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Arthritis. One of the most common conditions afflicting Canadians Most common cause of long term disability 4.5 million Canadians are affected 1500 Children in Quebec >100,000 Canadians are diagnosed with arthritis every year By 2026, 20% of the population will have some form of Arthritis

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Arthritis

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Arthritis

  • One of the most common conditions afflicting Canadians

  • Most common cause of long term disability

  • 4.5 million Canadians are affected

  • 1500 Children in Quebec

  • >100,000 Canadians are diagnosed with arthritis every year

  • By 2026, 20% of the population will have some form of Arthritis

  • Disease takes many forms and afflicts all ages, more so with age

  • Causes pain stiffness and sometimes swelling in or around the joint

  • Name “arth” meaning joint, “Itis” meaning inflammation

  • More than 100 types of arthritis

  • Not all associated with inflammation-> redness, swelling, heat emanating from the joint

  • Divided into 2 categories ->Inflammatory and Degenerative arthritis


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FeaturesInflammatory ArthritisDegenerative Arthritis

Who Gets it? Starts middle age 30-40

Can start at any age More common as we age

Cause?Body’s immune system Degeneration of cartilage

attacks the joints

Autoimmune

How does it start? Fairly quickly Slowly

How many joints?Many joints Few Joints SymmetricalAsymmetrical

Which Joints?Small joints of the hands and feetEnd joints of the fingers

Wrists, elbows, Larger weight bearing Shoulders, Kneesjoints

Hips Any joint Knees and hips, spine


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FeaturesInflammatory ArthritisDegenerative Arthritis

Usual Symptoms?Joint pain, swelling, tenderness,With use affected joints

redness of jointsmay become stiff, painful and Prolonged morning stiffness enlarged

Fever, weight loss, fatigue, Symptoms local

anaemia SYSTEMIC

Morning Stiffness>60 minutes>20 minutes

ExamplesRheumatoid & Psoriatic Arthritis Osteoarthritis

Ankylosing spondylitis

Systemic lupus erythematosus

Treatment options?NSAIDS, DMARDS,Analgesics

MedicationsSteroids BiologicsNSAIDS Steroid Injections

Steroid injections Viscosupplementation

Other treatments Exercise, Hot & Cold, TNS,Joint Protection

Managing Arthritis Surgery


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Common Types of Arthritis

  • Osteoarthritis

  • Rheumatoid Arthritis

  • Psoriatic Arthritis

  • Gout

  • Ankylosing Spondylitis

  • Fibromyalgia

  • Systemic Lupus Erythematosus (Lupus)

  • Polymyalgia Rheumatica

  • Polymyositis

  • Infectious Arthritis


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Diagnosis

  • History

  • Physical examination

  • Blood Analyses

    • Full blood count

      • Red blood cells-anemia

      • White blood cells=infection

    • Erythrocyte Sedimentation Rate (ESR)

      • Measures the stickiness of the red blood cells with a raised ESR suggests inflammation

    • Uric acid->forms crystals in the joints

    • Rheumatoid Factor->antibody that appears in the blood in some people with arthritis (can be found in low levels in normal people)

  • Joint fluid analyses

    • Synovial fluid studies

  • Biopsy

  • X-ray

    • Early stages completely normal


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Osteoarthritis

  • Most Common form of arthritis

  • Affects 3 million Canadians

  • Progressive destruction of the articular cartilage

  • Formation of new bone at the margins of the joint (osteophytes)

  • Chief complaints->pain, stiffness, deformity and loss of function

  • Referred to as the “wear and tear” of joints

  • Most commonly seen in the hips, knees and the spine

  • Cartilage wears off the end of the bone and then it hurts with every step

Obesity:

  • Overweight people are at greater risk for developing OA than people of average-weight

  • Weight-reduction is likely to cause reduction in OA symptoms.

  • Weight-bearing joints have strong correlation with obesity.

  • Surprisingly, OA of hand also has positive association with obesity, making it a systemic risk factor for OA.


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Rheumatoid Arthritis

  • Most common type of Inflammatory Arthritis

  • Auto-immune disease

  • Immune system, for unknown reasons, attacks a person’s own cells inside the joint capsule-Intense inflammation in the synovium

  • Inflammation results in warmth, redness, swelling and pain->typical symptoms of RA

  • During the inflammation process, the normally thin synovium thickens resulting in a joint that is swollen and puffy to the touch

  • As RA progresses these abnormal synovial cells begin to invade and destroy the cartilage and bone within the joint

  • Surrounding muscles, ligaments and tendons that support and stabilize the joint become weak and unable to work normally

