Rheumatoid Arthritis Quiz

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Questions and Answers

Which of the following are considered increased risk factors for rheumatoid arthritis?

  • Sedentary lifestyle
  • Female sex (correct)
  • Exposure to tobacco smoke (correct)
  • High fiber intake

What is a common clinical manifestation of rheumatoid arthritis?

  • Chronic headache
  • Joint deformities (correct)
  • Nausea and vomiting
  • Persistent high fever

Which of the following statements about the symptoms of rheumatoid arthritis is accurate?

  • Rheumatoid arthritis only affects women.
  • Joint pain only occurs in the lower extremities.
  • Symptoms are always constant and do not vary.
  • Symptoms can appear and disappear, with periods of flares and remission. (correct)

Which symptom is indicative of rheumatoid arthritis involvement in multiple joints?

<p>Morning stiffness lasting for at least one hour (D)</p> Signup and view all the answers

What type of arthritis is characterized by symmetrical involvement of joints?

<p>Rheumatoid arthritis (B)</p> Signup and view all the answers

In which percentage of patients with rheumatoid arthritis is the cervical spine likely to be involved?

<p>80-90% (B)</p> Signup and view all the answers

What does the presence of rheumatoid factor in the blood indicate?

<p>Potentially established disease but not specific to rheumatoid arthritis (D)</p> Signup and view all the answers

What modality is recommended during acute inflammation stages?

<p>Ice therapy (A)</p> Signup and view all the answers

Which condition is typically observed in X-ray findings of rheumatoid arthritis?

<p>Destruction of bone around involved joints (C)</p> Signup and view all the answers

Which temperatures significantly affect the activity of cartilage-destroying enzymes?

<p>Below 30° Celsius (A)</p> Signup and view all the answers

What is the ideal resting position for the shoulder joint in rheumatoid arthritis?

<p>45° abduction (D)</p> Signup and view all the answers

How much can loading over the hip joint be reduced by using a cane?

<p>50% (D)</p> Signup and view all the answers

What is the typical radiological finding in the early stages of rheumatoid arthritis?

<p>Juxta-articular osteopenia (C)</p> Signup and view all the answers

What is the purpose of orthosis and splinting in managing joint health?

<p>To prevent deformities and support joints (D)</p> Signup and view all the answers

Which modality is NOT used in physiotherapy for pain reduction and joint movement improvement?

<p>Deep tissue massage (B)</p> Signup and view all the answers

Which deformity is most commonly associated with rheumatoid arthritis affecting the hands?

<p>Ulnar deviation (B)</p> Signup and view all the answers

What is a common complication of tenosynovitis in rheumatoid arthritis?

<p>Trigger finger (D)</p> Signup and view all the answers

What is the effect of hydrotherapy-balneotherapy on patients beyond physical benefits?

<p>It has a positive effect on mental well-being (D)</p> Signup and view all the answers

Which of the following is NOT a typical knee deformity associated with rheumatoid arthritis?

<p>Hyperextension (B)</p> Signup and view all the answers

In the management of rheumatoid arthritis, which type of therapy specifically helps with energy conservation?

<p>Assistive devices (B)</p> Signup and view all the answers

What percentage of rheumatoid arthritis patients shows initial joint involvement in the foot?

<p>20% (A)</p> Signup and view all the answers

Which blood test is commonly performed for diagnosing rheumatoid arthritis?

<p>Rheumatoid factor (C)</p> Signup and view all the answers

Which of the following may indicate inflammation in the body for a person with rheumatoid arthritis?

<p>Elevated ESR (D)</p> Signup and view all the answers

Which of these deformities significantly affect a patient's grip strength late in rheumatoid arthritis?

<p>Boutonnière deformity (B)</p> Signup and view all the answers

What is the role of anti-cyclic citrullinated peptide (anti-CCP) antibodies in rheumatoid arthritis?

<p>They can be found in about 50% of patients with early arthritis. (B)</p> Signup and view all the answers

Which imaging modality is most sensitive for detecting early changes in rheumatoid arthritis?

<p>MRI scan (A)</p> Signup and view all the answers

Which of the following treatment categories primarily focuses on altering the disease course in rheumatoid arthritis?

<p>Disease-modifying anti-rheumatic drugs (DMARDS) (B)</p> Signup and view all the answers

Which dietary practices are recommended for managing symptoms of rheumatoid arthritis?

<p>Incorporating vitamin D and cod liver oil supplements (D)</p> Signup and view all the answers

What is one of the primary goals of physical therapy management for rheumatoid arthritis?

