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By: Amelia Clark Definition Epidemiology Symptoms Diagnosis Treatment Effects of Exercise Exercise Testing Exercise Rx Summary/References “Arthon”=joint “itis”=inflammation Inflammation of one or more joints resulting in pain, swelling, stiffness and limited movement. No cure YouTube - osteoarthritis Over 100 types Osteoarthritis (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) Osteoarthritis Commonly affects: hands, spine, hips, knees Primary Normal wear & tear of aging Secondary Heredity, obesity, injury Rheumatoid (RA): inflammation of synovial membrane, formation of pannus tissue, & eventual deterioration of bone and cartilage. Autoimmune disease Other: Juvenile arthritis Ankylosing Spondylitis Lupus fibromyalgia Psoriatic arthritis Gout Pseudogout Commonly affects: Wrists, hands, knees, feet, cervical spine UNITED STATES 1 in 5 adults=46 million More common among women 1 in 250,000 children has arthritis (294,000) Most common cause of disability More than back problems UTAH Adults with arthritis: 399,000 Have arthritis & are overweight/obese: 71% Have arthritis & are physically inactive: 14% Epidemiology Being overweight or obese increases your risk for arthritis. Arthritis is often coupled with diabetes and obesity. Physical activity can help prevent risk of arthritis. Symptoms Risk Factors Swelling Age Pain Genetics Stiffness Overweight/obesity Limited movement Females Fatigue Smokers Redness around joint Previous injury Occupation w/ repetitive movements Diagnosis Medical History Physical Exam Lab Tests Information about your health background Heredity Description of symptoms you’ve been having Details about how and when symptoms began Where? How is it affecting you? Other medical problems? Looks at joints Touches 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 joints ROM Goniometer Examine position & alignment of neck and spine. Watch you walk to see how you are able to move hips and knees. Osteoarthritis Rheumatoid Arthritis Joint aspiration extracts fluid for evidence of crystals or joint deterioration 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 X-ray see damage to bone MRI see soft tissue and cartilage NEW! MRI measures GAGs & early detection Treatment •Medications •Nonpharmacologic Therapies •Surgery NSAIDs Disease-modifying Target pain and inflammation Can be hard on the stomach and GI tract Acetaminophen Pain only Topical pain relievers Pain only Corticosteroids Relieve inflammation quickly Good for RA Don’t use frequently antirheumatic drugs (DMARDs) Hypnosis Splints/assistive aids Aromatherapy Essential Oils Supplements Fish oil Physical Therapy Electrical Stimulation Exercise Weight loss Patient Education Rub on hands and put rubber gloves on and soak on warm water 5-10 minutes Meditation Reduced pain in 56% of participants Hot & Cold treatments Joint replacement Improved movement Pain relief Improved joint alignment Arthroscopic surgery Not very beneficial for arthritis Youtube-Fight arthritis pain RA can affect cardiac and pulmonary function. Could cause vasculitis. Fear of joint pain or harming joint Joint ROM restriction Inability to perform rapid repetitive movements Deconditioned joints-swelling decreases performance “out of shape” Increased resting energy expenditure (REE) as much as 50% Associated with… Other diseases (i.e. diabetes, obesity, heart disease) Improve cardiovascular status, balance, flexibility and general health Every 1 lb lost is 4lbs off your knees! Decreased joint swelling Improve: Function Mood QOL Mobility Increased social and physical activity Reduced depression and anxiety Submaximal tests Treadmill (<3mph) Cycle ergometer Suspected cardiopulmonary disease-do a different test 1 rep max Low intensity intially ROM (goniometery) Gait analysis- for those with severe disease Avoid morning exercise (especially with RA) Spinal involvement may cause nerve disfunction Avoid vigorous and high repetitive exercises with unstable joints Methods Suggested Tests Strength Repetition Max (1, 8, or 12) Endurance 6 min walk Aerobic capacity (REP 6-20) Flexibility (helpful in preventing injury) Goniometry (ROM, symmetry) Functional Balance tests, gait analysis Goniometry Testing •Tests Range of Motion (ROM) •Progression of disease •Lack of progression of therapy Joint 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 nonweight-bearing exercises Recommend learning a strength routine Avoid activities that increase joint pain Post-exercise soft tissue discomfort is expected Do’s Don’ts Low-impact Stop and go movements Muscle are strengthened Prolonged one –legged before increase in intensity flexibility/ROM Proper shoes Several short sessions if necessary Alternate exercise modes Time goals (not distant) stance Stair climbing Contact sports Overstretching & hypermobility If pain or swelling-reduce load on joint Don’t encourage client to exceeding guidelines 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 23 reps, building to 10 reps 2-3 days/week ------ Flexibility Before aerobic or strength activities 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 Brittain, 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=related www.youtube.com/watch?v=u8bV5eV-wFQ http://en.allexperts.com/q/Etymology-Meaning-Words-1474/arthritis.htm Janssen, 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.htm www.arthritistoday.org www.nejm.org/doi/full/10.1056/NEJMoa0708333 www.cdc.gov www.lhup.edu/yingram/jennifer/webpage/homepage2.htm