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Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Definition and Characteristics
- Definition: a degenerative process of varied etiology, which includes mechanical changes, diseases, and/or joint trauma
- Characteristics: degeneration of articular cartilage, with hypertrophy of subchondral bone and joint capsule of weight-bearing joints
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Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Medications
- Corticosteroids
- NSAIDs
- Glucocorticoid injections (unresponsive to NSAIDs)
- Acetaminophen (mild pain without inflammation)
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Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Diagnostic Tests
- Plain film imaging: diminished joint space, decreased height of articular cartilage, presence of osteophytes
- Lab tests: rule out other disorders (RA)
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Degenerative Joint Disease (DJD); Degenerative Osteoarthritis (OA)/Osteoarthrosis: Physical Therapy Goals, Outcomes and Interventions
- Joint protection strategies
- Maintain/improve joint mechanics and connective tissue functions
- Implementation of aerobic capacity, endurance conditioning or reconditioning (i.e. aquatic programs)
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Rheumatoid Conditions: Subtypes
- Ankylosing Spondylitis (Marie-Strumpell disease, Bechterew's disease, rheumatoid spondylitis)
- Gout
- Psoriatic Arthritis
- Rheumatoid Arthritis
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Ankylosing Spondylitis: Definition and Characteristics
- Progressive inflammatory disorder of unknown etiology
- Initially affects axial skeleton
- Initial onset (mid and low back pain for 3 months or greater) before 4th decade of life
- 1st symptoms include mid and low back pain, morning stiffness, and sacroiliitis
- Results in kyphotic deformity of vertical and thoracic spine and decease in lumbar lordosis
- Degeneration of peripheral and costovertebral joints may be observed in advanced stages
- Affects men 3x more than women
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Ankylosing Spondylitis: Medications
- NSAIDs (aspirin): reduce inflammation and pain
- Corticosteroid therapy
- Medications to suppress immune system
- Cytotoxic drugs: block cell growth; for those who don't respond well to corticosteroids
- Tumor necrosis factors (TNF) inhibitors: shown to improve some symptoms
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Ankylosing Spondylitis: Diagnostic Tests
HLA-B27 antigen (helpful, but not diagnostic by itself)
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Ankylosing Spondylitis: PT Goals, Outcomes, and Interventions
- Implementation of flexibility exercises for trunk to maintain/improve normal joint motion and length of muscles in all directions (especially ext)
- Implementation of aerobic capacity/endurance conditioning or reconditioning (aquatic programs)
- Implementation of relaxation activities to maintain/improve respiratory function (breathing strategies to maintain/improve VC)
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Gout: Definition and Characteristics
- Genetic disorder of purine metabolism
- Characterized by elevated serum uric acid (hyperuricemia)
- Uric acid changes into crystals and deposits into peripheral joints and other tissues (i.e. kidneys)
- Most frequently seen at knee and great toe
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Gout: Medications
- NSAIDs (indomethacin)
- COX-2 Inhibitors (cardiac side effects may limit use)
- Colchichine
- Corticosteroids
- Adrenocorticotropic hormone (ACTH)
- Allopurinol
- Probenecid
- Sulfinpryazone
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Gout: Diagnostic Tests
Lab tests: identify monosodium urate crystals in synovial fluid and/or connective tissue samples
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Gout: PT Goals, Outcomes, and Interventiosn
- Pt/client education for injury prevention and reduction of involved joints
- Early identification of condition, with fast implementation of intervention is very important
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Psoriatic Arthritis: Definition and Characteristics
- Chronic, erosive inflammatory disorder of unknown etiology (associated with psoriasis)
- Erosive degeneration usually occurs in joints of digits as well as axial skeleton
- Both sexes equally affected
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Psoriatic Arthritis: Medications
- Acetaminophen (pain)
- NSAIDs
- Corticosteroids
- Disease-modifying antirheumatic drugs (DMARDs): can slow progression of psoriatic arthritis
- Biological response modifiers (BRMs) (i.e. Enbrel (etanercept)
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Psoriatic Arthritis: Diagnostic Tests
Lab tests - not useful except to rule out RA
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Psoriatic Arthritis: PT Goals, Outcomes, and Interventions
- Joint protection strategies
- Maintain/improve joint mechanics and connective tissue functions
- Implementation of aerobic capacity/endurance conditioning or reconditioning (aquatic programs)
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Rheumatoid Arthritis: Definition and Characteristics
- Chronic systemic disorder of unknown etiology
- Involves symmetrical pattern of dysfunction in synovial tissues and articular cartilage of joints of hands, wrists, elbows, shoulders, knees, ankles, and feet
- MCP and PIP joints usually affected
- Characteristic pannus formation (inflammatory granulation tissue that covers joint surface)
- Ulnar drift (observed at PIPs in severe forms)
- Volar subluxation of MCP joints
- DIP joints usually spared
- Other deformities = swan neck and boutonniere deformities and Bouchard's nodes (excessive bone formation on dorsal PIP joints)
- Women 2-3x greater incidence than men
- Juvenile RA onset prior to age 16 with complete remission in 75% of children
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Rheumatoid Arthritis: Medication
- Varies with disease progression
- May include gold compounds and anti rheumatic drugs (DMARDs) early
- NSAIDs, immunosuppressive agents, or cortocosteroids are commonly prescribed for long-term management
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Rheumatoid Arthritis: Diagnostic Tests
- Plain film imaging
- Laboratory testing (positive test findings include increased WBC count and erythrocyte sedimentation rate; hematocrit and hemoglobin tests will show anemia; rheumatoid factor will be elevated)
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Rheumatoid Arthritis: PT Goals, Outcomes, and Interventions
- Joint protection strategies
- Maintain/improve joint mechanics and connective tissue functions
- Implementation of aerobic capacity and endurance conditioning or reconditioning (aquatic programs)
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