OSC 604 Health And Occupational Participation: Older Adult Chronic Pain, And Rheumatic Diseases PDF

OSC 604 HEALTH AND OCCUPATIONAL PARTICIPATION: OLDER ADULT CHRONIC PAIN, AND RHEUMATIC DISEASES Sharon Montgomery, OTD, OTR/L, CHT, CEAS Objectives Review low back pain and chronic pain including impact on occupational performance Describe and define Rheumatic Disea...

OSC 604 HEALTH AND OCCUPATIONAL PARTICIPATION: OLDER ADULT CHRONIC PAIN, AND RHEUMATIC DISEASES Sharon Montgomery, OTD, OTR/L, CHT, CEAS Objectives Review low back pain and chronic pain including impact on occupational performance Describe and define Rheumatic Diseases: etiology, incidence, prevalence, signs, symptoms, course, prognosis, medical management, surgical management, and symptom management. Discuss Rheumatic Diseases and impact on occupational performance. Discuss opioid addiction and OTs role. Pain: definition “Unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” Willard and Spackman (2014, p1135) Acute versus chronic Types of chronic pain: low back pain, headaches, migraines, arthritis pain, cancer pain Incidence and Prevalence 2009 statistics, in the last 3 months: 16.1% US adults experienced severe headaches or migraines 28.5% US adults experienced low back pain 15.1% US adults experienced neck pain Prevalence: Over 12 months (2008) 37.3% in developed countries 41.1% in developing countries Prevalence of chronic pain tends to increase with age Chronic pain affects more than 116 million people in US (2018 source) Schell, B.A.B., & Gillen, G. (Eds.). (2014). Willard and Spackman’s occupational therapy (12th ed.). Lippincott Williams & Wilkins. Causes and risk factors Pain is subjective May be difficult to determine exact cause Description of location and duration Diagnostic testing: Xray, MRI, EMG, etc May be symptom of other condition such as arthritis, cancer Course and implications Chronic pain may develop after occurrence of injury or result of comorbidity but persists past expected recovery time Often resistant to treatment Medical management Medication Physical Therapy/Occupational therapy Psychological therapy Complementary and alternative therapies Conditions contributing to chronic pain Low back pain Arthritis Cancer (will cover later in course) Review of Common Causes of Low Back Pain Poor fitness Obesity Reduce muscle strength and endurance Poor body mechanics Common Low Back Pain Diagnoses Sciatic (nerve root) pain Spinal stenosis Facet joint pain Spondylosis Spondylolisthesis Hernia Compression or stress fracture Signs and symptoms of LBP Signs and symptoms of back pain can include: Muscle ache Shooting or stabbing pain Pain that radiates down your leg Pain that worsens with bending, lifting, standing or walking Pain that improves with reclining https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906 Incidence/prevalence of LBP Most common type of pain in US is low back pain: 27% Leading cause of disability in Americans younger than 45 Number one cause of years lived with disability in world and US. 1:12 experience frequent back pain of varying degrees Low Back Pain: course/prognosis For 90% of clients, back pain resolves within 6 weeks Lessthan 1% of back pain is due to “serious” spinal disease such as tumor or infection Lessthan 1% of back pain is from inflammatory disease and less than 5% is true nerve root pain LBP: management Medications: OTC Muscle relaxants Topical pain relievers Narcotics Antidepressants injections Exercise Strengthening and flexibility Healthy weight Quit smoking http://www.theindependentbd.com/magazine/details/34064/Back-care-and-occupational-therapy Ergonomics Surgery: few people to address structural problems https://www.mayoclinic.org/diseases-conditions/back-pain/ How does low back pain affect occupation? CONDITIONS IN OCCUPATIONAL THERAPY 5TH EDITION BEN J. ATCHISON AND DIANE POWERS DIRETTE CHAPTER 23: RHEUMATIC DISEASES  More than 200 distinct rheumatic diseases such as:  Rheumatoid arthritis  Osteoarthritis  Fibromyalgia  Gout Rheumatic  Systemic Lupus Erythematosus (lupus or SLE)  Spondyloarthropathies: Diseases  ankylosing spondylitis (AS)  psoriatic arthritis (PsA)  Sjogren’s syndrome  Scleroderma  Polymyalgia rheumatic  Infectious arthritis http://simpletasks.org/raising-awareness-rheumatic-diseases-in-america/   These conditions happen when your immune system goes awry and attacks your own tissues.  