Transcript Arthritis

By: Amelia Clark
 Definition
 Epidemiology
 Symptoms
 Diagnosis
 Treatment
 Effects of Exercise
 Exercise Testing
 Exercise Rx
 Summary/References
“Arthon”=joint
“itis”=inflammation
Inflammation of one
or more joints
resulting in pain,
swelling, stiffness and
limited movement.
No cure
YouTube - osteoarthritis
 Over 100 types
Osteoarthritis (OA): Deterioration or loss of cartilage
in synovial joints, particularly in weight-bearing joints
followed by formation of bone spurs and subchondral
cysts.
 Also known as Degenerative Joint Disease (DJD)
Osteoarthritis
Commonly affects:
hands, spine, hips,
knees
Primary
Normal wear &
tear of aging
Secondary
Heredity,
obesity, injury
 Rheumatoid (RA): inflammation of synovial membrane,
formation of pannus tissue, & eventual deterioration of
bone and cartilage.
 Autoimmune disease
 Other:
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Juvenile arthritis
Ankylosing Spondylitis
Lupus
fibromyalgia
Psoriatic arthritis
Gout
 Pseudogout
Commonly affects:
Wrists, hands, knees,
feet, cervical spine
 UNITED STATES
 1 in 5 adults=46 million
 More common among women
 1 in 250,000 children has arthritis (294,000)
 Most common cause of disability
 More than back problems
 UTAH
 Adults with arthritis: 399,000
 Have arthritis & are overweight/obese: 71%
 Have arthritis & are physically inactive: 14%
Epidemiology
Being overweight or
obese increases your
risk for arthritis.
Arthritis is often
coupled with
diabetes and obesity.
Physical activity can
help prevent risk of
arthritis.
Symptoms
Risk Factors
 Swelling
 Age
 Pain
 Genetics
 Stiffness
 Overweight/obesity
 Limited movement
 Females
 Fatigue
 Smokers
 Redness around joint
 Previous injury
 Occupation w/ repetitive
movements
Diagnosis
 Medical
History
 Physical Exam
 Lab Tests
 Information about your health background
 Heredity
 Description of symptoms you’ve been having
 Details about how and when symptoms began
 Where?
 How is it affecting you?
 Other medical problems?
 Looks at joints
 Touches those described
 Looks for areas that are tender, painful, or swollen, or
indications that the joint is damaged.
 May be asked to stand up and move joints
 ROM
 Goniometer
 Examine position & alignment of neck and spine.
 Watch you walk to see how you are able to move hips
and knees.
Osteoarthritis
Rheumatoid Arthritis
 Joint aspiration
 extracts fluid for evidence
of crystals or joint
deterioration
 Sed rate
 Rate at which blood cells sink
 C-reactive protein
 Measure inflammation
 Rheumatoid factor
 Antibody found in blood
 Antinuclear antibodies
 Antibody combined with nuclei
 Anti-CCP
 Antibody
 X-rays
 Swelling of soft tissue, loss of bone
density
 Bone scans
 Detect inflammation
 MRI
 Synovitis, inflammation in other
organs
 X-ray
 see damage to bone
 MRI
 see soft tissue and cartilage
 NEW!
 MRI measures GAGs &
early detection
Treatment
•Medications
•Nonpharmacologic
Therapies
•Surgery
 NSAIDs
 Disease-modifying
 Target pain and inflammation
 Can be hard on the stomach and GI
tract
 Acetaminophen
 Pain only
 Topical pain relievers
 Pain only
 Corticosteroids
 Relieve inflammation quickly
 Good for RA
 Don’t use frequently
antirheumatic drugs
(DMARDs)
 Hypnosis
 Splints/assistive aids
 Aromatherapy
 Essential Oils
 Supplements
 Fish oil
 Physical Therapy
 Electrical Stimulation
 Exercise
 Weight loss
 Patient Education
 Rub on hands and put
rubber gloves on and
soak on warm water 5-10
minutes
 Meditation
 Reduced pain in 56% of
participants
 Hot & Cold treatments
 Joint replacement
 Improved movement
 Pain relief
 Improved joint alignment
 Arthroscopic surgery
 Not very beneficial for arthritis
Youtube-Fight arthritis pain
 RA can affect cardiac and pulmonary function. Could
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cause vasculitis.
