TYPES OF ARTHRITIS:
- Osteoarthritis
- RA
- Fibromyalgia
- Spondyloarthropathies
OA: degeneration of cartilage in joints due to wear and tear
RA: autoimmune condition characterised by systemic inflammation primarily attacking synovium of joints
Fibromyalgia: chronic widespread pain syndrome involving all four quadrants of the body
Spondyloarthropathies: inflammatory joint diseases, predominantly affecting axial skeleton (e.g. AK, PA)
AK Diagnostic Criteria
- LBP > 3 months, improved with exercise but not relieved with rest
- Limitation of lx spine in frontal and sagittal planes
- Decreased chest expansion
- Bilateral or unilateral sacroilitis
OA: pathophysiology
- Cartilage fibrillation and erosion
- Subchondral bone sclerosis
- Osteophyte formation
- Joint space narrowing
- Fibrosis of joint capsule
- Mild inflammatory synovitis
OA: intrinsic vs extrinsic contributing factors
INTRINSIC:
- Age
- Metabolic
- Structural
- Genetics
- Gender
EXTRINSIC:
- Weight
- LL biomechanics
- Load / activity
OA: Clinical presentation
Signs:
- Bony enlargement (osteophyte)
- Joint effusion
- Crepitus and pain with motion
- Global reduced ROM
Symptoms:
- Morning stiffness
- Joint pain
OA: sources of pain
- Inflammation of synovium or joint capsule
- Periarticular ligament stretching
- Periarticular muscle spasm
- Subchondral bone micro #
- Osteophyte impinging periosteum
OA: Management
- Prevention - modifiable risk factors
- Slow progression - physio, DMARDs
- Treat ssx - pain mx, exercise, physio
OA: Goals of physio mx + PROMs
- Prevention - pt eduction on modifiable risk factors and importance of exercise to slow progression
- Slow progression - exercise
- Treat ssx - movement, heat/ice, TENS, acupuncture etc.
OA PROMS:
- AIMS (arthritis impact measurement scale)
- WOMAC (Western Ontario and McMaster Universities Arthritis Index)
RA: Pathophysiology
Autoimmune disease (can be triggered by environment, trauma, stress, diet, viruses)
Stage 1: synovitis
Stage 2: destruction
Stage 3: deformity
RA: Clinical presentation
Signs:
- Joint tenderness
- Heat / swelling
- Reduced ROM
- Deformity (severe)
Symptoms:
- Fatigue, weight loss
- Pain
- Swelling, stiffness
- Reduced function
RA Diagnostic Criteria
At least four of the following:
- Morning stiffness and/or arthritis of at least 3 areas for > 6 wks
- Rheumatoid nodules on exam
- Serum RF
- Radiographic changes (on AP film wrist and hand)