<p>Preventing deformity or controlling joint damage (D)</p> Signup and view all the answers

How should patient education be approached prior to starting an exercise program for rheumatoid arthritis?

<p>Patients must understand both their condition and available therapies. (A)</p> Signup and view all the answers

What characterizes the type of changes that may appear on an X-ray in the early stages of rheumatoid arthritis?

<p>Juxta-articular osteopenia may be present (D)</p> Signup and view all the answers

Among the four types of medications used to treat rheumatoid arthritis, which one is categorized as a Biologic Response Modifier?

<p>Adalimumab (C)</p> Signup and view all the answers

What is the minimum intensity for initiating moderate-intensive exercise therapy as a percentage of 1 repetition maximum?

<p>30-50 percent (C)</p> Signup and view all the answers

Which of the following exercises aims to improve coordination and stabilization by stimulating the sensorimotor system?

<p>Balance board exercises (B)</p> Signup and view all the answers

How many exercises are included in the SARAH exercise program for the hand?

<p>Seven mobility and four strength exercises (B)</p> Signup and view all the answers

What should be done if pain persists two hours after exercise therapy?

<p>Revise the exercise program (D)</p> Signup and view all the answers

Which of the following is NOT mentioned as part of alternative therapies for improving exercise therapy outcomes?

<p>Meditation (B)</p> Signup and view all the answers

What is the primary benefit of wearing therapy gloves?

<p>To improve hand grip strength and manage pain (D)</p> Signup and view all the answers

Which type of joint exercise is recommended during the acute phase?

<p>Isometric/static exercises (D)</p> Signup and view all the answers

What defines moderate-intensive exercise therapy?

<p>30 minutes of exercise performed 5 times a week at 55-64% of maximal heart rate (C)</p> Signup and view all the answers

What is the purpose of compression gloves?

<p>To give moderate joint compression to reduce swelling and pain (D)</p> Signup and view all the answers

Which of the following is NOT a recommendation for improving joint flexibility?

<p>Performing ballistic movements (B)</p> Signup and view all the answers

How often should intensive exercise therapy sessions be conducted?

<p>Three times a week for at least 20 minutes each (C)</p> Signup and view all the answers

What kind of materials are therapy gloves typically made from?

<p>Nylon, wool, and elastane fibers (A)</p> Signup and view all the answers

What is the recommended duration for isometric exercises in the acute phase?

<p>Held for 6 seconds, repeated 5-10 times each day (A)</p> Signup and view all the answers

Flashcards

Risk Factors for Rheumatoid Arthritis

Factors increasing the risk of developing rheumatoid arthritis.

Morning Stiffness

A common symptom of rheumatoid arthritis where there is stiffness in joints, especially in the morning, lasting for at least an hour.

Swelling in Multiple Joints

Inflammation and swelling in three or more joints simultaneously.

Symmetrical Arthritis

Inflammation present in the same joint on both sides of the body, often affecting hand, wrist, and finger joints.

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Rheumatoid Nodules

Firm lumps under the skin, commonly found in pressure points like the elbows, associated with rheumatoid arthritis.

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Cervical Spine Involvement

Inflammation of the cervical spine (neck) leading to instability and potential neurological symptoms like headache and tingling fingers.

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Rheumatoid Factor

A protein found in the blood, frequently present in patients with rheumatoid arthritis. Higher levels are associated with increased risk.

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X-ray Changes in Joints

Changes in bone structure visible on X-rays, indicating bone damage around the joints, often indicative of rheumatoid arthritis.

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Physiotherapy Modalities

The use of physical agents like heat, cold, ultrasound, and electrical stimulation to reduce pain and improve joint movement.

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Hydrotherapy (Balneotherapy)

A type of physiotherapy that uses water for exercise and therapy, allowing movement with less stress on joints.

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Treatment During Flare-Ups

Resting, splinting, and positioning are important strategies to manage painful flare-ups in rheumatoid arthritis.

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Orthosis and Splinting

Specialized supports that help maintain proper positioning and reduce strain on joints, preventing deformities.

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Assistive Devices and Adaptive Equipment

Devices that help individuals with limited mobility perform daily tasks and reduce strain on joints.

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Intra-Articular Temperature

The increase in temperature inside a joint, especially in rheumatoid arthritis, affects the activity of enzymes that can damage cartilage.

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Cartilage-Destroying Enzymes

Enzymes that break down cartilage, their activity increases with higher joint temperatures.

