Overview Definitions Epidemiology Clinical Aspects Treatment Effects of Exercise Testing Prescription Conclusion References Definitions Osteoarthritis OA Chronic deteriorative disease of cartilage in joints allowing bones to contactrub causing inflammation Result of agin ID: 775443
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Slide1
Patric Delquadro
Arthritis
Overview
Definitions
Epidemiology
Clinical Aspects
Treatment
Effects of Exercise
Testing
Prescription
Conclusion
References
Slide3Definitions
Osteoarthritis (OA)
– Chronic deteriorative disease of cartilage in joints allowing bones to contact/rub causing inflammation. Result of aging, genetics, previous injuries, and overuse.
Rheumatoid
Arthritis (RA) -
Chronic autoimmune disease were the body’s immune system, for reasons unknown, attacks the synovial lining surrounding joints causing
inflammation and destruction of joint cartilage.
Slide4OA Video
http
://
www.youtube.com/watch?v=0dUSmaev5b0
RA Video
http
://
www.youtube.com/watch?v=AYTutNDWPKg
Epidemiology
Arthritis
More than 100 different forms of arthritis
1 in 7 Americans have at least 1 type of arthritis
Osteoarthritis
1 in 12 Americans affected
Signs start showing after age 45
More common in men >55, women <55
Rheumatoid Arthritis
Close to 1% of
Americans affected
Affects women 3 X to men
Slide7Symptoms
Osteoarthritis (OA)
Symptoms include:
Stiffness and deep underlying ache or pain in joints
Warmth, swelling, and/or redness around joint (inflammation)
Reduced ROM
Usually felt in early morning, during/post activity, & inactivity
Late Stages
Bony spurs called
Heberden’s
nodes develop
Audible grinding or crackling noise from
joint (crepitation)
Joint
deformation
Spurring or crystallization of bone and/or cartilage
Osteoarthritis Images
Slide9Symptoms Continued
Rheumatoid Arthritis (RA)
Many of the same symptoms as OA with the exception of:
Joint pain is generally equal on both sides of body
Prolonged early morning stiffness
Greater joint deformation and rheumatoid nodules
RA is Systemic
Rheumatoid factor affects the whole body
Numbness or tingling of the hands and feet
Eye burning, chest pain, and/or dry-mouth
Damage to
cardiorespiratory
tissue
Fever and fatigue
Slide10Rheumatoid Arthritis Images
Slide11Test and Evaluation
Physical Exam
A traditional physical exam is performed on patients with any type of arthritis
Special attention is given to:
Joint movement and function
Visual appearance noting inflammation, redness, nodes etc.
History of symptoms and discomfort
Listening for crepitation
Blood testing does little to determine if the patient has arthritis.
Slide12Laboratory Diagnosis
Osteoarthritis
Joint aspiration
Synovial fluid
drawn from the joint is examined for deterioration
X-ray
Less invasive and helpful
for observing cartilage and bone
health
Rheumatoid arthritis
Rheumatoid factor (RF) test
Blood sample is taken and RF levels are evaluated
MRI or Ultrasound
Same purpose as x-ray, more detailed and convenient
Slide13Complications
Physically
Large joints like knees, shoulders, hips and back/neck are usually most affected by arthritis. This limits physical activity and daily tasks.
Joints in hands and feet also become problematic causing issues with balance, gait, and tasks requiring grip strength.
Emotionally
Physical appearance can be detrimental to the persons confidence and emotion wellbeing.
Being limited and in pain can cause a person to give up on exercise leading to a sedentary lifestyle.
Slide14Treatment
The best medicine for any type arthritis is…. STAYING ACTIVE!!!
By staying active, joints, bones and muscles are worked encouraging repair and growth.
Patients are asked to work through the initial morning pain and discomfort and participate in moderate exercise.
Over the counter pain relievers: Acetaminophen (Tylenol)
NSAID’s: ibuprofen, aspirin, and naproxen
Slide15Treatment Continued
RA preventative treatments
Disease modifying
antirheumatic
drugs (DMARDs):
Rheumatrex
,
Arava
,
Gold sodium
thiomalate
DMARDs target immune processes that cause
inflammation
and are administered via
IV, injection, pill
Corticosteroids: Prednisolone
These treatments are also used in severe cases of
OA
Slide16Treatment Continued
Physical therapy
Strengthens muscle and improves ROM
Educates patient with usable exercise routines
Surgery
Arthroscopic surgery
Partial and full joint replacements for knees, shoulders, hip, ankle, and elbow.
Alignment surgery (knee, elbow, tarsals)
Fusion (spine, ankle)
Slide17Effects of Exercise
Capable of improving all system functions
Improves joint ROM, stability, and function
Decreases inflammation and pain in joints
Creates positive social wellbeing and outlook on life
Increases activity and productivity
Slide18Ability to Exercise
Special Considerations
Joint stability must be planned for and monitored
Only low impact exercises should be used
Allow ample time for warm-up/cool down, especially early day
Progression in exercise intensity should be gradual
Progression in duration before intensity
Good shock absorbing shoes should be worn during exercise
Risk and issues increase with overweight/obese clients
Medications and Exercise
No exercise specific side-affects with DMARDs
Methotrexate
Increased bruising, nausea, decrease in
energy
Arava
Increased bruising, chest pain, numbness and weight loss
Gold sodium
thiomalate
Abdominal pain, shortness of breath, and bruising
Slide20Exercise Testing
Methods
Measures
Strength
Repetition Max
(1, 8, or 12 reps)
Isometric knee extension
Standardized functional
measures
Timed chair rise
Timed up and go
Endurance
6
min walk
Cycle Ergometer
HR
Flexibility
Goniometry
Functional
ROM
Assess Symmetry
Slide21Exercise Prescription
Frequency, Intensity, Time an Type (FITT)FITT principles apply same as a healthy individual
Resistance
Aerobic
Flexibility
Frequency
2-3 day/week
3-5
day/week
Daily
Intensity
S
tart @ 10% Max
Increase 10% (Max) weekly
60-80% HR peak
Pain
Dependent
Tension (not pain)
Time
10-15
rep warm-up
3-5 exercises
5-10 reps (tolerable)
5-10 min warm-up
20-30
min (tolerable)
5-10 min
Beginning
of day
Pre/Post
Exercise
Type
Circuit
training
Free/Machine Weights
Elastic bands
Isometric
Low
resistance
Walking
Cycling
Water aerobics
ROM joint
stretching
All major muscles
Slide22Importance of Flexibility at 80
http
://
www.youtube.com/watch?v=UQASHZMeMnk
Summary and Conclusion
OA is the most common type of arthritis
Deteriorative disease of joint cartilage
Most times age dependent
No cure, only temporary relief or invasive
surgery
RA is less common but with more complications
Autoimmune disease attacks the synovial lining around joints
Not age dependent
Detrimental to other systems of the body
Medications can be used to slow disease progression
Slide24References
Byk
, C. (2008). Osteoporosis: An Exercise Guide. El Paso:
Workfit
Consultants.
M.D., G. C. (2008). The Arthritis Handbook. New York, NY :
DiaMedica
.
M.D., T. L. (2003). Living with
Rheumatiod
Arthritis. Baltimore, MD: Johns Hopkins Press.
Medicine, A. C. (2010). ACSM's Guidelines for Exercise Testing and
Perscription
(8th ed.). Baltimore, MD:
Wolters
Kluwer.
Medicine, U. N. (2012, March 21). Medline Plus. Retrieved March 21, 2012, from http://www.nlm.nih.gov/medlineplus/arthritis.html