Podcast
Questions and Answers
Which of the following are considered increased risk factors for rheumatoid arthritis?
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?
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?
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?
Which symptom is indicative of rheumatoid arthritis involvement in multiple joints?
What type of arthritis is characterized by symmetrical involvement of joints?
What type of arthritis is characterized by symmetrical involvement of joints?
In which percentage of patients with rheumatoid arthritis is the cervical spine likely to be involved?
In which percentage of patients with rheumatoid arthritis is the cervical spine likely to be involved?
What does the presence of rheumatoid factor in the blood indicate?
What does the presence of rheumatoid factor in the blood indicate?
What modality is recommended during acute inflammation stages?
What modality is recommended during acute inflammation stages?
Which condition is typically observed in X-ray findings of rheumatoid arthritis?
Which condition is typically observed in X-ray findings of rheumatoid arthritis?
Which temperatures significantly affect the activity of cartilage-destroying enzymes?
Which temperatures significantly affect the activity of cartilage-destroying enzymes?
What is the ideal resting position for the shoulder joint in rheumatoid arthritis?
What is the ideal resting position for the shoulder joint in rheumatoid arthritis?
How much can loading over the hip joint be reduced by using a cane?
How much can loading over the hip joint be reduced by using a cane?
What is the typical radiological finding in the early stages of rheumatoid arthritis?
What is the typical radiological finding in the early stages of rheumatoid arthritis?
What is the purpose of orthosis and splinting in managing joint health?
What is the purpose of orthosis and splinting in managing joint health?
Which modality is NOT used in physiotherapy for pain reduction and joint movement improvement?
Which modality is NOT used in physiotherapy for pain reduction and joint movement improvement?
Which deformity is most commonly associated with rheumatoid arthritis affecting the hands?
Which deformity is most commonly associated with rheumatoid arthritis affecting the hands?
What is a common complication of tenosynovitis in rheumatoid arthritis?
What is a common complication of tenosynovitis in rheumatoid arthritis?
What is the effect of hydrotherapy-balneotherapy on patients beyond physical benefits?
What is the effect of hydrotherapy-balneotherapy on patients beyond physical benefits?
Which of the following is NOT a typical knee deformity associated with rheumatoid arthritis?
Which of the following is NOT a typical knee deformity associated with rheumatoid arthritis?
In the management of rheumatoid arthritis, which type of therapy specifically helps with energy conservation?
In the management of rheumatoid arthritis, which type of therapy specifically helps with energy conservation?
What percentage of rheumatoid arthritis patients shows initial joint involvement in the foot?
What percentage of rheumatoid arthritis patients shows initial joint involvement in the foot?
Which blood test is commonly performed for diagnosing rheumatoid arthritis?
Which blood test is commonly performed for diagnosing rheumatoid arthritis?
Which of the following may indicate inflammation in the body for a person with rheumatoid arthritis?
Which of the following may indicate inflammation in the body for a person with rheumatoid arthritis?
Which of these deformities significantly affect a patient's grip strength late in rheumatoid arthritis?
Which of these deformities significantly affect a patient's grip strength late in rheumatoid arthritis?
What is the role of anti-cyclic citrullinated peptide (anti-CCP) antibodies in rheumatoid arthritis?
What is the role of anti-cyclic citrullinated peptide (anti-CCP) antibodies in rheumatoid arthritis?
Which imaging modality is most sensitive for detecting early changes in rheumatoid arthritis?
Which imaging modality is most sensitive for detecting early changes in rheumatoid arthritis?
Which of the following treatment categories primarily focuses on altering the disease course in rheumatoid arthritis?
Which of the following treatment categories primarily focuses on altering the disease course in rheumatoid arthritis?
Which dietary practices are recommended for managing symptoms of rheumatoid arthritis?
Which dietary practices are recommended for managing symptoms of rheumatoid arthritis?
What is one of the primary goals of physical therapy management for rheumatoid arthritis?
What is one of the primary goals of physical therapy management for rheumatoid arthritis?
How should patient education be approached prior to starting an exercise program for rheumatoid arthritis?
How should patient education be approached prior to starting an exercise program for rheumatoid arthritis?
What characterizes the type of changes that may appear on an X-ray in the early stages of rheumatoid arthritis?
What characterizes the type of changes that may appear on an X-ray in the early stages of rheumatoid arthritis?
Among the four types of medications used to treat rheumatoid arthritis, which one is categorized as a Biologic Response Modifier?
Among the four types of medications used to treat rheumatoid arthritis, which one is categorized as a Biologic Response Modifier?
What is the minimum intensity for initiating moderate-intensive exercise therapy as a percentage of 1 repetition maximum?
What is the minimum intensity for initiating moderate-intensive exercise therapy as a percentage of 1 repetition maximum?
