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What medications are given for arthritis symptom control?
- Non-Prescription: acetominophen for painrelief, and Ibuprofen, and ASA for antiinflammatoryeffect
- Prescription (NSAIDS- nonsteroidal antiinflammatories):Voltaren, Arthrotec, Relafen,Mobicox and Narcotics such as codeine,morphine, oxycodone, Fentanyl, andTramadol
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What does DMARDs stand for?
Disease modifying anti-rheumatic drugs
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How long do DMARDs take to take effect?
6-12 weeks
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What is the purpose of DMARDs?
Meant to settle down the inflammatory process,prevent joint damage
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Anti inflammatory affect
Can modulate the immune system
Joint Injection
Oral administration
Deltasone (Prednisone)
Depomedrol (Methylprednisolone)
Corticosteroids
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Reduce production ofTNF , Interfering with T-cell communication anddestroying B-cells
Biologics (Biologic Response Modifiers)
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group of inflammatory arthropathies that affect children under the age of 16
Juvenile Idiopathic Arthritis
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What are the 4 subsets of presentation for JA?
- 1. Pauciarticularonset JA
- 2. Juvenile spondylitis
- 3. Polyarticular Onset JA
- 4. SystemicOnset JA
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Are males or females more commonly affected by JA?
Females
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Is Juvenile spondylitis more common in males or females?
Males
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Chronic inflammatory disease
Sacroiliac joints and spine
Progressive stiffening of the spine with possible ankylosis, and flexion deformity of spine
Ankylosing Spondylitis
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In addition to inflammation in the spine, in Anklyosing Spondylitis this also occurs
- ossification
- -the extent and areas of fusion vary
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What are the primary symptoms of Anklyosing Spondylitis?
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Inflammation of entheses
Where tendons and ligaments attach to bone
Radiographic appearance of osteopenia initially
Later radiographically detectable bony overgrowth or spur
Enthesitis
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What are the early symptoms of Anklyosing Spondylitis?
- Pain/ache/stiffness in buttocks, lateral hips and low back
- May notice SOB with activities
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Inflammation associated with osteopenia andosteitis near or in the region of a joint
Radiographic appearances of widening of thesacroiliac joint
Sacroiliitis
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Peripheral synovitis characterized bydistribution of joint involvement rather thanhistological changes
May precede, accompany or follow the onsetof spinal symptoms
Hips, knees, ankles, MTP joints
Synovitis
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Upper extremities almost never involved
If peripheral involvement more presentation of one joint or asymmetrical
Synovitis
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Oligoarticular
Asymmetrical
Episodic
Joint erosion especially of MTP joints withsubluxation deformity
TMJ may also be affected with decreasedmouth opening and difficulty with chewing
Synovitis
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What are the treatment goals of Ankylosing Spondylitis? (4)
- Maintain normal upright posture
- Maintain spinal mobility
- Minimize impact of hip andperipheral symptoms- decrease painand stiffness
- Manage fatigue, poor sleep,depression, and issues of body image and role changes
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What are the treatment methods for Ankylosing Spondylitis? (6)
- Medications
- Regular exercise that includes stretchingof the spine and minimizes contact sports
- Posture education
- Joint Protection- especially avoidingprolonged positioning
- Positioning/ Biomechanics for driving/travelling, work, sleep, dressing
- Psychosocial interventions
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Heterogeneous disease
Features of spondyloarthropathies in someand features of RA in others, and features ofboth diseases coexisting in others
Etiology unknown
Psoriatic Arthritis
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Fusiform soft- tissue swelling
Joint space loss, with or withoutankylosis of the IP joints
Destruction of IP joints
Joint erosion with tapering of proximalphalanx and bone proliferation of thedistal phalanx (pencil- in- cup)
Periostitis
Psoriatic Arthritis
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Common syndrome characterized by widespread soft tissue pains accompanied by fatigue, and poor quality sleep
Fibromyalgia
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Muscle studies fail to identify consistentabnormalities
Sleep studies have shown evidence of alphawave intrusion during delta sleep andreduction of rapid eye movement sleep
Recent work queries central mechanisms maybe significant
Fibromyalgia
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Widespread pain of at least 3 months duration: Pain in the left side of the body,pain in the right side of the body, pain above the waist, pain below the waist.Additionally, axial skeletal pain must be present.
Pain in 11 of 18 tender point sites on digital palpation (force of approximately 4 kg).
Fibromyalgia
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“A skeletal disorder characterized by compromised bone strength predisposing to increased fracture risk. Bone strength reflects the integration of bone density and bone quality”
Osteoporosis
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What bone cell:
Synthesizes the bone matrix
Osteoblasts
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What bone cell:
Has a role in carrying nutrition throughout the bone
Osteocytes
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What bone cell:
Removes bone
Osteoclasts
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What change occurs in young bones and aged bones?
strength and hardness are not balanced at either end of the age spectrum
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Refers to the stagebetween normal boneand osteoporosis
Osteopenia
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A fracture caused by an injury thatwould be insufficient to fracture normal bone.
It refers to a fracture with minimal trauma such as a fall from a standing height or less.
Can refer to a fracture with no trauma
Fragility Fracture
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Reduced bone density, or osteopenia,affecting skeletal components.
Increases fragility and may lead tofractures with minimal trauma.
Decreased thickness in trabeculae andcortical areas
Risk areas- primarily vertebral and hipfractures; other sites include forearm,ribs; cortical bone stress fractures in lowerextremities and feet.
Pain, radiating pain, posture, andfunctional changes.
Osteoporosis
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What are the 3 components of a fall?
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What are the treatment considerations for osteoporosis and osteopenia?
- Education of patient
- Environmental Safety and FallsProtection Posture
- Biomechanics and alignment for function
- Exercise
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