Unknown cause: Etiology Genetic Environmental: cigarette smoke, pollution, or something that causes an infection https://www.webmd.com/rheumatoid-arthritis/an-overview-of-rheumatic-diseases#1 Incidence and Gender also plays a role -- rheumatic diseases seem to Prevalence affect women more than men. Autoimmune diseases, which affect more than 50 million Americans, are the third leading cause of death in the United States. Rheumatic diseases Osteoarthritis and Rheumatoid arthritis Fibromyalgia Gout Systemic Lupus Erythematosus (SLE) (Lupus) Ankylosing spondylitis Psoriatic arthritis Sjorgren’s syndrome Scleroderma Polymyalgia rheumatic Infectious arthritis Description/definitions of Arthritis Osteoarthritis (OA) Rheumatoid Arthritis (RA) https://physiotherapyworks.ie/osteoarthritis-vs-rheumatoid-arthritis/  Osteoarthritis Osteoarthritis Degenerative joint disease  Inflammation of bone / joints  Primary OA: wear / tear over time  Secondary OA: injury / insult to joint Osteoarthritis http://www.hand-surgery.eu/en/hand-conditions/osteoarthritis-fingers Signs and symptoms of OA Joint pain Stiffness Tenderness Limited movement Variable degrees of local inflammation Crepitus Most commonly affects DIP, PIP and CMC, Cervical and lumbar apophyseal joints 1st MTP joints of feet, Knee and hip Symptoms are gradual and may being as a minor ache with motion Worse in morning and periods of inactivity Advanced disease: bony appearance of joint d/t osteophyte formation and possibly atrophy  Osteoarthritis Figure 38-2. Joint changes in osteoarthritis. Figure 38-1. Normal joint structures. (From Ignatavicius DD, Workman ML: Medical-surgical nursing: patient-centered collaborative care, ed 7, St. Louis, 2013, Saunders.) Osteophytes in PIP and DIP joints Figure 38-6. Osteophyte formation in the proximal interphalangeal joints (Bouchard's nodes) and the distal interphalangeal joints (Heberden's nodes) is a common finding with osteoarthritis. Incidence/prevalence Osteoarthritis (OA)  10% - 15% world pop  ~ 27 million in US  Knee most common site  47% women vs 40% men  Hands  9.7% women vs 4% men  Hip OA African American men 32.2% (highest)  Knee OA Chinese women 46.6%  Hand + hip OA Caucasians 47% Etiology Osteoarthritis  Polygenic hereditary + environment  General aging  Chondropenia  Degradative enzymes in synovial fluid Diagnosis History and physical Used related pain and stiffness or gelling after inactivity R/o other systemic condition Confirmation with x-ray, MRI Medical management No cure Treatment goals are to relieve symptoms, improve function, limit disability and avoid drug toxicity Medications; Analgesics Nonsteroidal anti-inflammatory drugs Corticosteroids- injections Disease modifying antirheumatic drugs Biologic response modifiers Nonpharmacologic agents called nutraceuticals Alternative/complementary treatments Surgical management Arthroscopic joint debridement Resection or perforation of subchondral bone to stimulate the formation of cartilaginous tissue Grafts to replace damaged cartilage Joint fusion Joint replacement Course/prognosis of OA  Faster progression in distal joints  Greater BMI = rapid progression  Osteophytes and sclerosis = greater progression  Joint replacement improves prognosis   Usually impacts same joint on both sides  Erosions/ periarticular sinuses in affected joints Rheumatoid  Subchondral cysts Arthritis  Severe periarticular bone fragmentation Rheumatoid Arthritis https://www.rheumtutor.com/diseases/rheumatoid-arthritis/ Signs and symptoms Symmetrical polyarticular pain (acute or chronic) swelling Prolonged morning stiffness Malaise Fatigue Low grade fever Joints most affected: PIP, MCP, thumb, wrist, elbow, ankle, MTP, temporomandibular joints, hips, knees, shoulders, and cervical spine Synovitis Nodules Tenosynovitis Exacerbation or flare Etiology of RA An abnormal response of the immune system plays a leading role in the inflammation and joint damage that occurs. No one knows for sure why the immune system goes awry, but there is scientific evidence that genes, hormones and environmental factors are involved. https://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/causes.php RA Figure 38-3. Joint changes in patients with rheumatoid arthritis. (From Jarvis C: Physical examination and health assessment, ed 7, St. Louis, 2016, Elsevier.)  