1
Q
what is the most common chronic arthritis in childhood
A
juvenile idiopathic arthritis
2
Q
when does JIA start
A
before the age of 16 and persists for longer than 6 months
3
Q
what are the primary SS of JIA
A
- joint swelling, pain, stiffness
- morning stiffness
- muscle atrophy, weakness, poor endurance
- acute or chronic iridocyclitis (inflammation of the iris)
- systemic manifestations
- gait deviations
4
Q
what are the secondary SS of JIA
A
- limited joint motion
2.fatigue - decreased aerobic capacity
- growth abnormalities
- osteopenia
- difficulty with ADLs
- gait deviations
5
Q
which JIA is more common in men
A
enthesitis-related arthritis
6
Q
what is the most common type of JIA
A
oligoarthritis
7
Q
polyarthritis affects how many joints
A
more than 5 joints
8
Q
which JIA is seen throughout childhood
A
systemic arthritis
9
Q
which JIA is seen in late childhood or adolescence
A
rheumatoid factor-positive polyarthritis
10
Q
onset age of oligoarthritis
A
2-4yrs
11
Q
onset age of rheumatoid factor-negative polyarthritis
A
early peak is at 2-4 yrs
later peak at 6-12 yrs
12
Q
onset age of psoriatic arthritis
A
early peak is 2-4 yrs
later peak at 9-11yrs
13
Q
what is the diagnostic marker for systemic JIA
A
spiking fever or higher once or twice for at least 2 weeks
14
Q
which JIA has a fever accompanied by a rash
A
systemic JIA
15
Q
which JIA is the most painful
A
systemic JIA
16
Q
what is the joint involvement for systemic JIA
A
symmetrical and polyarticular (>4 joints )
17
Q
which location is most commonly affects with sJIA and polyJIA
A
hip arthritis
decreased hip flexion and ER
18
Q
which JIA has a low grade inflammation in 4 or fewer joints
A
oligoarticular JIA
19
Q
Iridocyclitis is going to have what SS
A
none; asymptomatic but if not treated it can lead to blindness
20
Q
how many joints are involved with polyarticular JIA
A
5 or more joint
21
Q
what is joint presentation for polyarticular JIA
A
symmetrical affecting both large and small joints; includes cervical spine and temporomandibular
22
Q
which JIA has swollen and warm joint but rarely red
A
polyarticular JIA
23
Q
which JIA is similar to adult rheumatoid arthritis
A
RF positive polyarthritis
it is severe and destructive
24
Q
what are the different origin and pathogenesis possibilities
A
autoimmune inflammatory disorder activated by external trigger in a genetically predisposed individual
25
why people think that origin is genetic and environmental component
altered immunity, abnormal immunoregulation, and cytokine production
26
which chromosome is thought to be affected
chromosome 6
27
Human leukocyte antigen (HLA)
proteins on cells that help the immune system distinguish "self" from "non-self,"
-linked to increased risk of autoimmune arthritis
28
Spondyloarthritis
inflammatory arthritis of sacroiliac joint, joints along axial spine (hips and shoulders)
29
enthesitis related arthritis
inflammation where tendons and ligaments attach to bones
30
which RIA affects males older than 12
spondyloarthritis
31
what is the chief complaint of spondy
low back pain (important to look at spinal mobility)
32
what are the different secondary issues that occur due to the inflammation seen in JIA
-end rage stress pain
-intra-articular effusion ( extra fluid build up in the joint)
-synovial hypertrophy
-increased production of synovial fluid
-soft tissue edema
-muscle atrophy
33
perarticular tenosynovitis
inflammation of tendon sheaths surrounding the joint
34
why does bone overgrowth occur in JIA
there is an increase in blood supply because of the inflammation
35
why does a painful muscle spasm occur in JIA
the muscle is trying to limit excessive range of motion due to the consistent inflammation that occurs
36
what are the chronic effects of inflammation
ligamentous laxity with joint instability
37
why does erosion of articular cartilage occur in JIA
the consistent inflammation of the synovium gradually damages the cartilage and bone underneath it
38
why does joint contracture occur with JIA
this is caused by the fibrosis, muscle shortening, or joint deformity = causes loss in full ROM
39
what happens to the hip joint
leg length inequality, pain in groin, increase lumbar lordosis
40
what happens to the knee joint
flexion contracture, tight IT band, vlagus deformity
41
what happens to the ankle joint
loss of ROM, sublux metatarsophalangeal joints, hallux valgus, hallux rigidus, hammertoes, hindfoot valgus
42
what happens to the cervical spine
loss of extension and rotation of atlantoaxial subluxation
43
what happens to the temporomandibular joint
loss of range and difficulty chewing
44
what happens to larynx
hoarse voice
45
what happens to the shoulder joint
