EXSC 637 LIBERTY UNIVERSITY Chapter Twenty-Three Arthritis _2024.pdf

Chapter Twenty-Three

Arthritis

Definition

Arthritis is a generic term for conditions that involve inflammation of one or more joints.

There are more than 100 different forms of arthritis, each characterized by varying

degrees of joint damage, restriction of movement, functional limitation, and pain

Pathophysiology

Osteoarthritis

oDegradation of joints

oAffects articular cartilage and subchondral bone

oResults in host of processes leading to joint space narrowing, loss of cartilage,

bone-on-bone rubbing, ligament strain/weakening

oHands, feet, spine, hips, and shoulders most often affected

oSome genetic link, but also affected by injury and obesity

Rheumatoid

oMore likely in females

oResult of chronic autoimmune disorder

Systemic inflammation

oTypically affects synovial joints

Hand and feet most often.

Common negative effects of most types of arthritis

oExercise tolerance

oMuscle strength

oAerobic capacity

oRange of movement

oBiomechanical efficiency

oProprioception

Stages of arthritis

oAcute: reversible signs and symptoms in the joint related to synovitis

oChronic: stable but irreversible structural damage brought on by the disease

process

oChronic with acute exacerbation of joint symptoms: increased pain and

decreased ROM and physical function

Type of arthritis Disease Stage Related impairments

Osteoarthritis Acute joint pain Often insidious

Chronic radiographic joint

disease

Chronic with exacerbation Increase joint pain and

swelling, muscle weakness,

and progressively declining

functional impairment

Rheumatoid arthritis Acute disease in multiple

joints with pain, limited range

of motion, and worsened

functional impairment

Joint stiffness, adverse body

composition changes

(rheumatoid cachexia; muscle

loss and fat gain), muscle

weakness, fatigue, and

increased cardiovascular

disease risk

Ankylosing spondylitis Acute spinal pain and

stiffness without significant

decrease in mobility

Muscle loss, muscle

weakness, and fatigue

Chronic spinal ankyloses

predominant with decreased

spinal and thoracic mobility

Chronic with exacerbation Increased pain and stiffness

of the back or peripheral

joints

Table 23.1 Types of arthritis, stages, and related impairments

Clinical Considerations

Signs and Symptoms

oJoint

Pain

Stiffness

Effusion

Synovitis

Deformity

Crepitus

oHistory and physical exam

General assessment of joint range of motion, alignment, and function

Assess symptoms and family history (genetic component for arthritis)

Assess for extra-articular features specific to types of arthritis to aid

diagnosis

Cardinal signs:

Redness

Swelling

Pain

Heat

oDiagnostic Testing

There are no definitive tests or markers for arthritis diagnosis

Some serum and synovial fluid tests can assist in arthritis type

differentiation

See able 23.2 on distinguishing characteristics and American college of

rheumatology (ACR) diagnostic criteria for arthritis

Exercise Testing

Cardiovascular testing may be needed in patients who are at risk of CVD:

oThose with RA are at increased risk due to the associated systemic inflammation

oThose who are sedentary for extended periods and have other risk factors may

also be at risk

Musculoskeletal and range of motion testing can be performed to provide a baseline for

changes and to help guide the exercise prescription

See table 23.4 on strength, range of motion, and balance testing in arthritis

Treatment

Goals:

oReduce disability

oRestore physical activity

oImprove body composition

oControl symptoms and reduce pain

Treatment focus is now on movement versus previously on rest:

o69% of those with RA are inactive

Nonpharmacologic:

oEducation

oPhysical and occupational therapy

oBraces and bandages

oCanes and other walking aids

oShoe modification and orthotics

oIce and heat modalities

oWeight reduction

oAvoidance of repetitive-motion occupations

oJoint irrigation and joint surgery (in select circumstances).

Pharmacologic

oDisease-modifying antirheumatic drugs ( DMARDs)

oSee table 23.5 Pharmacology

Exercise Prescription

Goals:

oMaintain or improve physical function by maintaining or improving muscle

strength, cardiovascular fitness, and ROM

oImprove body composition (i.e., restore muscle mass and reduce fat mass), and

when appropriate, reduce body weight.

oReduce the risk of comorbidities such as CVD and osteoporosis

oReduce inflammation and pain

oPrevent contractures and deformities

See table 23.6 for arthritis site-specific recommendations

See table 23.7 for athritis stages, general signs and symptoms, and exercise prescription

See table 23.8 for exercise prescription review

Important considerations

oPreventing musculoskeletal injury

oFatigue

oPrevious joint replacement

oTime of day

oWater therapy

oFootwear

oCV and pulmonary issues with RA

oAnkylosing spondylitis (arthritis of the spine leading to vertebral fusing)

oCorticosteroids

oBody composition

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