Osteoarthritis and Rheumatoid Arthritis

Question	Answer
Osteoarthritis primary effects weight bearing joints and the most commonly effected sites include?	Cervical spine (C5-C6), lumbar spine, hips, knees
Osteoarthritis is a degeneration of what type of cartilage?1)hyaline cartilage (articular cartilage) 2) elastic cartilage 3) fibrocartilage	articular cartilage
After the articular cartilage is degenerated is osteoarthritis, what type of bone is thickened? 1)trabecular bone 2) spongy bone 3)subchondral bone	subchondral bone
Osteoarthritis is diagnosed at what age in what population	After age 40, men more than women
What are the risk factors of osteoarthritis?	Trauma, repetitive micro trauma, obesity
What is the step by step pathogenesis of osteoarthritis?	1)cartilage becomes soft and damaged 2)osteophytes form 3)subchondral bone thickens 4) synovitis is mild to moderate
What types of things would increase the pain in osteoarthritis?	Increased pain after exercise, increased pain with weather changes
How long would joint stiffness last in osteoarthritis?	Less than 15 minutes
What clinical findings with the joints would you find with osteoarthritis?	Pain present at the affected joint, localized to a few joints, joints enlarged,joint motion limited, joint crepitus, joint stiffness < 15 minutes, Bouchard’s nodes, Heberden’s nodes
What type of onset is found in osteoarthritis?	Gradual onset
What types of modalities can you use with patients with osteoarthritis?	Cold,heat,US, hydrotherapy,paraffin,TENS,NSAIDs
How can you reduce the wb on the effected joints effected by OA?	Patient education on energy conservation, body mechanics, joint protection techniques, Rest, splinting, assistive devices, weight loss
What types of exercises would you do for patients with osteoarthritis?	Isometric followed by gradual progression to isotonic exercise
Where do you find Heberden’s nodes and Bouchard’s nodes; in RA or OA?	OA
What is a hard or bony swelling that can develop in the DIP?	Herberden’s nodes
What is a hard or bony swelling that can develop in the PIP?	Bouchard’s nodes
Will orthopedic surgical intervention be effective in OA or RA?	OA because RA is more of a systemic disease
In what joints does RA start?	Onset may occur first at any joint but it is common to find it in the small joints of the hand,foot,wrist and ankle
What is rheumatoid arthritis and how common is it?	Systemic autoimmune disorder of unknown etiology that involves periods of exacerbation and remission; 1-2% of the American population
Which of the following structures in RA has a chronic inflammatory reaction?A) Articular cartilage B) synovial tissues C) capsule D)subchondral	B) synovial tissues
Who is more affected by RA and at what age does it start?	Women affected 3 times more than men, most common age of onset is between 30-50 years of age
What is the pathogenesis of RA?	1)thickening of synovial membrane in affected joints 2) colonization of lymphocytes which synthesize the rheumatoid factor 3) subsequent erosion of cartilage and supporting structures
How long does morning stiffness last in joints effected by RA?	Greater than one hour
What clinical presentation will you find with joints effected by RA?	Symmetrical polyarthritis, Pain and tenderness of affected joints, morning stiffness > 1 hour, warm joints, redness at joints
What type of onset typically presents with RA?	Onset may be gradual or immediate
What particular deformity of the joints occurs in joints affected by RA?	Boutonniere deformity-DIP extension, PIP flexion, Swan neck deformity-DIF flexion, PIP hyperextension
What is a Boutonniere deformity?	DIP extension, PIP flexion
What is a Swan neck deformity?	DIP flexion, PIP hyperextension
What are the systemic characteristics associated with RA?	Decrease in appetite, malaise and increased fatigue
What types of modalities can be used on joints with RA?	Hydrotherapy, hot pack, paraffin, cold; AVOID deep heat
What type of therapy should be used with the acute stage of RA?A) Active ROM B) isometrics C) passive ROM D) joint mobilizations	passive ROM
What type of therapy should be used in the subacute stage of RA?A)Active ROM B) isometrics C) passive ROM D) joint mobilizations	Active ROM
In OA or RA is complete bed rest or regular rest periods indicated?	RA
In OA or RA should splinting and use of assistive devices be used?	Both OA and RA
What should the patient education be focused on in OA and RA patients?	Patient education on disease process, energy conservation,body mechanics, joint protection techniques
What is rheumatism?	Non specific term for medical problems effecting the joints and connective tissues
What are some conditions that present with rheumatism?	OA, RA,JRA, gout, systemic lupus erythematosus, ankylosisng spondylitis
What is rheumatism characterized by?	Inflammation, degeneration or metabolic derangement of the connective tissue, soreness, joint pain, stiffness of muscles
What does the PT exam consist of for a patient who has rheumatism?	Measurement of independence with functional activities, measurement of joint inflammation, measurement of joint ROM, determination of limiting factors including pain, weakness, and fatigue
What should you measure in the joints in a person with rheumatism?	Joint ROM and joint inflammation
What are the short term goals in a patient with rheumatism in the acute stage?	Alleviate pain,Decrease inflammation maintain strength and endurance to activity
What can you provide to help the patient with rheumatism in the acute stage to be safe with motion?	Provide splinting and/or assistive devices to increase safety
What would you want the patient with rheumatism be independent with as a long term goal?	Proper body mechanics, reduction of biomechanical stressors, exercise program
What things do you want your patient with rheumatism to maximize as part of their long term goal?	Functional mobility, endurance to tolerate ADL