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Transcutaneous Electrical Nerve Stimulation (TENS)

A type of electrical stimulation used for pain relief, it works by sending mild electrical impulses to the nerves.

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What are anti-CCP antibodies?

Anti-cyclic citrullinated peptide (anti-CCP) antibodies are a more specific marker for rheumatoid arthritis compared to rheumatoid factor.

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What is the role of X-rays in rheumatoid arthritis?

X-rays are useful for tracking the progression of rheumatoid arthritis. In early stages, there might be no visible changes on X-ray, but later on, changes like juxta-articular osteopenia (bone density loss near joints) might occur.

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Why are MRI scans useful for rheumatoid arthritis?

MRI scans are particularly effective in detecting early and subtle changes in rheumatoid arthritis, making them a useful tool for diagnosis. They provide superior visualization of soft tissues compared to X-rays.

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What are DMARDs and why are they important?

Disease-modifying antirheumatic drugs (DMARDs) are a key treatment for rheumatoid arthritis. They aim to slow down disease progression and protect joints.

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What is the role of NSAIDs in rheumatoid arthritis?

While NSAIDs can help manage pain and inflammation, they don't address the underlying cause of rheumatoid arthritis. They are a short-term option.

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What are biologic response modifiers for rheumatoid arthritis?

Biologic response modifiers, also known as biologics, are medications used to suppress the immune system and reduce inflammation in rheumatoid arthritis.

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What are corticosteroids used for in rheumatoid arthritis?

Corticosteroids are potent anti-inflammatory drugs that can be used to manage symptomatic flare-ups of rheumatoid arthritis.

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What is the role of physical therapy in rheumatoid arthritis?

Physical therapy is a vital part of rheumatoid arthritis management. Its goals include pain control, improving range of motion, preventing deformities, and boosting functional abilities.

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Thermal Gloves

Therapy gloves designed to provide warmth, aiding in pain management and improved hand function.

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Compression Gloves

Therapy gloves used for compression, often recommended for reducing swelling and pain in hands.

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Range-of-Motion Exercises

Exercises aimed at maintaining or increasing flexibility in joints. This can involve passive, assisted, or free movements.

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Passive ROM Exercises

A type of ROM exercise where someone else moves the joint for you. It helps maintain joint mobility.

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Active-Assisted ROM Exercises

A type of ROM exercise where you help move your joint.

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Active-Free ROM Exercises

A type of ROM exercise that allows for full, independent movement of the joint.

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Aerobic Conditioning Exercises

Exercises designed to improve overall fitness, such as swimming, walking, or cycling.

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Strengthening Exercises

Exercises that build strength and endurance by engaging muscles against resistance. Examples include isometric exercises.

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Early X-ray findings in RA

X-ray findings in the early stages of rheumatoid arthritis (RA) may be subtle or absent. In some cases, it might show reduced bone density near the joints (juxta-articular osteopenia), soft tissue swelling, and narrowing of joint spaces.

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Advanced X-ray changes in RA

As rheumatoid arthritis progresses, bony erosions may form, and the joints might partially dislocate (subluxation).

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Common hand deformities in RA

The most common hand deformities in rheumatoid arthritis are ulnar deviation at the metacarpophalangeal (MCP) joints, boutonniere deformities, and swan neck deformities.

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Ulnar deviation in RA

Ulnar deviation refers to the fingers drifting towards the little finger side of the hand, often occurring at the MCP joints.

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Boutonniere deformity in RA

A boutonniere deformity is a flexed PIP joint and an extended DIP joint, causing a characteristic button-shaped appearance.

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Swan neck deformity in RA

A swan neck deformity is characterized by a flexed DIP joint and an extended PIP joint.

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Common foot deformities in RA

Hallux valgus (bunion), dropped metatarsal heads (the balls of the feet sink down), hammertoes, and claw toes are common foot deformities associated with rheumatoid arthritis.

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Common knee deformity in RA

The knee in rheumatoid arthritis can develop fixed flexion deformity (the knee is stuck in a bent position), valgus deformity (knees point outward), and external rotation (the lower leg twists outwards).

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SARAH Exercise Program

An exercise program aiming to strengthen and improve range-of-motion in the hands, incorporating mobility exercises and strength exercises using resistance tools like therapy putty, TheraBand or hand exerciser balls.

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Moderate-Intensive Exercise Therapy

A type of exercise therapy where a minimum of 8-10 exercises, repeated 8-10 times each, is performed with a minimal initial intensity of 30-50% of the maximum weight one can lift for a single repetition.

