PATRIC DELQUADRO

Arthritis

Overview

DefinitionsEpidemiologyClinical AspectsTreatmentEffects of ExerciseTestingPrescriptionConclusionReferences

Definitions

Osteoarthritis (OA) – Chronic deteriorative disease of cartilage in joints allowing bones to contact/rub causing inflammation. Result of aging, genetics, previous injuries, and overuse.

Rheumatoid Arthritis (RA) - Chronic autoimmune disease were the body’s immune system, for reasons unknown, attacks the synovial lining surrounding joints causing inflammation and destruction of joint cartilage.

OA Video

http://www.youtube.com/watch?v=0dUSmaev5b0

RA Video

http://www.youtube.com/watch?v=AYTutNDWPKg

Epidemiology

Arthritis More than 100 different forms of arthritis 1 in 7 Americans have at least 1 type of arthritis

Osteoarthritis 1 in 12 Americans affected Signs start showing after age 45 More common in men >55, women <55

Rheumatoid Arthritis Close to 1% of Americans affected Affects women 3 X to men

Symptoms

Osteoarthritis (OA) Symptoms include:

Stiffness and deep underlying ache or pain in joints Warmth, swelling, and/or redness around joint

(inflammation) Reduced ROM Usually felt in early morning, during/post activity, &

inactivity Late Stages

Bony spurs called Heberden’s nodes develop Audible grinding or crackling noise from joint

(crepitation) Joint deformation Spurring or crystallization of bone and/or cartilage

Osteoarthritis Images

Symptoms Continued

Rheumatoid Arthritis (RA) Many of the same symptoms as OA with the exception

of: Joint pain is generally equal on both sides of body Prolonged early morning stiffness Greater joint deformation and rheumatoid nodules

RA is Systemic Rheumatoid factor affects the whole body Numbness or tingling of the hands and feet Eye burning, chest pain, and/or dry-mouth Damage to cardiorespiratory tissue Fever and fatigue

Rheumatoid Arthritis Images

Test and Evaluation

Physical Exam A traditional physical exam is performed on patients

with any type of arthritis Special attention is given to: Joint movement and function Visual appearance noting inflammation, redness,

nodes etc. History of symptoms and discomfort Listening for crepitation

Blood testing does little to determine if the patient has arthritis.

Laboratory Diagnosis

Osteoarthritis Joint aspiration

Synovial fluid drawn from the joint is examined for deterioration

X-ray Less invasive and helpful for observing cartilage and

bone health

Rheumatoid arthritis Rheumatoid factor (RF) test

Blood sample is taken and RF levels are evaluated MRI or Ultrasound

Same purpose as x-ray, more detailed and convenient

Complications

Physically Large joints like knees, shoulders, hips and back/neck

are usually most affected by arthritis. This limits physical activity and daily tasks.

Joints in hands and feet also become problematic causing issues with balance, gait, and tasks requiring grip strength.

Emotionally Physical appearance can be detrimental to the

persons confidence and emotion wellbeing. Being limited and in pain can cause a person to give

up on exercise leading to a sedentary lifestyle.

Treatment

The best medicine for any type arthritis is…. STAYING ACTIVE!!!

By staying active, joints, bones and muscles are worked encouraging repair and growth.

Patients are asked to work through the initial morning pain and discomfort and participate in moderate exercise.

Over the counter pain relievers: Acetaminophen (Tylenol)

NSAID’s: ibuprofen, aspirin, and naproxen

Treatment Continued

RA preventative treatments Disease modifying antirheumatic drugs (DMARDs): Rheumatrex, Arava, Gold sodium thiomalate DMARDs target immune processes that cause

inflammation and are administered via IV, injection, pill

Corticosteroids: Prednisolone These treatments are also used in severe cases of OA

Treatment Continued

Physical therapy Strengthens muscle and improves ROM Educates patient with usable exercise routines

Surgery Arthroscopic surgery Partial and full joint replacements for knees,

shoulders, hip, ankle, and elbow. Alignment surgery (knee, elbow, tarsals) Fusion (spine, ankle)

Effects of Exercise

Capable of improving all system functions Improves joint ROM, stability, and function

Decreases inflammation and pain in joints

Creates positive social wellbeing and outlook on life

Increases activity and productivity

Ability to Exercise

Special Considerations

Joint stability must be planned for and monitored Only low impact exercises should be used Allow ample time for warm-up/cool down, especially

early day Progression in exercise intensity should be gradual Progression in duration before intensity Good shock absorbing shoes should be worn during

exercise Risk and issues increase with overweight/obese

clients

Medications and Exercise

No exercise specific side-affects with DMARDs

Methotrexate

Increased bruising, nausea, decrease in energy

Arava Increased bruising, chest pain, numbness and weight

loss

Gold sodium thiomalate Abdominal pain, shortness of breath, and bruising

Exercise Testing

Methods Measures

StrengthRepetition Max (1, 8, or 12 reps)Isometric knee extensionStandardized functional measures

Timed chair riseTimed up and go

Endurance6 min walkCycle Ergometer

HR

FlexibilityGoniometry Functional ROM

Assess Symmetry

Exercise Prescription

Frequency, Intensity, Time an Type (FITT) FITT principles apply same as a healthy individual

Resistance Aerobic Flexibility

Frequency

2-3 day/week 3-5 day/week Daily

Intensity Start @ 10% MaxIncrease 10% (Max) weekly

60-80% HR peakPain Dependent

Tension (not pain)

Time 10-15 rep warm-up3-5 exercises5-10 reps (tolerable)

5-10 min warm-up20-30 min (tolerable)

5-10 minBeginning of dayPre/Post Exercise

Type Circuit trainingFree/Machine WeightsElastic bandsIsometric

Low resistanceWalkingCyclingWater aerobics

ROM joint stretching

All major muscles

Importance of Flexibility at 80

http://www.youtube.com/watch?v=UQASHZMeMnk

Summary and Conclusion

OA is the most common type of arthritis Deteriorative disease of joint cartilage Most times age dependent No cure, only temporary relief or invasive surgery

RA is less common but with more complications Autoimmune disease attacks the synovial lining

around joints Not age dependent Detrimental to other systems of the body Medications can be used to slow disease progression

References

Byk, C. (2008). Osteoporosis: An Exercise Guide. El Paso: Workfit Consultants.

M.D., G. C. (2008). The Arthritis Handbook. New York, NY : DiaMedica.

M.D., T. L. (2003). Living with Rheumatiod Arthritis. Baltimore, MD: Johns Hopkins Press.

Medicine, A. C. (2010). ACSM's Guidelines for Exercise Testing and Perscription (8th ed.). Baltimore, MD: Wolters Kluwer.

Medicine, U. N. (2012, March 21). Medline Plus. Retrieved March 21, 2012, from http://www.nlm.nih.gov/medlineplus/arthritis.html