By: Amelia Clark Arthritis
Dec 22, 2015
By: Amelia Clark
Arthritis
DefinitionEpidemiologySymptomsDiagnosisTreatmentEffects of ExerciseExercise TestingExercise RxSummary/
References
Overview
“Arthon”=joint “itis”=inflammation
Inflammation of one or more joints
resulting in pain, swelling, stiffness
and limited movement.
Definition
No cure
YouTube - osteoarthritis
Over 100 typesOsteoarthritis (OA): Deterioration or loss of
cartilage in synovial joints, particularly in weight-bearing joints followed by formation of bone spurs and subchondral cysts. Also known as Degenerative Joint Disease (DJD)
DefinitionTypes of Arthritis
Osteoarthritis
Primary Secondary
Normal wear & tear of aging
Heredity, obesity, injury
Commonly affects:hands, spine, hips, knees
Rheumatoid (RA): inflammation of synovial membrane, formation of pannus tissue, & eventual deterioration of bone and cartilage.Autoimmune disease
Other: Juvenile arthritisAnkylosing SpondylitisLupusfibromyalgiaPsoriatic arthritisGout
Pseudogout
DefinitionTypes of Arthritis
Commonly affects:Wrists, hands, knees, feet, cervical spine
UNITED STATES1 in 5 adults=46 millionMore common among women1 in 250,000 children has arthritis (294,000)Most common cause of disability
More than back problems
UTAHAdults with arthritis: 399,000Have arthritis & are overweight/obese: 71%Have arthritis & are physically inactive: 14%
Epidemiology
Epidemiology
Being overweight
or obese
increases your
risk for arthritis.
Arthritis is often
coupled with
diabetes and
obesity.
Physical activity
can help prevent
risk of arthritis.
SymptomsSwellingPainStiffnessLimited movementFatigueRedness around joint
AgeGeneticsOverweight/obesityFemalesSmokersPrevious injuryOccupation w/
repetitive movements
Symptoms & Risk Factors
Risk Factors
Diagnosis
Medical History
Physical Exam
Lab Tests
DiagnosisMedical HistoryInformation about your health backgroundHeredityDescription of symptoms you’ve been
havingDetails about how and when symptoms
beganWhere?How is it affecting you?Other medical problems?
Looks at jointsTouches those described
Looks for areas that are tender, painful, or swollen, or indications that the joint is damaged.
May be asked to stand up and move jointsROMGoniometer
Examine position & alignment of neck and spine.
Watch you walk to see how you are able to move hips and knees.
DiagnosisPhysical Exam
OsteoarthritisJoint aspiration
extracts fluid for evidence of crystals or joint deterioration
X-raysee damage to bone
MRIsee soft tissue and
cartilageNEW!
MRI measures GAGs & early detection
Sed rate Rate at which blood cells sink
C-reactive protein Measure inflammation
Rheumatoid factor Antibody found in blood
Antinuclear antibodies Antibody combined with nuclei
Anti-CCP Antibody
X-rays Swelling of soft tissue, loss of bone
density Bone scans
Detect inflammation MRI
Synovitis, inflammation in other organs
DiagnosisLab Tests Rheumatoid
Arthritis
•Medications
•Nonpharmacolo
gic Therapies
•Surgery
Treatment
TreatmentMedications
NSAIDsTarget pain and inflammationCan be hard on the stomach
and GI tractAcetaminophen
Pain onlyTopical pain relievers
Pain onlyCorticosteroids
Relieve inflammation quicklyGood for RADon’t use frequently
Disease-modifying antirheumatic drugs (DMARDs)
TreatmentNonpharmacologic TherapiesHypnosisAromatherapySupplements
Fish oilPhysical Therapy
Electrical Stimulation
ExerciseWeight lossPatient Education
Splints/assistive aidsEssential Oils
Rub on hands and put rubber gloves on and soak on warm water 5-10 minutes
MeditationReduced pain in
56% of participantsHot & Cold
treatments
Joint replacementImproved movementPain reliefImproved joint alignment
Arthroscopic surgeryNot very beneficial for arthritis
Youtube-Fight arthritis pain
TreatmentSurgery
RA can affect cardiac and pulmonary function. Could cause vasculitis.