Rheumatoid nodules https://www.webmd.com/rheumatoid- arthritis/guide/rheumatoid-nodules#1 Figure 38-7. Rheumatoid nodule present on the extensor surface of the elbow. (From Tilstra JS, Lienesch DW: Rheumatoid nodules, Dermatol Clin 33:361–371, 2015.) Swan neck deformity Figure 38-5A. A, A swan neck deformity results in proximal interphalangeal hyperextension and distal interphalangeal flexion.  Deformity of the IP joints Figure 23.11 Rheumatoid hand with an index finger boutonniere deformity and middle and ring finger swan-neck deformities. (From St. Clair, E. W., Pisetsky, D. S., & Haynes, B. F. (2004). Rheumatoid arthritis. Philadelphia, PA: Wolters Kluwer.)  Ulnar drift of the MP joints Figure 38-9. Volar subluxation and ulnar deviation of the metacarpophalangeal joints with lateral displacement of the extensor tendons characteristic of rheumatoid arthritis. (From Chung KC: Hand and upper extremity reconstruction with DVD. A volume in the Procedures in Reconstructive Surgery Series, Edinburgh, 2009, Saunders.) Copyright © 2018 Elsevier Inc. All rights reserved. Diagnosis No single test Clinical evaluation of characteristic signs and symptoms Laboratory findings: 85% rheumatoid factor (antibody) Radiologic findings Rheumatoid arthritis: Incidence and Prevalence RA  Affects 1% of world population  Prevalence increases with age  Diagnosis between age 40 – 70  Equally affects all races, ethnic groups, gender  Juvenile rheumatoid arthritis = onset < age 16 43 Copyright © 2017 Wolters Kluwer All Rights Reserved  Medical management No known cure Major goals: reducing pain, swelling and fatigue Improving joint function and minimizing joint damage and deformity (OT/PT) Preventing disability and disease-related morbidity Maintaining physical, social, and emotional function while minimize long term toxicity from medications Medications: Nsaids, corticosteroids, disease modifying antirheumatic drugs (DMARDs) Nsaids rarely used alone because they cannot alter disease process Surgical management Frequently indicated to relieve pain and improve function Synovectomy Tensosynovectomy Tendon surgery (relocation, repair, release of shortened tendons) Most commonly on extensor tendons of hand and wrist Tendon transfers Nerve decompression Arthroplasty (hip, knee and MCP) Arthrodesis (wrist, thumb MCP, IP joints and cervical spine) Course/prognosis Joint involvement is bilateral but disease progression may not be equal on both sides Function declines with severity 20% adults remission 1st year Majority will develop chronic progressive disease 70% - 90% of JRA satisfactory recovery; small chance of recurrence as adult Women diagnosed prior to age 50 have worst prognosis to develop severe / chronic form of RA  Description/Signs and symptoms  Widespread pain / tender points  Chronic widespread pain  Point tenderness Fibromyalgia  Lower abdomen cramps  Depression  Poor sleep, fatigue, headaches  Signs can occur unilaterally / bilaterally  Chest, upper back, neck, buttocks, arms, shoulders  Etiology  Disabling pain / tenderness; muscles, joints, tendons  Unclear etiology  Theory: genetics + immunological + hormonal  Without joint inflammation Incidence and Prevalence  Often accompanied with RA / OA  1% - 4.7% worldwide  More common in women Fibromyalgia  US:.5% men vs 3.4% women  Costs (direct) nearly $11000 annually per patient; indirect higher Diagnosis  Disease appears to be linked to changes in how the brain and spinal cord process pain signals.  Because there is no test for fibromyalgia, diagnosis must depend solely on group of https://www.mayoclinic.org/diseases- conditions/fibromyalgia/in- symptoms to make a diagnosis. depth/fibromyalgia-symptoms/art- 20045401 Course and Prognosis  Non-progressive  Can begin widespread or unilaterally to bilaterally  Treatment of fibromyalgia  NSAID  Opioids Fibromyalgia  Most effective: antidepressants / neuromodulating antiepileptic medications  Description/signs and symptoms:  Primary impact: 1st metatarsophalangeal joint  “unwalkable disease” Also impacts: elbows / interphalangeal joints of hands Joint inflammation Gout  Symptoms: more intermittent vs progressive  Left untreated = quite destructive  Edema, erythema, increased localized temp  Most often big toe affected  Feet, ankles, wrist, hands, elbows, knees  Etiology  Crystallization of uric acid in joints  Diet high in purines, rise in blood uric acid  Hyperuricemia Incidence and Prevalence  Most common form of inflammatory arthritis  1% - 4% worldwide Gout  8.3 million in US  Men and African Americans mostly affected Course and prognosis  Untreated = very progressive / destructive to joints  Tx early = long-term effects can be eliminated  Episodic and chronic   Joint aspiration: Urate crystals may be visible when the fluid is examined under a microscope.  