This document both covers Rheumatoid Arthritis and Osteoarthritis with its medical-surgical component and PT application such as: definition, etiology, epidemiology, pathophysiology, clinical manifestations/presentation, risk factors, medical management, surgical management, and physical therapy ma...
ORAL REVALIDA 2
MEDICAL-SURGICAL WITH PT APPLICATION | BY: NB
ARTHRITIS
RHEUMATOID ARTHRITIS found in synovial fluid of patients
with RA.
DEFINITION ● Stress
○ Inflammation in RA is partly caused
● A systematic inflammatory disease.
by molecules called cytokines.
● Primarily a disease of the synovium.
While cytokines can be released for
● The inflammatory process primarily affects
a variety of reasons, stress also
the lining of the joints or the synovial
releases them.
membrane but it can also affect other
● Environmental Exposure
organs.
○ Exposure to cigarette smoke, air
● Known as an autoimmune disease
pollution, insecticides, and
because the body’s immune system
occupational exposures to mineral
attacks the joint lining.
oil and silica.
RISK FACTORS
● MC affected joints:
○ UE: wrist, MCP, PIP
○ LE: knee, ankle, foot
● Periods of immobilization
● Long term use of corticosteroids and
disease-modifying antirheumatic drugs
(DMARDS)
● Patients w/ RA have a 1.5-3 times greater
risk of osteoporotic fractures at the hip.
● Gene HLA-DRB1 on chromosome 6,
susceptibility to RA
PATHOPHYSIOLOGY
EPIDEMIOLOGY
● F> M (<40 y/o); M = F (65 y/o)
● Estimated prevalence of RA among adults
in the US is ~1.3M and its prevalence
increases with age.
ETIOLOGY
● Autoimmune disease of unknown
complex etiology.
● Genetic factors (increased risk and
clustering families)
○ Human Leukocyte Antigen–DR
isotype (HLA-DRB1) – strongest
genetic factor
● Infection
○ Epstein-Barr Virus (EBV) – The
virus with the strongest association
with risk for developing RA; Studies
linking EBV with RA have found
high levels of the virus in
lymphocytes that circulate in the
body. Additionally, EBV has been
1
, ORAL REVALIDA 2
MEDICAL-SURGICAL WITH PT APPLICATION | BY: NB
ARTHRITIS
CLASSIFICATION OF PROGRESSION OF RA
STAGE DESCRIPTION
・ No destructive changes on
Stage II, radiographic examination.
Early ・ Radiographic evidence of
osteoporosis may be present.
・ Radiographic evidence of
osteoporosis, with or without slight
CLASSIFICATION AND DIAGNOSTIC CRITERIA subchondral bone destruction;
slight cartilage destruction may be
present.
CRITERION DEFINITION Stage II, ・ No joint deformities, although
Moderate limitation of joint mobility may be
・ Hallmark clinical feature present.
Morning stiffness ・ Lasting at least one hour ・ Adjacent muscle atrophy.
before maximal improvement. ・ Extra-articular soft tissue lesions,
such as nodules and tenosynovitis,
・ At least three joint areas may be present.
Arthritis of three simultaneously have had soft
or more joint tissue swelling or fluid (not ・ Radiographic evidence of
areas bony overgrowth alone) osteoporosis, with or without slight
observed by a physician. subchondral bone destruction;
slight cartilage destruction may be
Arthritis of hand ・ At least one area swollen in a present.
joints wrist, MCP, or PIP joint Stage III, ・ No joint deformities, although
Severe limitation of joint mobility may be
・ Simultaneous involvement of present.
the same joint areas on both ・ Adjacent muscle atrophy.
Symmetrical sides of the body (bilateral ・ Extra-articular soft tissue lesions,
arthritis involvement of PIPs, MCPs, or such as nodules and tenosynovitis,
MTPs is acceptable without may be present.
absolute symmetry)
Stage IV, ・ Fibrous or bony ankylosis
・ Subcutaneous nodules, over Terminal ・ Criteria of stage III
Rheumatoid bony prominences, or
nodules extensor surfaces, or in
juxta-articular regions CLINICAL PRESENTATION
Serum ・ Demonstration of abnormal
rheumatoid amounts of serum JOINT
DEFINITION
factor rheumatoid factor. IMPAIRMENTS
・ Radiographic changes typical ・ Systemic features of RA
of rheumatoid arthritis on Systemic include weight loss, fever, and
posteroanterior hand and extreme fatigue.
wrist radiographs, which must
Radiographic
include erosions or ・ Atlantoaxial subluxation
changes
unequivocal bony Cervical Spine ・ Atlantoaxial impaction
decalcification localized in or ・ Subaxial subluxation
most marked adjacent to the
involved joints. Temporo- ・ Swelling
2
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