By: Amelia Clark

Arthritis

DefinitionEpidemiologySymptomsDiagnosisTreatmentEffects of ExerciseExercise TestingExercise RxSummary/

References

Overview

“Arthon”=joint “itis”=inflammation

Inflammation of one or more joints resulting in pain, swelling, stiffness

and limited movement.

Definition

No cure

YouTube - osteoarthritis

Over 100 typesOsteoarthritis (OA): Deterioration or loss of

cartilage in synovial joints, particularly in weight-bearing joints followed by formation of bone spurs and subchondral cysts. Also known as Degenerative Joint Disease (DJD)

DefinitionTypes of Arthritis

Osteoarthritis

Primary Secondary

Normal wear & tear of aging

Heredity, obesity, injury

Commonly affects:hands, spine, hips, knees

Rheumatoid (RA): inflammation of synovial membrane, formation of pannus tissue, & eventual deterioration of bone and cartilage.Autoimmune disease

Other: Juvenile arthritisAnkylosing SpondylitisLupusfibromyalgiaPsoriatic arthritisGout

Pseudogout

DefinitionTypes of Arthritis

Commonly affects:Wrists, hands, knees, feet, cervical spine

UNITED STATES1 in 5 adults=46 millionMore common among women1 in 250,000 children has arthritis (294,000)Most common cause of disability

More than back problems

UTAHAdults with arthritis: 399,000Have arthritis & are overweight/obese: 71%Have arthritis & are physically inactive: 14%

Epidemiology

EpidemiologyBeing overweight or obese increases your risk for arthritis.

Arthritis is often coupled with diabetes and obesity.

Physical activity can help prevent risk of arthritis.

SymptomsSwellingPainStiffnessLimited movementFatigueRedness around joint

AgeGeneticsOverweight/obesityFemalesSmokersPrevious injuryOccupation w/

repetitive movements

Symptoms & Risk FactorsRisk Factors

Diagnosis

Medical History

Physical Exam

Lab Tests

DiagnosisMedical HistoryInformation about your health backgroundHeredityDescription of symptoms you’ve been

havingDetails about how and when symptoms

beganWhere?How is it affecting you?Other medical problems?

Looks at jointsTouches those described

Looks for areas that are tender, painful, or swollen, or indications that the joint is damaged.

May be asked to stand up and move jointsROMGoniometer

Examine position & alignment of neck and spine.

Watch you walk to see how you are able to move hips and knees.

DiagnosisPhysical Exam

OsteoarthritisJoint aspiration

extracts fluid for evidence of crystals or joint deterioration

X-raysee damage to bone

MRIsee soft tissue and

cartilageNEW!

MRI measures GAGs & early detection

Sed rate Rate at which blood cells sink

C-reactive protein Measure inflammation

Rheumatoid factor Antibody found in blood

Antinuclear antibodies Antibody combined with nuclei

Anti-CCP Antibody

X-rays Swelling of soft tissue, loss of bone

density Bone scans

Detect inflammation MRI

Synovitis, inflammation in other organs

DiagnosisLab Tests Rheumatoid

Arthritis

•Medications

•Nonpharmacologic Therapies

•Surgery

Treatment

TreatmentMedications

NSAIDsTarget pain and inflammationCan be hard on the stomach

and GI tractAcetaminophen

Pain onlyTopical pain relievers

Pain onlyCorticosteroids

Relieve inflammation quicklyGood for RADon’t use frequently

Disease-modifying antirheumatic drugs (DMARDs)

TreatmentNonpharmacologic TherapiesHypnosisAromatherapySupplements

Fish oilPhysical Therapy

Electrical Stimulation

ExerciseWeight lossPatient Education

Splints/assistive aidsEssential Oils

Rub on hands and put rubber gloves on and soak on warm water 5-10 minutes

MeditationReduced pain in

56% of participantsHot & Cold

treatments

Joint replacementImproved movementPain reliefImproved joint alignment

Arthroscopic surgeryNot very beneficial for arthritis

Youtube-Fight arthritis pain

TreatmentSurgery

RA can affect cardiac and pulmonary function. Could cause vasculitis.