Blood test: to measure the levels of uric acid and creatinine in the blood. X-ray imaging. Joint X-rays can be helpful to rule Diagnosis of out other causes of joint inflammation. gout  Ultrasound. Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus.  Dual energy CT scan. can detect the presence of urate crystals in a joint, even when it is not acutely inflamed.  Rheumatic Diseases Signs and Symptoms, cont’d Gout Copyright © 2017 Wolters Kluwer All Rights Reserved 57 Gout Gout tophi http://www.jrheum.org/content/41/3/554  Medical Management of acute Gout:  an anti-inflammatory medication  Ice and elevate the joint  Drink plenty of fluids (no alcohol or sweet sodas)  Call your doctor and make an appointment  Relax; stress can aggravate gout.  Ask friends and family to help you with daily tasks. Gout  Despite the sudden onset and intense pain, gout attacks usually peak and resolve within a week or 10 days and then management disappear completely. The first 36 hours are typically the worst. However, it’s important that once you have an attack, you begin working with your doctor to control uric acid levels and prevent future gout attacks.  NSAIDs  Xanthine oxidase inhibitors (XOI) treats hyperuricemia  Surgery-occasionally Arthrtis.org  Description/signs and symptoms:  Autoimmune disease  Skin rash Etiology  Unclear etiology  Autoimmune disorder  Impact on joints similar to RA Systemic Lupus Incidence and Prevalence  Frequency of new cases is decreasing Erythematosus  Northern Ireland highest prevalence  Caribbean descent highest incidence / prevalence  Females 6x > males  Direct/indirect costs per pt. $4453-52415 Course and prognosis  With close follow-up and treatment, 80-90% of people with lupus can expect to live a normal life span. It is true that medical science has not yet developed a method for curing lupus, and some people do die from the disease. However, for the majority of https://www.lupus.org/resources/prog people living with the disease today, it will not be fatal. nosis-and-life-expectancy  Diagnosis of Lupus  Diagnosing lupus is difficult because signs and symptoms vary considerably from person to person. Signs and symptoms of lupus may vary over time and overlap with those of many other disorders.  No one test can diagnose lupus. The combination of blood and urine tests, signs and symptoms, and physical examination findings leads to the diagnosis. Treatment of Lupus  Depends on signs and symptoms Lupus-  May include: diagnosis  Nonsteroidal anti-inflammatory drugs (NSAIDs)  Antimalarial drugs.  Corticosteroids.   Immunosuppressants.  Biologics  belimumab (Benlysta) Rituximab (Rituxan) Lupus- butterfly rash Symptoms https://medlineplus.gov/ency/article/000435.htm Spondyloarthro ankylosing spondylitis (AS) pathies – psoriatic arthritis (PsA) https://www.spondylitis.org/Ankylosing-Spondylitis  Ankylosing spondylitis (AS) Ankylosing  a form of arthritis that primarily affects the spine  other joints can become involved shoulders, hips, ribs, heels, and spondylitis small joints of the hands and feet. Sometimes the eyes can become involved (known as iritis or uveitis), and -- rarely -- the lungs and heart can be affected.  inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort.  over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture.  If ribs are affected, it can be difficult to breathe deeply.  The hallmark feature of ankylosing spondylitis is the involvement of the sacroiliac (SI) joints during the progression of the disease.  Etiology:  unknown  genetics play a key role in the disease.  a "genetic marker," a protein called HLA-B27 is found in more than 95 percent of people in the Caucasian population with AS.  other genes -- along with a triggering environmental factor such as a bacterial infection, for example -- are needed to Ankylosing activate AS in susceptible people.  One classic hypothesis has been that AS may start when the Spondylitis (AS) defenses of the intestines break down and certain bacteria pass into the bloodstream, triggering changes in the immune response.  