Fear of joint pain or harming jointJoint ROM restrictionInability to perform rapid repetitive movementsDeconditioned joints-swelling decreases
performance“out of shape”Increased resting energy expenditure (REE) as
much as 50%
Effects of Exerciseability to exercise
Effects of Exerciseability to exercise
Other diseases (i.e. diabetes, obesity, heart disease)
Improve cardiovascular status, balance, flexibility and general health
Decreased joint swellingImprove:
FunctionMoodQOLMobility
Increased social and physical activity
Reduced depression and anxiety
Every 1 lb lost is 4lbs off your knees!
Associated with…
Submaximal testsTreadmill (<3mph)Cycle ergometer
Suspected cardiopulmonary disease-do a different test
1 rep maxLow intensity intiallyROM (goniometery)Gait analysis- for those with severe diseaseAvoid morning exercise (especially with RA)Spinal involvement may cause nerve disfunctionAvoid vigorous and high repetitive exercises with
unstable joints
Exercise Testing
Methods Suggested Tests
Strength Repetition Max (1, 8, or 12)
Endurance 6 min walkAerobic capacity (REP 6-20)
Flexibility (helpful in preventing injury)
Goniometry (ROM, symmetry)
Functional Balance tests, gait analysis
Exercise TestingRecommendations
Goniometry Testing
•Tests Range
of Motion
(ROM)
•Progression
of disease
•Lack of
progression of
therapy
NormsJoint Flexion Extension
Hip 115-125° 10-30°
Knee 135-150° 0 - -10°
Ankle 0-10°(dorsiflexion)
20-30° (plantarflexion)
Shoulder 160-180° 40-60°
Stretching and warm-up always (even on days when there is a flare up)
Use weight-bearing, partial weight-bearing and non-weight-bearing exercises
Recommend learning a strength routineAvoid activities that increase joint painPost-exercise soft tissue discomfort is
expected
Exercise PrescriptionRecommendations
Do’sLow-impactMuscle are
strengthened before increase in intensity
flexibility/ROMProper shoesSeveral short sessions if
necessaryAlternate exercise
modesTime goals (not distant)
Stop and go movementsProlonged one –legged
stanceStair climbingContact sportsOverstretching &
hypermobilityIf pain or swelling-
reduce load on jointDon’t encourage client
to exceeding guidelines
Exercise PrescriptionRecommendations
Don’ts
Modes Intensity Frequency Duration
Aerobic 40-60% VO2max 3-5 days/week 5-10 min build to 30 min sessions
Strength 1 or more sets of 2-3 reps, building to 10 reps
2-3 days/week ------
Flexibility Before aerobic or strength activities
Exercise PrescriptionACSM guidelines
Arthritis is characterized by swelling in the joint(s).Osteoarthritis, rheumatoid arthritis are most
common.It is often common in people with other
conditions such as heart disease, obesity, and diabetes.
Exercise helps decrease symptoms and is affective for and increase in QOL.
Exercise Rx should include a variety of modes of exercise and flexibility.
Low-impact exercises are best
Summary
ReferencesBrittain, D.R., Gyurcsik, N.C., McElroy, M., Hillard, S.A. (2011).
Woman’s Health Issues. (issue 1, vol. 21).
www.youtube.com/watch?v=0dUSmaev5b0&feature=related
www.youtube.com/watch?v=u8bV5eV-wFQ
http://en.allexperts.com/q/Etymology-Meaning-Words-1474/arthritis.htm
Janssen, I. I., & Mark, A. E. (2006). Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis. International Journal of Obesity, 30(8), 1223-1228. doi:10.1038/sj.ijo.0803287
www.cdc.gov/arthritis/resources/quickstats.htm
www.arthritistoday.org
www.nejm.org/doi/full/10.1056/NEJMoa0708333
www.cdc.gov
www.lhup.edu/yingram/jennifer/webpage/homepage2.htm