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Stabilizing and Coordinating Exercises

Exercises that focus on improving stability and coordination of a specific joint by stimulating the sensorimotor system, commonly including activities like standing on a balance board, improving motion control, balance and coordination.

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Usual Care + Hand Exercises

An approach to treating hand pain, emphasizing proper hand function and including seven mobility exercises and four strength exercises with resistance, incorporating various tools like therapy putty, TheraBand, or hand exerciser balls.

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Alternative Therapies for Rheumatoid Arthritis

Exercises that help improve overall physical and mental well-being, including stretching, strengthening and balance exercises, along with mindfulness techniques, suitable for people with rheumatoid arthritis.

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Study Notes

Rheumatoid Arthritis (RA)

  • RA is a chronic, systemic, autoimmune inflammatory disease
  • Inflammation affects synovial tissue, primarily in wrists, hands, and feet
  • Can affect other body systems (skin, eyes, lungs, heart, blood vessels)
  • HLA DR4 and "Shared" epitope on HLA DRB1 are associated with genetic predisposition, and account for ~30% of heritable risk.
  • RA affects roughly 0.5 to 1% of the global population
  • Women are affected 2-3 times more often than men
  • Peak prevalence is between 30 and 50 years of age
  • Disease can begin at any age

Pathogenesis

  • Immune system attacks synovium
  • Unknown trigger, though genetic predisposition and environmental factors (infections) are implicated
  • Synovium thickens, forming a pannus
  • Damage to articular cartilage and subchondral bone
  • Erosion of bone and juxta-articular osteopenia (localized bone loss).
  • Tendons and ligaments weaken, and joints deform or shift
  • Inflammation often flares and remits

Clinical Manifestations

  • Joint pain (feet, hands, knees), swelling, fatigue, fever, limping
  • Polyarthritis (multiple joints affected)
  • Loss of range of motion, tender joints
  • Anemia, joint warmth, and joint deformities (later stages)
  • Impacts daily activities (grooming, eating, dressing)
  • Disease severity varies and symptom duration varies

Diagnostic Criteria

  • No single test confirms diagnosis
  • Elevated erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) indicate inflammation
  • High rheumatoid factor (RF) in blood is common but not specific.
  • 45% positive in first 6 months; 85% positive with established disease
  • Anti-cyclic citrullinated peptide (anti-CCP) antibodies found in about 50% of patients with early arthritis. High titer early is a bad sign
  • Imaging tests (X-rays, MRI, and ultrasound) are important to monitor progression
  • X-rays may show no change early in disease or juxta-articular osteopenia.
  • MRI can show changes earlier than X-rays.

Deformities in RA

  • Ulnar drift in hands (deviation toward the little finger side)
  • Boutonniere and swan-neck deformities
  • Hallux valgus, dropped metatarsal heads
  • Hammer and claw toes

Treatment

  • Pharmacological:
    • NSAIDs (nonsteroidal anti-inflammatory drugs)
    • Disease-modifying antirheumatic drugs (DMARDs)
    • Corticosteroids
    • Biologic response modifiers ("biologics")
  • Nutritional Guidelines:
    • Diet can manage symptoms
    • Supplements (vitamin D, cod liver oil, multivitamins)
    • Avoid foods that cause inflammation (processed foods, high salt, oils, butter, sugar, animal products)
  • Physical Therapy:
    • Knowledge and patient education
    • Pain control, daily living activities, joint stiffness, preventing deformity
    • Improve strength, fatigue, quality of life, Aerobic capacity (swimming, walking etc.)

Physical Therapy Modalities

  • Heat (subacute/chronic stages)
  • Ice (acute inflammation)
  • Ultrasound
  • Electrical stimulation (TENS, Iontophoresis, Interferential current)

Joint Protection Strategies

  • Rest and positioning (shoulder 45° abduction, wrist 20°-30° extension, etc.)
  • Splinting

Orthotic Devices

  • Ankle foot orthoses to lessen joint contractures
  • Viscoelastic soles to decrease shock loading

Assistive Devices

  • Assistive devices and adaptive equipment are used to protect joints, conserve energy, reduce functional deficits, diminish pain, and maintain independence.
  • Examples include elevated toilet seats, widened gripping handles, and canes.

Alternative Therapies

  • Includes practices such as tai chi, muscular therapy, yoga therapy, relaxation techniques, and Pilates.

  • Intra-articular temperature rise (up to 36° C) is associated with increased collagenase activity and cartilage damage

Important Note

  • Disease progression varies greatly among patients.
  • Early diagnosis and treatment are crucial to reduce joint damage and disability.

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