The risk factors that predispose a person to AS include:  Testing positive for the HLA-B27 marker  A family history of AS  Frequent gastrointestinal infections  Psoriatic arthritis (PsA)  Definition/signs and symptoms:  Psoriatic arthritis is often associated with psoriasis of the skin or nails. PsA is characterized by stiffness, pain, swelling, and tenderness of the joints and surrounding ligaments and tendons. Psoriatic  Common findings include enthesitis (inflammation of the tendon arthritis insertion points on bone) and dactylitis (inflammation of the fingers).  Severity of disease ranges from mild synovitis to severe, erosive arthropathy. https://www.webmd.com/arthritis/psoriatic-arthritis/psoriatic-arthritis-symptoms#1  Incidence and prevalence:  According to estimates, up to ≈750,000-1.5 million people in the Psoriatic US are living with psoriatic arthritis. It is believed that many arthritis (PsA) cases remain misdiagnosed or undiagnosed  About one in three people with the skin disease psoriasis, will get psoriatic arthritis. https://www.discoverpsa.com/ Etiology of PsA  Diagnosis of PsA relies on a detailed history, particularly as many of the manifestations may be mild or transient, and therefore not reported by the patient.  Xray, MRI, RF and joint fluid test Course and prognosis Diagnosis of  60% higher risk of premature mortality than the general population, their life expectancy is estimated to be approximately three years shorter. psoriatic  Aggressive treatment of early stage progressive PsA can substantially improve the long-term prognosis. (PsA) Medical management arthritis  No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability.  NSAIDs, Disease-modifying antirheumatic drugs (DMARDs), Immunosuppressants, Biologic agents https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/diagnosis-treatment/drc-20354081 https://www.hopkinsarthritis.org/arthritis-info/psoriatic-arthritis/ https://www.ncbi.nlm.nih.gov/pubmed/25603589 Sjogren’s syndrome Sjogren’s syndrome  Definition/signs and symptoms:  Sjogren's syndrome is an autoimmune disease. This means that your immune system attacks parts of your own body by mistake. In Sjogren's syndrome, it attacks the glands that make tears and saliva. This causes a dry mouth and dry eyes. You may have dryness in other places that need moisture, such as your nose, throat, and skin. Sjogren's can also affect other parts of the body, including your joints, lungs, kidneys, blood vessels, digestive organs, and nerves.  Diagnosis:  Sjorgens syndrome: doctors may use a medical history, physical exam, certain eye and mouth tests, blood tests, and biopsies Sjogren’s Incidence and prevalence syndrome  Most people are women.  Starts after age 40.  It is sometimes linked to other diseases such as rheumatoid arthritis and lupus. https://medlineplus.gov/sjogrenssyndrome.html  Course and prognosis The prognosis of Sjögren's syndrome is favorable. The life expectancy of pSS patients is comparable with that of the general population (18). However, the patients' quality of life is reduced by Sjogren’s the diverse manifestations of the disease. syndrome Treatment: Focuses on relieving symptoms. may include  artificial tears for dry eyes  sucking on sugar-free candy or drinking water often for a dry mouth  medicines may help with severe symptoms. https://www.aerzteblatt.de/int/archive/article/188638/The-diagnosis-and-treatment-of-Sjoegren-s-syndrome  Scleroderma Definition/signs and symptoms:  Scleroderma, or systemic sclerosis, is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases. The word “scleroderma” comes from two Greek words: “sclero” meaning hard, and “derma” meaning skin. Hardening of the skin is one of the most visible manifestations of the disease.  Scleroderma is an autoimmune disease whose symptoms typically Scleroderma include some or all of the following: sensitivity to cold in extremities, thickening of the skin, shortness of breath, difficulty swallowing, joint stiffness and pain, and damage to internal organs.  2 forms:  1. Systemic sclerosis affects internal organs or structures of the body  Two types of system:  Limited cutaneous  Diffuse cutaneous  2. Localized: affects localized area of skin either in patches (morphea) or linear Scleroderma  Incidence and prevalence:  300,000 cases of scleroderma are estimated in the United States.  80% of scleroderma patients are female.  Scleroderma typically strikes between the ages of 25 and 55.  