Arthritis
PTA 104 Orthopedic Dysfunctions

Arthritis

Refers to any inflammation of joint/joint structures. Most common forms are osteoarthritis and rheumatoid arthritis, respectively.

Signs and Symptoms

• pain
• impaired mobility (typically a capsular pattern)
• chronic - firm end-feel
• acute - guarded end-feel
• includes effusion
• loss of accessory joint motion
• impaired muscle performance
• muscle length-tension relationships
• inadequate activation or guarding of postural stabilizers
• impaired balance
• joint degeneration limits feedback from proprioceptors
• functional limitations
• may need adaptive equipment to complete a functional activity or to protect joint(s) from further injury

Osteoarthritis

A chronic, degenerative disorder primarily affecting the articular cartilage of synovial joints, with eventual bony remodeling and overgrowth at the margins of the joint

Background and Characteristics

• Refers to degeneration and inflammation of bone and cartilage in articulating (moving) areas
• Pain with weight bearing and joint motion can progress into partial to full loss of motion and pathological fusion (ankylosis)
• Osteophytes (bone spurring) may be identified on x-ray or diagnostic imaging
• 
• http://www.medical-look.com/Joint_pain/Osteoarthritis.html
• Pathological bone remodeling can lead to ligamentous laxity and joint hypermobility/instability
• Can result in secondary nerve or postural dysfunction due to loss of joint height/space
• Symptoms are exacerbated with overuse, weather changes, or prolonged immobilization
• Associated with advanced age, lifestyle habits (sedentary, obesity, high-impact sports, repetitive loading/lifting), and family history

Principles of Management of Osteoarthritis

• Patient instruction
• Pain management—early stages
• emphasis is on reducing joint stiffness, balancing activity and rest, and reinforcing the role of movement in joint health
• Pain management—late stages
• consider modalities for home use, pacing and prioritizing, modifying activities
• Assistive and supportive devices and activity
• bracing, aquatics, assistive devices for ADLs, home and environmental modifications
• Resistance exercise
• emphasis is on strengthening within non-painful ranges, isometrics to minimize disuse atrophy
• open chain activities with resistance across long lever arms can increase joint loads and exacerbate arthritis symptoms
• Stretching and joint mobilization
• assisted and patient instruction in safe and effective technique
• involved joints typically have a firm end-feel due to bony changes in the articulating areas
• Balance activities
• Aerobic conditioning
• patient education on exercise parameters, including low impact-low joint stress activities

Rheumatoid Arthritis

An autoimmune, chronic, inflammatory, systemic disease primarily affecting the synovial lining of joints as well as other connective tissue. It is characterized by a fluctuating course with periods of active disease and remission.

Background and Characteristics

• Source of pain is inflammation of the synovium
• Typically presents bilaterally, with >=3 joints involved, redness and increased skin temperature
• Higher incidence in women and can be diagnosed in childhood (Juvenile Rheumatoid Arthritis (JRA)
• Autoimmune response is thought to be trigger by some bacterial or viral exposure
• Some association with family history and presence of rheumatoid factor (RF) in the blood

Principles of Management of Rheumatoid Arthritis

Acute Inflammatory Period

• Joint protection
• especially the smaller joints in the hands and feet
• spinting to protect from subluxation due to hypermobility from synovial degeneration
• includes patient instruction in correct exercise technique to prevent further joint stresses during activity
• Energy conservation
• Joint mobility
• stretching is NOT performed when joints are swollen (increased risk for subluxation)

http://arthritis.about.com/od/rheumatoidarthritis/ss/pictures_photos.htm

• Exercise
• PROM, AAROM, AROM depending on pain and swelling in affected joints
• Functional training
• similar to OA; instruction in methods to incorporate joint protection in everyday activities

Subacute and Chronic Stages

http://arthritis.about.com/od/rheumatoidarthritis/ss/pictures_photos.htm

• To improve function, exercise should be aimed at improving flexibility, muscle performance, and cardiopulmonary endurance
• Nonimpact or low-impact conditioning exercises such as swimming and bicycling
• Group activities such as water aerobics

Self-Assessments

Test your knowledge on characteristics of OA versus RA