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Gen Ortho- Inflammatory Arthretides

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taylormaloney's version from 2016-12-04 08:35

Section 1

Question Answer
Define Inflammatory ArthretidesA group of inflammatory diseases affecting connective tissues, including the joints.
Define Ankylosing SpondylitisA chronic systematic inflammatory disorder that involves specific areas of the body, primarily the spine.
AS- causes?Generally idiopathic, possibly genetic.
AS- associated with which genetic marker?The HLA-B27 Antigen. 90% of those diagnosed with AS have gene.
AS- characteristics?Men more affected, usually beginning early adulthood with inflammatory stage ending by 40 y/o. Possibility of remissions/flareups. Begins with synovitis at SI joint.
AS- inflammation at junctions of lig+vertebrae result in?Fibrosing of ligaments, bone erosion, and later replacement with new bone.
After affecting SI joints, how does it progress?SI Joint, then ligaments, intervertebral discs, facet joints, and intervertebral foramen of L spine, then T spine.
What is the term describing the appearance of vertebrae after longstanding AS?Bamboo spine, referring to the appearance of fused vertebrae.
What complication of AS may result in pain, blurred vision and edema of the eyes?Uveitis- inflammation of the iris. Up to 30% of cases.
AS- early stages?Fatigue and morning stiffness in L spine, pain in buttock/low back/and post thighs. Loss of L spine Lordosis, flexion contracture in hips, worse after immobility.
AS- later stages?Reduced movement in spine, mm wasting/disuse atrophy, increased thoracic curve, fixed and flattened chest, atrophy of thoracic mms, decreased chest expansion, mainly diaphragmatic breathing, loss of neck movement.
What may be seen in severe cases?Whole spine fused into flexion, causing person to always be looking down rather than ahead. Pain may diminish with further fusion.
What are the potential treatment options?Anti-inflammatories, no cure. Stretching and breathing exercises.
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Section 2

Question Answer
Define Rheumatoid ArthritisAn inflammatory, destructive, chronic autoimmune disease of multiple joints and connective tissues throughout the body.
Cause ?Idiopathic.
Characteristics?1% of population, women 3X more likely, all ages affected. MC= 25-50 y/o. Period of remission/flareups.
At what point would you be likely to see a complete remissionFirst 2 years.
What joints would be most likely to be affected long term?The joints that are affected within the first year. (90%)
What percentage of people with RA are most likely to experience severe disability because of it?3%
RA begins with..The activation of injury of the synovial microvasculature of the endothelial cells.
The inflammation and edema causes the synovial cells to..Grow, which causes the proliferation of capillaries among the newly grown synovial cells.
The affected joints are usually ...Hot, puffy, and swollen with the skin over the joint shiny and tight.
What causes the loss of ROM associated with RA?The pain and stiffness caused, especially after immobility.
Where is RA most likely to present first? In the hands and wrists, usually symmetrically. (PIP>MCP>wrists>knees>MTP>subtalar>C1/C2)
Because RA is a systemic disease, those affected are likely to see what type of symptoms?Generalized aching, stiffness, fatigue, and weightloss.
What is Pannus?The folding and thickening of the synovial membrane- extending to involve the articular cartilage.
The inflammatory process is likely to cause the release of what substance?Proteolytic Enzymes, which attack and erode cartilage which erodes and subsequently exposes subchondral bone.
What does the Pannus cause?Adhesions between the joint margins which decreases ROM.
Over the long term, what may happen to the fibrous ankylosis?Becomes bony ankylosis.
What may take place due to the swelling and thickening of the joint capsule?Joint Deformities- such as spindle shaped fingers.
What may take place in the tendons/muscles that cross affected joints?Development of spasms which causes imbalances- moving joint more out of alignment. -> Subluxations possible.
Define a 'Swan-neck' Deformity?Intrinsic Hand muscle contracture causing PIP hyperextension and DIP flexion. Cannot make fist.
Define a 'Boutonniere' Deformity?A rupture of the central slip of extensor tendons. PIP flexed, DIP hyperextended.
Define a Valgus Deformity of Patella?Swelling is excessive in knee, causing the contours of the patella to disappear.
RA could also potentially cause what type of deformity within the knee joint?Baker's Cyst- with the potential of knee flexion contractures if person cannot bear weight.
What may result in cervical instability or neurological symptoms caused by RA?The erosion of the Alar ligaments and Odontoid Process of C2.
How is RA diagnosed?Lab tests, x rays, and the presence of morning stiffness/involvement of 3+ joints, symmetrical joint swelling, and rhematoid nodules.
How is RA medically treated?No cure, NSAIDS, immunosuppressants, corticosteroids, splints/orthotics, joint replacement, and physio to maintain ROM.
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Section 3

