Arthritis

  inflammation of joints due to infectious, metabolic, or autoimmune causes resulting in  pain, stiffness and limitation of motion of the affected joint.

Pathophysiology

  • affects synovial joints
  • characterized by inflammation and degeneration of the joint
  • antigen complexes adhere to joint surfaces
  • phagocytosis of the immune complexes result in tisue estruction
  • phagocytosis produces leukotrienes and prostaglandins which determine the level of inflammation
  • prostaglandins produce collagenase degrading collagen in the joints

 

Menchanical stress

  • repetitive impact loading results in cartilage destruction
  • walking transimts 3-4 times the body weight to the knee
  • repeated mechanical stress decreases elastiticity of ligaments and articular cartilage
  • the joints shock absorbancy declines
  • thining of subchrondral bone results
  • joint stability overall decreases
  • osteophytes form
  • synovial capsule and membrane thicken
  • joint cartilage atrophies

 

Joint lubrication:

  • declines as mechanisms that normally operate under high weight loads to produce joint lubricating film decline.

 

Immobilization of a joint

  • may result in joint degeneration
  • cartilage degeneration may result from loss of lubrication flow within the joint capsule with lack of mechanical movement.

 

Clinical Manifestation

  • pain
  • joint swelling
  • limited movement
  • stiffness
  • weakness
  • fatigue

 

Assessment

  • Hx of symptom evolution and onset
  • previous tx and effectiveness
  • fx assessment
  1. gait
  2. posture
  3. musculoskeletal size and structure
  4. gross deformities and abnormalities noted
  5. symmetry, size and contour of other connective tissues
  6. reported abilities vs observable functioning

 

Dx:

  1. ESR – erythrocyte sedimentation rate – indicative of degree of inflammation
  2. arthrocentesis – relieve pressure and analysis for infection (rule out infectious arthritis or tx gout)
  3. X-ray – joint changes
  4. Arthrography – detect connective tissue disorder
  5. Bone and Joint scan – indicative of bone density in affected region and joint degeneration
  6. Tissue biopsies – myositis, vascular changes
  7. blood test – auto-Abs

 

Geri:

  • individual may expect limitations with aging as normal
  • OA increases in prevalence with aging
  • pharmacologic intervention SE intensifies in the elderly

 

Management

  • involves multidisciplinary team

 

Pharmacologic intervention

  • symptom management and anti-inflammatories
  1. Salicylates
  2. NSAIDs
  3. antirheumatics
  4. pain management
  5. sleep aids – promote adequate and normal sleep pattern

 

Additional management

  1. heat and cold packs
  2. protective splinting
  3. supportive devices
  4. maintain low impact regular ROM excercise
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