95% of scleroderma cases begin with Raynaud Phenomenon (hands and feet abnormally sensitive to cold.) Etiology  Federal research funding for scleroderma lags behind other diseases of similar prevalence. Scleroderma Diagnosis:  Misdiagnosis is common. It can take three years or more for an individual to be diagnosed and receive appropriate treatment, often due to lack of familiarity with the disease among medical professionals. Course and Prognosis  In some cases, the skin problems associated with scleroderma fade away on their own in two to five years. The type of scleroderma that affects internal organs usually worsens with time  Medications  Treat or slow skin changes. Steroid creams or pills may help reduce swelling and joint pain, loosen stiff skin, and slow the development of new skin changes.  Dilate blood vessels. Blood pressure medications that dilate blood vessels may help prevent lung and kidney problems and may help treat Raynaud's disease.  Suppress the immune system. Drugs that suppress the immune system, such as those taken after organ transplants, may help reduce scleroderma symptoms.  Reduce digestive symptoms. Pills to reduce stomach acid can help relieve heartburn. Antibiotics and medications that help move food through the intestines may help reduce bloating, diarrhea and constipation. Scleroderma  Prevent infections. Antibiotic ointment, cleaning and protection from the cold may help prevent infection of fingertip ulcers caused by Raynaud's disease. Regular influenza and pneumonia vaccinations can help protect lungs that have been damaged by scleroderma.  Relieve pain. If over-the-counter pain relievers don't help enough, you can ask your doctor to prescribe stronger medications. Surgery No treatment: mild disease may not need medication at all and occasionally people can go off treatment when their scleroderma is no longer active. Great variation in the treatments prescribed. https://www.scleroderma.org/site/SPageNavigator/patients_whatis.html#.XZ-XB0ZKiUk https://www.mayoclinic.org/diseases-conditions/scleroderma/diagnosis-treatment/drc-20351957 Scleroderma Scleroderma  Polymyalgia rheumatica (PMR)  Definition/signs and symptoms:  Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders.  Signs and symptoms of polymyalgia rheumatica (pol-e-my-AL-juh rue-MAT- ih-kuh) usually begin quickly and are worse in the morning.  The signs and symptoms of polymyalgia rheumatica usually occur on Polymyalgia both sides of the body and might include:  Aches or pain in your shoulders rheumatica  Aches or pain in your neck, upper arms, buttocks, hips or thighs  Stiffness in affected areas, particularly in the morning or after being inactive for a time  Limited range of motion in affected areas  Pain or stiffness in your wrists, elbows or knees  You might also have more-general signs and symptoms, including:  Mild fever  Fatigue  A general feeling of not being well (malaise)  Loss of appetite  Unintended weight loss  Depression Polymyalgia rheumatica  Incidence and prevalence:  Most people who develop polymyalgia rheumatica are older Polymyalgia than 65. It rarely affects people under 50. rheumatica  This condition is related to another inflammatory called giant cell arteritis. Giant cell arteritis can cause headaches, vision difficulties, jaw pain and scalp tenderness. It's possible to have both conditions together. https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/symptoms-causes/syc-20376539   Etiology:  The exact cause of polymyalgia rheumatica is unknown. Two factors appear to be involved in the development of this condition:  Genetics. Certain genes and gene variations might increase your susceptibility.  An environmental exposure. New cases of polymyalgia rheumatica tend to come in cycles, possibly developing seasonally. This suggests that an environmental trigger, such as a virus, might play a role. But no specific virus has been shown to cause polymyalgia rheumatica.  Giant cell arteritis  Polymyalgia rheumatica and another disease known as giant cell arteritis Polymyalgia share many similarities. Many people who have one of these diseases also have symptoms of the other. rheumatica  Giant cell arteritis results in inflammation in the lining of the arteries, most often the arteries in the temples. Signs and symptoms include headaches, jaw pain, vision problems and scalp tenderness. If left untreated, this condition can lead to stroke or blindness.  Incidence and prevalence  Risk factors for polymyalgia rheumatica include:  Age. Polymyalgia rheumatica affects older adults almost exclusively. It most often occurs between ages 70 and 80.  Sex. Women are about two to three times more likely to develop the disorder.  