Question Answer
Define OsteoathritisA group of chronic, degenerative conditions that affect joints- specifically articular cartilage and subchondral bone.
What other terms are used synonymously to describe OA? Degenerative Joint Disease, and Osteoarthrosis.
Define Primary OAIdiopathic, local or generalized, considered wear and tear, usually developing between 55-60 y/o.
What is the characteristic specific to OA relating to water content of cartilage/bone?Water content usually decreases with age, but increases with OA.
Define Secondary OAResult of a known cause, such as trauma or underlying pathologies. (Obesity, surgery to joints, gout, RA, diabetes, hormone disorders, etc.)
What is the difference in symptoms felt by those with Primary vs Secondary RA.Generally feels the same to those suffering from them.
What cell is specific to cartilage? Describe the blood supply to cartilage.Chrondrocytes. Cartilage is generally avascular.
What substances give elasticity to cartilage?Proteoglycans. (Interwoven with collagen fibers). Makes up large percentage of ECM.
What is the other main function of the above substance?Binds with water and helps its transport and other molecules through the ECM.
What is the main component that aids in resiliency of cartilage?High water content. (Up to 80%)
What is the function of muscles that are slightly stretched during joint motion?Shock absorption to protect articular cartilage.
With OA what portion of articular cartilage is affected first?Load-bearing portions.
What is the general reason for higher water content in the cartilage of those suffering from OA?Due to the avascular nature of cartilage the body cannot repair damaged fibers. It's response is to increase water content and # of proteoglycans.
What is considered the non-inflammatory stage of OA?The early stages, possibly lasting years.
What takes place during the non-inflammatory stage of OA?Collagen fibers break down and proteoglycans deplete, leaving the cartilage softer and thinner. Clefts develop which leads to small fragments of cartilage to break off into synovial fluid. Over time leading to the exposure of subchondral bone.
What takes place in the later stages of OA?Subchondral bone remodels and thickens, exposed areas become eburnated. Microfragments/cysts appear, new bone grows at margin of joint. Osteophytes change joint shape and impede ROM.Muscle wasting occurs in mm's that cross joint.
What are the potential complications of the later stages of OA?Compression of nerve roots by the vertebral osteophytes, possible mild chronic synovitis due to the irritation of synovial lining.
What are the causes of OA?Generally idiopathic, possibly altered biomechanics, immobilization, trauma, or pathologies.
How is OA medically treated?Generally no cure, medication/physio/surgery are the only options to control pain and maintain ROM. Strengthening muscles crossing the joint so not to stress them excessively.
What are the characteristics of OA?More common in older individuals ( 85% over 70 y/o affected), can be unilateral or bilateral.
What are the potential symptoms of OA?Can be painless in early stages, later pain may follow excessive joint use but relieved by rest. Pain is local, reduced ROM, joint stiffness which subsides after working it out.
What are the general pain symptoms of Later stages of OA?Pain- first with moderate joint use, and progressing to minimal action/passive motion/rest.
What are the symptoms relating to late stage OA?Local tenderness, crepitus, stiffness/reduced ROM, contractures, joint misalignment, periods of acute inflammation, mm spasms/edema, eventually affecting cardiopulmonary system.
What are the common locations of OA?Hand, Spine, Hip, Knee.
Define Heberden's NodesOsteophyte formation at the DIP Joints w/ lateral deviation.
Define Bouchard's NodesOsteophyte formation at the PIP Joints, possibly trapezioscaphoid joint.
What levels of the spine are most likely to be affected by OA?Intervertebral discs, vertebrae, facet joints of L4/L5 + C4-C7, and upper thoracic vertebrae.
What complications could occur due to osteophyte formation in the spine?Narrowing of intervertebral foramen and spinal stenosis.
What ranges of motions would be limited in OA of the hip?Internal Rotation + Extension. Causing Pain over groin/adductors.
What actions would be most likely to cause pain due to OA in the knee?Walking/Standing. (Pain is local)
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