OT in Health: Rheumatology and Arthritis

Flashcards about Rheumatology and Arthritis, including Rheumatoid Arthritis, Osteoarthritis, and related OT interventions.

Rheumatism

Refers to a wide variety of disorders of connective tissue, including inflammatory and degenerative conditions.

Arthritis

Refers to rheumatoid disorders specifically confined to the joints.

Rheumatoid Arthritis (RA)

Systemic illness characterized by polyarthritic, bilateral involvement and erosive changes on X-ray.

Erosive changes on X-ray

Hallmark of irreversible joint damage in Rheumatoid Arthritis (RA).

Stage 1 (Early) RA

No destructive changes on roentgenographic examination; possible radiographic evidence of osteoporosis.

Stage 2 (Moderate) RA

Radiographic evidence of osteoporosis, possible slight cartilage destruction, no joint deformities, adjacent muscle atrophy.

Stage 3 (Severe) RA

Radiographic evidence of cartilage and bone destruction, joint deformity, extensive muscle atrophy.

Stage 4 (Terminal) RA

Fibrous or bony ankylosis and criteria similar to Stage 3.

Common RA Deformities

Mallet, boutonniere, swanneck, ulnar drift or deviation, subluxation.

Thumb Deformity Type 1 (boutonniere)

CMC joint: Not involved, MCP joint: Flexed, IP joint: Hyperextended.

Thumb Deformity Type 2

CMC joint: Flexed and adducted, MCP joint: Flexed, IP joint: Hyperextended.

Thumb Deformity Type 3 (swanneck)

CMC joint: Subluxed, flexed, and adducted, MCP joint: Hyperextended, IP joint: Flexed.

Thumb Deformity Type 4 (gamekeeper’s)

CMC joint: not subluxed, flexed and adducted, MCP joint: Hyperextended, ulnar collateral ligament unstable, IP joint: Not involved

American Collage of Rheumatology Classification of Global Functional Status in Patients with RA Class 1

completely able to perform usual activities of daily living.

American Collage of Rheumatology Classification of Global Functional Status in Patients with RA Class 2

able to perform usual self-care and vocational activities but limited in avocational activities

American Collage of Rheumatology Classification of Global Functional Status in Patients with RA Class 3

able to perform usual self-care but limited in vocational and avocational activities.

American Collage of Rheumatology Classification of Global Functional Status in Patients with RA Class 4

limited in ability to perform usual self-care, vocational and avocational activities.

Osteoarthritis (OA)

Degenerative joint disease.

Risk factors for Osteoarthritis

Age, gender, heredity, obesity, anatomical joint abnormality, injury, and occupation leading to overuse of joints.

Primary OA

Has no known cause; polyarticular, familial, and could be associated with intense inflammatory changes.

Secondary OA

Monoarticular, cartilage destruction due to trauma, gout, septic arthritis, tuberculosis etc.

Joints Affected by Osteoarthritis

Weight-bearing joints (hip, knee, spine, big toe), hands (CMCJ, PIPJ, DIPJ, wrist).

Common Osteoarthritis Deformities

Heberden’s nodes (DIPJ), Bouchard’s nodes (PIPJ), subluxated CMC.

Surgical Medical Treatments for Arthritis

Synovectomy, tenosynovectomy, extensor tendon surgery, arthrodesis (joint fusion), arthroplasty (joint replacement).

Occupational Therapy Assessment for Arthritis

ADL function, hand function, disabilities of the arm, shoulder, and hand questionnaire (DASH), Pain, ROM & deformities, Muscle strength, Sensibility, OT history.

General Occupational Therapy Interventions for Arthritis

Splints, joint protection, assistive devices, energy conservation, ergonomics, recommendations with regards to ADL adaptations, life skills, pain management, hand therapy, psychological interventions.

Symptoms of Acute Stage Arthritis

Pain, inflammation, hot, red joints, tenderness, overall stiffness, limited motion.

Treatment Considerations for Subacute Stage Arthritis

Less restrictive splinting during the day, splinting continued at night, joint protection, assistive devices, physical agent modalities, active ROM or passive ROM with gentle stretch, proper positioning.

Symptoms of Chronic Active Stage Arthritis

Minimal inflammation, less pain and tenderness, increased activity tolerance, low endurance.

Treatment Considerations for Chronic Active Stage Arthritis

Joint protection, splinting as needed, assistive devices as needed, physical agent modalities as needed, active ROM and passive ROM with stretch to end range, Resistive exercises, Cardiovascular exercises , Increased functional activities.

Symptoms of Chronic Inactive Stage Arthritis

No inflammation, pain and stiffness from disuse, low endurance.

Splinting in Stage 1 (Early) Arthritis

Resting splints to decrease acute inflammation, decrease pain, and protect joints.

Splinting in Stage 2 (Moderate) Arthritis

Day splints to provide comfort, night splints to relieve pain or protect joints against potential deformity, splints to increase ROM.

Splinting in Stage 3 (Severe) Arthritis

Day splints to improve function, night splints to provide positioning and comfort.

Goals of splinting

Decreased inflammation, decreased pain and protect joints.

Tips for Splinting

During “flare-up” patient should wear splints 24 hours for immobilization, During remission they may be worn only at night, Don’t try to splint fixed deformities / “burnt out RA” without pain.

Respect for pain in Joint Protection

Stop activities before you reach the point of discomfort or pain, Limit activities which cause your pain to last more than one hour after you have stopped the activity.

Balance activity and rest in Joint Protection

Rest before becoming tired, Plan rest periods during longer or more difficult activities, By resting 10 minutes during an activity, you will have more energy to continue.