Fear of joint pain or harming joint
Joint ROM restriction
Inability to perform rapid repetitive movements
Deconditioned joints-swelling decreases performance
“out of shape”
Increased resting energy expenditure (REE) as much
as 50%
Associated with…
 Other diseases (i.e.
diabetes, obesity, heart
disease)
 Improve cardiovascular
status, balance, flexibility
and general health
Every 1 lb lost is
4lbs off your knees!
 Decreased joint swelling
 Improve:
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Function
Mood
QOL
Mobility
 Increased social and
physical activity
 Reduced depression and
anxiety
 Submaximal tests
 Treadmill (<3mph)
 Cycle ergometer
 Suspected cardiopulmonary disease-do a different test
 1 rep max
 Low intensity intially
 ROM (goniometery)
 Gait analysis- for those with severe disease
 Avoid morning exercise (especially with RA)
 Spinal involvement may cause nerve disfunction
 Avoid vigorous and high repetitive exercises with unstable
joints
Methods
Suggested Tests
Strength
Repetition Max (1, 8, or 12)
Endurance
6 min walk
Aerobic capacity (REP 6-20)
Flexibility (helpful in preventing injury)
Goniometry (ROM, symmetry)
Functional
Balance tests, gait analysis
Goniometry
Testing
•Tests Range of
Motion (ROM)
•Progression of
disease
•Lack of
progression of
therapy
Joint
Flexion
Extension
Hip
115-125°
10-30°
Knee
135-150°
0 - -10°
Ankle
0-10°
(dorsiflexion)
20-30°
(plantarflexion)
Shoulder
160-180°
40-60°
 Stretching and warm-up always (even on days when
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there is a flare up)
Use weight-bearing, partial weight-bearing and nonweight-bearing exercises
Recommend learning a strength routine
Avoid activities that increase joint pain
Post-exercise soft tissue discomfort is expected
Do’s
Don’ts
 Low-impact
 Stop and go movements
 Muscle are strengthened
 Prolonged one –legged
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before increase in
intensity
flexibility/ROM
Proper shoes
Several short sessions if
necessary
Alternate exercise modes
Time goals (not distant)
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stance
Stair climbing
Contact sports
Overstretching &
hypermobility
If pain or swelling-reduce
load on joint
Don’t encourage client to
exceeding guidelines
Modes
Intensity
Frequency
Duration
Aerobic
40-60% VO2max
3-5 days/week
5-10 min build to
30 min sessions
Strength
1 or more sets of 23 reps, building to
10 reps
2-3 days/week
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Flexibility
Before aerobic or strength activities
 Arthritis is characterized by swelling in the joint(s).
 Osteoarthritis, rheumatoid arthritis are most common.
 It is often common in people with other conditions
such as heart disease, obesity, and diabetes.
 Exercise helps decrease symptoms and is affective for
and increase in QOL.
 Exercise Rx should include a variety of modes of
exercise and flexibility.
 Low-impact exercises are best
Brittain, D.R., Gyurcsik, N.C., McElroy, M., Hillard, S.A. (2011). Woman’s
Health Issues. (issue 1, vol. 21).
www.youtube.com/watch?v=0dUSmaev5b0&feature=related
www.youtube.com/watch?v=u8bV5eV-wFQ
http://en.allexperts.com/q/Etymology-Meaning-Words-1474/arthritis.htm
Janssen, I. I., & Mark, A. E. (2006). Separate and combined influence of body
mass index and waist circumference on arthritis and knee osteoarthritis.
International Journal of Obesity, 30(8), 1223-1228. doi:10.1038/sj.ijo.0803287
www.cdc.gov/arthritis/resources/quickstats.htm
www.arthritistoday.org
www.nejm.org/doi/full/10.1056/NEJMoa0708333
www.cdc.gov
www.lhup.edu/yingram/jennifer/webpage/homepage2.htm