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General Arthritis Info
- 101 different kinds, akll involve joint inflammation as dominant problem
- affects 37 million americans
- most are chronic need to be managed oer the pt lifetime
- includes rheumatoid, juvenile RA,
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Joint Changes With Arthritis
- Joint capsule: stretches out due to inflammtion allows movement between bones
- Synovium: produces too muc fluid, lining becomes thick
- Joint Space: enlarges due to excess fluid
- Cartilage: eaten away by inflammatory process, rough, brokes pieces: decrease ROM, increase pain
- Bones: inflammation stretches supporting ligaments, bones shift resulting in poor alignment absent cartilage in bone on bone grinding osteophytes form
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Osteoarthritis
- decrease cartilage: erroded from excess mechanical stress
- Eventullay expossi subchondral bone
- Cysts and osteophytes for, break off into synovial cavity and cuase further irritation
- Synovial & casular thickening, joint effusion
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OA / DJD Pathology & Etiology
- Patho: part of normal aging process but influenced by lifestyle work demands
- Wear and tear over time
- Most common type affects 7% of population
- Etiology: unknow related to cumulative trauma over time
- Congenital deformity or injury predisposis pt to DJD
- Genetic
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DJD Onset and S&S
- Onset: after 50
- S&S: pain localized to few WB joints ( hips, knees, spine)
- Pain wiht exercise - decreases with rest
- Stiffness with inactivity
- Joint enlargement, heberdens nodes
- As disease progresses symptoms increase
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DJD Treatment
- Medical: medication - aspirin, analgesics for pain Corticosteroid injections into joint
- Surgery: debridement of bony spurs, fusion, arthroplasty
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DJD Therapeutic Exercise
- Rest of involved joints
- Wt Reduction if obese
- Isometrics, limited isotonic
- need to watch joint mechanic very carefully
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RA general info
- Ch;ronic progressive nonspecific inflammation of peripheral joints
- In response granulation tissue, forms results in destruction of articular surfaces adhesion form and decreased ROM results
- A systemic disease also affect lungs heart blood vessesl eyes and skin
- Characterized by EXACERBATIONS and REMISSIONS
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RA Etiology
- Autoimmure
- Infection
- Genetic
- Stress
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Onset of RA
- Ages 25-50
- 75% insidious 25% acute
- Diagnosed when pt has joint pain for 6 months
- 3:1 female to male ratio
- Approximately 1% of population
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RA Symptoms
- Swollen, painful joints, Bilateral distal involement
- Order of involvement of joints: hands, wrists, knees, elbows, shoulder, hips
- Stiffness in Am or after prolonged position
- Early afternoon fatigues and malaise
- decreased ROM of joints
- Anemci undernourished chronically ill
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RA deformaties
- After Inflammation recedes, stretche out damaged join settels into wrong positon
- Ulnar Deviation
- Swan Neck Deformity: PIP hyperextension DIP flexion
- Boutonier Deformity: PIP flextion DIP hyperextention
- Frozen shoulder
- Hypermobility
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RA treatment
- Early Treatment/ management - better outcome
- Need team approach: MD, RN, PT/OT, SW
- Consdierations: 75% improce wtih conervative mgmt, 10% eventually fully disable
- Functional problems due to joint damge
- Limited eneryg will need to learn about energy conservations
- Side effects of medications
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RA medications
- Asprin NSAID
- Steroids
- Gold compounds
- Tetracycline (antibiotic)
- Immunosuppressive meds
- No one drug helps all
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RA Medical Managment
- Lifestyle Changes: rest for acute phase, balance of rest and exercise for rest of life
- Therapy: pain control, supportice and assistive devices, joint protection, energy conservation, ROM (gentle, within limits of pain)
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RA Therapy Goals druing Exacerbation
- Decrease inflammation and pain
- Minimize joint stiffness, maintain ROM
- Minimize muscle atrophy
- Joint protection
- Prevent Deformities - protect joint structures
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RA therapy goals during Remission
- Maintain ROM, strenth
- Non-impact low impact conditioning exercise
- Pt education, family training, provide resources such as Arthritis foundation
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Juvenile RA
- Systemic like RA
- Females more than males
- Early onset, more acute
- Symptoms: affects large joints, systemic effect more severe, can interfere with growth and development
- not as severe and slower progressing
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Juvenile RA Treatment
- Medicine: aspirin, NSAID
- Avoid steroids unless severe
- More meds needed during growth spurts
- Therapy PROM, AROMS aquatic therapy
- Splintin
- need to monitor, educate parents
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Ankylosing Spondylitis
- Inflammatory disease of the spine
- Bony growth into tissue space - vertebral fusion - no pain
- deformity if poor positioning while ankylosing process proceeds
- Onset 1% of population 3:1 male to female
- late teens early 20's
- Course: exacerbations and remissions
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Ankylosing Spondylitis Symptoms
- unknown cause
- Symptoms: fever, fatigue, wt loss, anorexia, anemia, X-ray shows si joint fusion, pain in low back prios to fusion, neck 75% LS spine 50%, Si joint 100%, hips30%, shoulders 30%
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Ankylosing Spondylitis Treatment
Meds, proper posture during fusin process, exercise to help strenthen extensors
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Septic Arthritis
- Patho: hx of minor trauma, blood borne bacteria
- Etiology: staphyloccus aureus
- Symptoms: Edema, purulent exudate, pain, redness
- Treatment: aggressive antibiotics
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Gout
- Patho: Deposits of uric acit crystals in jt. trigger inflammtion
- Etiology: decreased renal excertion or uic acid or metabolic prob.
- S&S: red swollen big toe MP joint
- Pain during gait
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Gout Treatment
- Decrease serum uric acid levels
- Meds and diet
- NSAIDs
- therapy: teach gain with assistive divice
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Bursitis/Tendinitis
- Def: inflammtion of tendon/ bursa, tennis elbow, dequervain syndrome
- Etiology: trauma, overuse/ disuse, aging
- S&S: pain, tenderness, decrease strength, decrease ROM
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Bursitis/ Tendinitis Treatment
- Pain management
- Gradual ROM, strengthening
- Joing portection
- Work site assmt
- posure and body mech.
- Prevention
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