glenohumeral acromioclavicular and sternoclavicular ROM loss
46
what happens to the elbow joint
flexion contracture
47
what is the goal of pharmacological management
to induce remission
prevent joint erosions
prevent extraarticular issues
48
what is the first line of defense for pharmacologic management
nonsteroidal anti-inflammatory
49
methotrexate
disease modifying antirheumatic (helps control inflammation)
50
Biologic targeting tumor necrosis factor
class of biological medications that inhibit tumor necrosis factor (decreases inflammation)
51
glucocorticoid drugs
class of drugs that is a powerful anti-inflammatory and immunosuppressive
52
which medication is used for systemic JIA
glucocorticoid drugs
53
Cyclosporin A
class of drug that suppresses the overactive immune response
54
what is the side effects of NSAIDs
GI irritation
55
what are the side effects of long term oral steroid
Cushing's syndrome, myopathy, growth disturbance, osteoporosis, DM, obesity, infection
56
what are important things to ask about for morning stiffness
general duration, types of activities or practice which relieve or exacerbate SS, lasts around 30min to 2 hours
57
what are the SS of an acute flare
joint warmth
swelling
muscle spasm
pain with active and passive ROM
increased discomfort with weight bearing activities
morning or AM stiffness
58
what are the SS of the subacute phase
muscle atrophy
weakness
contracture
59
what are things you need to keep in mind while palpating
-assess for warmth around joints, bogginess around joints
-mobilize patella
60
what are things you are looking out for when looking at joints
joint inflammation, joint effusion, laxity, joint instability
61
what are the things you are looking out for in subacute chronic phase of the joints
joint swelling due to synovial hypertrophy, joint integrity loss, erosive changes in cartilage, joint alignment loss
62
which ranges are typically lost first
shoulder abduction and IR
knee flexion, ankle inversion/eversion
63
what are key things you need to remember when looking at the ROM
-check all two joint muscles, c spine, l spine
-look for compensation (lordosis with mild hip flexion contracture)
-hip and knee flexion contracture
64
what are things you are looking for while assessing the knee joint
rapid atrophy of the quads
65
what is a common gait deviation in JIA
trendelenburg due to glute medius weakness
66
what are the different postural deviations that can be seen in sitting and standing
-forward head
-kyphosis/lordosis
-scoliosis
-pelvic obliquity
-hip and knee flexion contractures
-genu vlagum
-tibial torsion
-hind foot valgus and pronation
-look at leg length
67
what are the different things to keep in mind while looking at functional mobility
proficiency, quality, speed, endurance
68
impairment based interventions should include
maintaining optimal joint alignment, maximize range of motion and strength, prevent secondary derformities
69
what are different things you can do to maintain optimal joint alignment
-prevent prolonged sitting
-promote extension activities (tummy time)
-daily ROM exercises
70
how do you address pain
if pain is the primary problem address pain management; refer out if it is unresolved
71
what does POC look like for acute/flare phase
-maintain and preserve function
- morning bath
-isometrics
-gentle AROM/AAROM
-limite flexion postures (limit prolonged sitting, wear splints, prone positioning,)
-avoid joint stress
72
what does POC look like in the chronic phase
-restoration and compensation
-increase ROM as flare subsides
-progress to resistive exercises (extensor and antigravity muscles)
-aerobic activity
73
what is the dosing for aerobic exercises
-improve endurance
-2x/wk with mod to vigorous intensity for 45-60 min for 6-12 weeks `
74
which muscles should you focus on for muscle strengthening
target muscles surrounding and supporting the joint
75
what strengthening should you perform during acute joint inflammaiton
isometric
76
what is the dosing for muscle strengthening when they are not in a flare
-low intensity, high rep
-LE group
-closed chain activities
-concentric and eccentric
-2x/week
77
what is the dosing for sports
2x/week
moderate to vigorous
40-60 min
78
Peds
flashcards
Decks in class (15)
# Cards
-
Gait75
-
Cerebral palsy4
-
Practical #184
-
Motor Learning and Interventions for CP80
-
Orthotics31
-
Congenital Muscular Torticollis69
-
Pediatric Physical Therapy Models: early intervention and school setting55
-
Developmental Coordination disorder30
-
Hypotonia and developmental Delay28
-
JIA78
-
Brachial plexus injury46
-
TBI78
-
Myelodysplasia95
-
Pre-term infants70
-
Neuromuscular diseases91
