms, allowing for functional improvement comparable to the subacute stage.
    • The chronic stage involves periods of disease exacerbation that may last for many years.
    • Treatment approaches are similar to subacute management, but with special care to avoid undue stress to already weakened tissues.

    Considerations for RA Management

    • Joint protection and activity modification are essential (splints, assistive devices, environmental accommodations).
    • Cardiopulmonary endurance exercises such as aquatic exercise, cycling, dancing, walking/running, maintain or improve aerobic capacity, mitigate the effects of depression. Group activities promote social support.
    • Vigorous stretching or manipulative techniques are unsuitable.
    • Monitoring exercises is important while exercising individuals with RA as fatigue and pain can compromise the patient's condition.

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