Race. Polymyalgia rheumatica is most common among white people whose ancestors were from Scandinavia or northern Europe.   Course and prognosis/Complications  Symptoms of polymyalgia rheumatica can greatly affect the ability to perform everyday activities, such as:  Getting out of bed, standing up from a chair or getting out of a car  Combing hair or bathing Polymyalgia  Getting dressed  These difficulties can affect one’s health, social interactions, physical rheumatica activity, sleep and general well-being.  In addition, people with polymyalgia rheumatica seem to be more likely to develop peripheral arterial disease, although it's usually mild and responds well to treatment.  Medical management of polymyalgia rheumatic  Medications to calm down immune system:  prednisone   Definition/signs and symptoms:  Infectious arthritis, also called septic arthritis, is an infection in a Infectious joint that causes arthritis-like symptoms. It is a type of inflammatory arthritis but much more severe. Infectious arthritis occurs when arthritis bacteria or a virus enters the joint and multiplies, causing painful symptoms in and around the joint. https://www.medicalnewstoday.com/articles/323049.php https://www.arthritis.org/about-arthritis/types/infectious-arthritis/  Primary symptoms of infectious arthritis are swelling, pain, and stiffness in the affected joints. Other symptoms of infectious arthritis can include:  pain that is more significant than in non-infectious inflammatory arthritis  a limited range of motion in the affected joint  redness, or erythema  fever, which may be higher than in inflammatory arthritis  fatigue  weakness  Infectious  changes in appetite increased irritability Arthritis   skin rashes The joints most commonly affected by chronic infectious arthritis include the:  knee  shoulder  wrist  hip  elbow  Symptoms can appear and become severe very soon after a person has contracted the infection, sometimes within a few hours. People may also experience other symptoms, depending on the organism causing the infection. Infectious arthritis https://medlineplus.gov/infectiousarthritis.html https://www.orthobullets.com/trauma/1058/septic-arthritis--adult   Despite its name, infectious arthritis is not contagious.  Common bacterial causes:  Staphylococci  Streptococcus, which cause strep infections  Gonococcus, which cause gonorrhea  The bacteria typically reach the joint through the bloodstream.  A bacterial infection usually causes infectious arthritis, but a virus or fungus can also be responsible.  Increased risk of developing the condition, including: Infectious   existing joint problems, such as other forms of arthritis an open wound arthritis   intravenous drug use diabetes  excessive alcohol use as alcohol suppresses the immune system  a weakened immune system  contact with non-sterilized needles  an infection elsewhere in the body  Incidence/prevalence  The estimated incidence of septic arthritis in industrialized countries is six per 100,000 of the population per year.  The incidence increases to approximately 30–60 per 100,000 of the population per year in patients with underlying joint disease and prosthetic https://www.medscape.com/viewar joints. ticle/765917_2   Diagnosis:  Tests may include a blood test and taking a sample of fluid from the affected joint.  X-rays or MRI scans to assess the extent of the damage already caused by the infection. Infectious  Etiology arthritis  infectious arthritis is caused by an active infection within the joint, while reactive arthritis usually develops as a result of an infection in another part of the body.  Infectious arthritis is a severe condition. It may cause permanent damage to the bones and tissue surrounding the affected joint.   Course/prognosis  Infectious arthritis usually affects just one joint, but it can also spread to other joints.  In most cases, symptoms will start to improve after a 1–2 full days of treatment. A full recovery can take several weeks, but the infection should disappear entirely.  Without any treatment, it can also cause a severe blood infection blood called sepsis, which can be fatal.  It can also lead to an infection in the bone, called osteomyelitis. Infectious  Early and aggressive treatment can significantly improve a person's outlook. arthritis  Medical treatment  The best treatment for infectious arthritis depends on the cause.  Antibiotics for bacterial  Antifungal  Antiviral  Draining joint  Exercises What is OT’s role?