FF - system interactions

Describe sarcoidosis

systemic disease of unknown cause characterized by granulomatous inflammation in nodular form

• scarring of skin, lymphatics, lungs, liver, spleen

• SOB, dry cough, fever, weight loss, skin lesions, erythema nodosum (inflammation of fat cells), chest pain, hemoptysis, pneumothorax

• mm weakness, aches, tenderness, fatigue that reduces functional capacity

What are the dx criteria for rheumatoid arthritis (RA)?

≥4 of the following:

• morning stiffness >1 hr

• arthritis of ≥3 joint areas: wrist/hand, ankle/foot, upper cervical spine

  • OA: hip, knee, CMC 1, MTP 1, DIP, lower cervical spine, thoracic, lumbar facet joints

• arthritis of ≥1 hand joints: wrist, MCP, PIP

• BIL, symmetrical

• rheumatoid nodules: subcutaneous nodules, over PIP, bony prominences or extensor surfaces

  • OA: both PIP & DIP

• serum rheumatoid factor (RF)

• peri-articular osteopenia on the X-ray

  • OA: osteophytes, reduced joint space, cartilage breakdown

What are the extra-articular presentations of RA?

• pulmonary: pleural effusion, pleurisies, ILD

• CV: pericarditis, myocarditis, atherosclerosis

• neuro: peripheral neuropathy, myelopathy

• skin: nodules, vasculitis, anemia

• eyes: uveitis/iritis, scleritis

• Reiter’s syndrome: conjunctivitis, urethritis, OA of big joints

• lab values: increased C-reactive protein, ESR

How can you treat pts with RA?

• if in relapse → splints w/ neutral wrist, cryotherapy

• if in remission → functional mobility, light resistance exercise, heat pack

• meds: DMARDs, corticosteroids

Describe Ehlers-Danlos Syndrome (EDS)

group of hereditary CT disorder

• hallmark signs: skin hyperextensibility, smooth & velvet-like texture, fragility, delayed wound healing, thin atrophied scars after wound healing

• MSK: joint hypermobility, joint laxity → dislocations/subluxations, osteoporosis, early onset OA, scoliosis, kyphosis

• neuro: generalized mm weakness, low mm tone

• CVP: autonomic dysfunction resulting in abnormal chest pain, palpitations, abnormal BP responses

• hematologic: easy bruising, prolonged bleeding

How can you treat pts with EDS?

• aerobic

• strengthening

• AD

• bracing

• myofascial release techniques

Describe psoriatic arthritis (PsA)

autoimmune disease

• affects DIP, PIP, foldable joints

• symmetrical

• yellowish, brownish

How can you treat pts with PsA?

corticosteroids

Describe septic arthritis

bacterial infection in the joint, affecting ages <3, >65

• affects hip joint

• asymmetrical

• red, hot, swollen, difficulty WB, fever, elevated WBC

How can you treat pts with septic arthritis?

CALL 911, drain the joint, antibiotics

Describe reactive arthritis (Reiter’s syndrome)

bacterial infection in the gut: E. coli, salmonella, chlamydia, Crohn’s disease, RA

• asymmetrical

• can’t see (conjunctivitis), can’t pee (urethritis), can’t climb a tree (OA of big joints)

How can you treat pts with reactive arthritis?

antibiotics, then PT Sx’s

Describe Sjögren syndrome

• dry mouth & eyes

• decreased salivation & lacrimation

• seen w/ RA