Fear of joint pain or harming jointJoint ROM restrictionInability to perform rapid repetitive movementsDeconditioned joints-swelling decreases

performance“out of shape”Increased resting energy expenditure (REE) as

much as 50%

Effects of Exerciseability to exercise

Effects of Exerciseability to exercise

Other diseases (i.e. diabetes, obesity, heart disease)

Improve cardiovascular status, balance, flexibility and general health

Decreased joint swellingImprove:

FunctionMoodQOLMobility

Increased social and physical activity

Reduced depression and anxiety

Every 1 lb lost is 4lbs off your knees!

Associated with…

Submaximal testsTreadmill (<3mph)Cycle ergometer

Suspected cardiopulmonary disease-do a different test1 rep maxLow intensity intiallyROM (goniometery)Gait analysis- for those with severe diseaseAvoid morning exercise (especially with RA)Spinal involvement may cause nerve disfunctionAvoid vigorous and high repetitive exercises with

unstable joints

Exercise Testing

Methods Suggested Tests

Strength Repetition Max (1, 8, or 12)

Endurance 6 min walkAerobic capacity (REP 6-20)

Flexibility (helpful in preventing injury)

Goniometry (ROM, symmetry)

Functional Balance tests, gait analysis

Exercise TestingRecommendations

Goniometry Testing

•Tests Range of Motion (ROM)

•Progression of disease

•Lack of progression of therapy

NormsJoint Flexion Extension

Hip 115-125° 10-30°

Knee 135-150° 0 - -10°

Ankle 0-10°(dorsiflexion)

20-30° (plantarflexion)

Shoulder 160-180° 40-60°

Stretching and warm-up always (even on days when there is a flare up)

Use weight-bearing, partial weight-bearing and non-weight-bearing exercises

Recommend learning a strength routineAvoid activities that increase joint painPost-exercise soft tissue discomfort is

expected

Exercise PrescriptionRecommendations

Do’sLow-impactMuscle are

strengthened before increase in intensity

flexibility/ROMProper shoesSeveral short sessions if

necessaryAlternate exercise

modesTime goals (not distant)

Stop and go movementsProlonged one –legged

stanceStair climbingContact sportsOverstretching &

hypermobilityIf pain or swelling-

reduce load on jointDon’t encourage client

to exceeding guidelines

Exercise PrescriptionRecommendations

Don’ts

Modes Intensity Frequency Duration

Aerobic 40-60% VO2max 3-5 days/week 5-10 min build to 30 min sessions

Strength 1 or more sets of 2-3 reps, building to 10 reps

2-3 days/week ------

Flexibility Before aerobic or strength activities

Exercise PrescriptionACSM guidelines

Arthritis is characterized by swelling in the joint(s).Osteoarthritis, rheumatoid arthritis are most

common.It is often common in people with other

conditions such as heart disease, obesity, and diabetes.

Exercise helps decrease symptoms and is affective for and increase in QOL.

Exercise Rx should include a variety of modes of exercise and flexibility.

Low-impact exercises are best

Summary

ReferencesBrittain, D.R., Gyurcsik, N.C., McElroy, M., Hillard, S.A. (2011).

Woman’s Health Issues. (issue 1, vol. 21).www.youtube.com/watch?v=0dUSmaev5b0&feature=relatedwww.youtube.com/watch?v=u8bV5eV-wFQhttp://en.allexperts.com/q/Etymology-Meaning-Words-1474/

arthritis.htmJanssen, I. I., & Mark, A. E. (2006). Separate and combined influence

of body mass index and waist circumference on arthritis and knee osteoarthritis. International Journal of Obesity, 30(8), 1223-1228. doi:10.1038/sj.ijo.0803287

www.cdc.gov/arthritis/resources/quickstats.htmwww.arthritistoday.orgwww.nejm.org/doi/full/10.1056/NEJMoa0708333www.cdc.govwww.lhup.edu/yingram/jennifer/webpage/homepage2.htm