RA/OA/gout - NPTE

how do you confirm the diagnosis of gout

-identification of uric acid crystals in synovial fluid, collected via synovial biopsy

what are the PT interventions used for OA

-PROM, AROM -heating and cooling agents -pt education -strengthening exercises -transcutaneous electrical nerve stimulation -energy conservation -weight loss -body mechanics -joint protection techniques -bracing

which joints are involved in OA

-any joint may be involved however the most commonly affected sites include the hands and WBing joints such as hips and knees

what are the two kinds of gout

-can be a chronic condition or a series of acute attacks

how is RA diagnosed

-clinical presentation of involved joints, presence of blood rheumatoid factor and radiographic changes

what is gout

-complex form of arthritis resulting from an abnormally high uric acid level (hyperuricemia) in the body -Gout is a common and complex form of arthritis that can affect anyone. It's characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe.

what are the signs and symptoms of OA

-gradual onset of pain at affected joint -inc pain after exercise -inc pain with weather changes -enlarged joints -crepitus -stiffness -limited ROM -Heberden's nodes -Bouchard's nodes

what are the risk factors of developing OA

-overweight, fractures of other joint or other joint injuries and occupational or athletic overuse

what are the PT goals of gout

-pt education for injury prevention and reduction of involved joints - pt/client education on dietary effects on the dz -early identification of condition with fast implementation of intervention is very important

what is the goal for PT for pt w/RA

-reduce inflammation and pain, promote joint function and prevent joint destruction and deformity

what are the classic findings of gout

-warmth, intense joint pain, inflammation - swelling, cutaneous erythema (redness of skin), and severe pain of the first MTP joint.

what are the meds used for gout

NSAIDs, COX-2 inhibitors (cardiac side effects may limit use), colchicine, corticosteroids, adrenocorticotrophic hormone (ACTH), allopurinol, probenecid, and sulfinpyrazone

what joints are affected in gout

first MTP joint (podagra), shoulder, knee, wrist, ankle, elbow or fingers podagra means- gout of the foot, esp the big toe

what are the most common sites for gout

great toe of foot, ankle and knee

gout is the most common form of inflammatory arthritis in what pt population

men older than 40

when does the onset of gout usually occur

onset is usually sudden, often during the night or early morning.

what are the signs and symptoms of RA

onset may be gradual or immediate, symmetrical involvement, pain and tenderness of affected joints, morning stiffness, warm joints, decrease in appetite, malaise, inc faigue, swan neck deformity (DIP flexion, PIP hyperextension), boutonniere deformity (DIP extension, PIP flexion) low grade fever

what is treatment geared towards in gout

pharmacologic control of serum uric acid levels

in gout, uric acid is formed as the body breaks down foods that are high in ___

purine

the gout diet should have foods that are low in ____ what are foods that are HIGH in this

purine Alcoholic beverages (all types) Some fish, seafood and shellfish, including anchovies, sardines, herring, mussels, codfish, scallops, trout and haddock. Some meats, such as bacon, turkey, veal, venison and organ meats like liver. -eat lean meat for gout, eat fruits veggies and whole grains

what is used to diagnose OA

radiographs can show diminished joint space or bone spure

what is the goal of tx for OA

reduce pain, promote joint function, and protect the joint

what is RA

systemic autoimmune disorder of unknown etiology -presents with a chronic inflammatory reaction in the synovial tissues of a joint that result in erosion of cartilage and supporting structures within the capsule. -this dz has periods of exacerbation and remission

what age does OA typically appear and what population

typically appears during middle age and affects nearly all individuals to some extent by age 70. -OA occurs more in men than women up to age 55, however it is more common in women later in life

what is the cause of OA

unkown

what is the common population to get RA

women are affected 3 times more than men and the most common age of onset falls between 40-60 y/o

what are the pharmalogical management for OA

acetaminophen, NSAIDs, and corticosteroids

What is boutonniere deformity?

DIP extension, PIP flexion *bring knee up to put on boot (knee is the PIP joint)

what is OA

chronic disease that causes degeneration of articular cartilage, primarily in WBing joints. Subsequent deformity and thickening of subchondral bone occur resulting in impaired functional status.

what are the common joint sites of RA to occur

common in small joints of the: -hand -foot -wrist -ankle

___ medications may be desirable (for pts w/RA) during severe flare-ups or when the pts condition is not responding to NSAIDs

corticosteroids

what are the symptoms of gout other than at the joint(s)

fever, chills and malaise accompany an episode of gout -as the condition becomes chronic- pt may report morning stiffness and joint deformity, progressive loss of function, or disability. Chronic gouty neuropathy may occur

What is swan neck deformity?

DIP flexion, PIP hyperextension (swan is going down and drinking water)