Which of the following exercises aims to improve coordination and stabilization by stimulating the sensorimotor system?
Which of the following exercises aims to improve coordination and stabilization by stimulating the sensorimotor system?
How many exercises are included in the SARAH exercise program for the hand?
How many exercises are included in the SARAH exercise program for the hand?
What should be done if pain persists two hours after exercise therapy?
What should be done if pain persists two hours after exercise therapy?
Which of the following is NOT mentioned as part of alternative therapies for improving exercise therapy outcomes?
Which of the following is NOT mentioned as part of alternative therapies for improving exercise therapy outcomes?
What is the primary benefit of wearing therapy gloves?
What is the primary benefit of wearing therapy gloves?
Which type of joint exercise is recommended during the acute phase?
Which type of joint exercise is recommended during the acute phase?
What defines moderate-intensive exercise therapy?
What defines moderate-intensive exercise therapy?
What is the purpose of compression gloves?
What is the purpose of compression gloves?
Which of the following is NOT a recommendation for improving joint flexibility?
Which of the following is NOT a recommendation for improving joint flexibility?
How often should intensive exercise therapy sessions be conducted?
How often should intensive exercise therapy sessions be conducted?
What kind of materials are therapy gloves typically made from?
What kind of materials are therapy gloves typically made from?
What is the recommended duration for isometric exercises in the acute phase?
What is the recommended duration for isometric exercises in the acute phase?
Flashcards
Risk Factors for Rheumatoid Arthritis
Risk Factors for Rheumatoid Arthritis
Factors increasing the risk of developing rheumatoid arthritis.
Morning Stiffness
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
Swelling in Multiple Joints
Inflammation and swelling in three or more joints simultaneously.
Symmetrical Arthritis
Symmetrical Arthritis
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Rheumatoid Nodules
Rheumatoid Nodules
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Cervical Spine Involvement
Cervical Spine Involvement
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Rheumatoid Factor
Rheumatoid Factor
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X-ray Changes in Joints
X-ray Changes in Joints
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Physiotherapy Modalities
Physiotherapy Modalities
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Hydrotherapy (Balneotherapy)
Hydrotherapy (Balneotherapy)
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Treatment During Flare-Ups
Treatment During Flare-Ups
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Orthosis and Splinting
Orthosis and Splinting
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Assistive Devices and Adaptive Equipment
Assistive Devices and Adaptive Equipment
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Intra-Articular Temperature
Intra-Articular Temperature
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Cartilage-Destroying Enzymes
Cartilage-Destroying Enzymes
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Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous Electrical Nerve Stimulation (TENS)
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What are anti-CCP antibodies?
What are anti-CCP antibodies?
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What is the role of X-rays in rheumatoid arthritis?
What is the role of X-rays in rheumatoid arthritis?
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Why are MRI scans useful for rheumatoid arthritis?
Why are MRI scans useful for rheumatoid arthritis?
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What are DMARDs and why are they important?
What are DMARDs and why are they important?
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What is the role of NSAIDs in rheumatoid arthritis?
What is the role of NSAIDs in rheumatoid arthritis?
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What are biologic response modifiers for rheumatoid arthritis?
What are biologic response modifiers for rheumatoid arthritis?
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What are corticosteroids used for in rheumatoid arthritis?
What are corticosteroids used for in rheumatoid arthritis?
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What is the role of physical therapy in rheumatoid arthritis?
What is the role of physical therapy in rheumatoid arthritis?
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Thermal Gloves
Thermal Gloves
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Compression Gloves
Compression Gloves
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Range-of-Motion Exercises
Range-of-Motion Exercises
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Passive ROM Exercises
Passive ROM Exercises
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Active-Assisted ROM Exercises
Active-Assisted ROM Exercises
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Active-Free ROM Exercises
Active-Free ROM Exercises
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Aerobic Conditioning Exercises
Aerobic Conditioning Exercises
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Strengthening Exercises
Strengthening Exercises
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Early X-ray findings in RA
Early X-ray findings in RA
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Advanced X-ray changes in RA
Advanced X-ray changes in RA
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Common hand deformities in RA
Common hand deformities in RA
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Ulnar deviation in RA
Ulnar deviation in RA
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Boutonniere deformity in RA
Boutonniere deformity in RA
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Swan neck deformity in RA
Swan neck deformity in RA
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Common foot deformities in RA
Common foot deformities in RA
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Common knee deformity in RA
Common knee deformity in RA
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SARAH Exercise Program
SARAH Exercise Program
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Moderate-Intensive Exercise Therapy
Moderate-Intensive Exercise Therapy
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Stabilizing and Coordinating Exercises
Stabilizing and Coordinating Exercises
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Usual Care + Hand Exercises
Usual Care + Hand Exercises
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Alternative Therapies for Rheumatoid Arthritis
Alternative Therapies for 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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