  • 3X as common in women as Men

  • Peak onset between 30 and 50

  • Can destroy the joint-most destructive kind of arthritis

  • Often associated with deformities-must seek medical attention


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Psoriatic Arthritis

  • Inflammatory, associated with Psoriasis

  • Afflicts up to 30% of people with Psoriasis

  • Equal numbers of men and women

  • Appears between the ages of 20 and 50

  • Localized mild or generalized disabling

  • Fingers, wrists, toes, knees, ankles, elbows, shoulders, spine, SI joint

  • Asymmetrical


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Crystal ArthritisGout

  • Crystals

  • Inflammation within the joint space

  • Sudden onset

  • Metabolic disorder ->build up of uric acid in the blood and crystals form in the joints

  • Disease of life style, affected by:

    • body weight, diet and alcohol

    • Ratio male to female 6:1

  • Treatment;

    • acute->drugs to block inflammatory the reaction

    • non-acute -> drugs to decrease uric acid production


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Ankylosing Spondylitis

  • Chronic inflammatory arthritis

  • Affects spinal and Sacro-iliac joints

  • Affects 1 in 100 people

  • Onset between 15 and 40 years of age

  • Men affected 3x as often as women

  • Cause unknown, runs in families


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Fibromyalgia

  • Chronic pain condition affecting the soft tissues-muscles ligaments tendons

  • Pain is in all 4 quadrants of the body

  • Affects 3 in 100 people

  • Women affected 4x more often than men

  • Can occur at all ages, more frequently over 50

  • Associated with sleep disorders

  • Diagnosed by the process of elimination and the presence of tender spots 11 out of a possible 18

  • No joint destruction

  • Cause unknown

  • Often associated with many other symptoms

  • No cure


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Lupus (SLE)

  • Autoimmune disease

  • Inflammation in skin, muscles or joints

  • Heart, lungs, kidneys, blood vessels or nervous system can be attacked

  • Affects 1 in 2000

  • Women 10X more than men

  • Onset between 15 and 45

  • Cause unknown, some have family members with the disease

  • Often affects women during childbearing years


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Polymyalgia Rheumatica

  • Pain in many muscles

    • Poly =many, my = muscle, Algia=pain

  • Inflammatory condition which affects the small blood vessels

  • Symmetrical muscle pain and stiffness in the shoulder and hip girdle “shawl and shorts” distribution

  • Sudden onset

  • Rare under 50 ->average age 70

  • Affects 3 in every 100 people

  • Women 2-3X more than men

  • Diagnosed->High sedimentation rate

  • Treated with corticosteroid medication


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Polymyositis

  • Inflammation in the muscle ->destruction of muscle fibers

  • Occurs at any age 40-60

  • Women >Men

  • Areas affected->upper arms, upper legs, neck hips and shoulders

  • Characterized by muscle weakness->have difficulty getting out of a chair, climbing stairs

  • Slow onset

  • Systemic symptoms->fever, fatigue, weight loss

  • Associated skin changes and other organ involvement

  • Blood tests, EMG, muscle biopsy

  • Treated with corticosteroid medication


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Infectious Arthritis

  • Bacterial infection of the joint, e.g. staph

  • Usually 1 joint involved

  • May be fever with patient feeling ill

  • Usually only one joint involved.. In the largest joints in the body... knee most frequent followed by ankle, wrist, shoulder and elbow

  • Joint is red warm and swollen

  • Treatment with antibiotics


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Management of Arthritis

  • To alleviate pain

  • To prevent further strain or damage to affected joints…slow progression rate

  • To improve movement

  • To improve muscle strength & endurance

  • To maintain or improve functional independence

  • To maximize quality of life


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National Population Health Survey

  • <20% of Canadians with arthritis are active

  • Inactivity is associated with:

    • Decreased Quality Of Life

    • Increased Cardiovascular Risk

    • Increased Disability

  • Physical Inactivity predicts functional loss

  • Physiological aspects of aging + physical inactivity exacerbate arthritis


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Medication

  • Analgesics-> analgesic

  • NSAIDS->analgesic + anti-inflammatory

    • Hours to days, 2-3 weeks

  • DMARDS->symptom and disease control

    • 6 to 8 weeks to work

  • Corticosteroids->Anti-inflammatory

    • Few hours to a few days

  • Biologics->Anti-inflammatory and disease modifying

    • Days to weeks->3 to 6 months


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Nonpharmacologic Therapy

  • Patient Education:

    • Arthritis Self-Help courses administered by Arthritis Foundation

    • Hydrotherapy->aqua fitness

  • Physical Therapy:

    • Pain Control

    • Exercises, modalities( TENS, Heat, Cold)

  • Occupational Therapy:

    • Splints.

    • Ambulation devices (braces, walkers, patellar taping and canes).

    • Lateral heel and sole wedge insoles.

  • Weight Reduction:

    • Referral to Dietitian.

    • Enrollment in aerobic exercise program.


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Protection of Affected Joints

  • Reduction of activities that increase pain

  • Improvement of posture

  • Selection of an appropriate walking aid

  • Orthotics/ Braces

  • Pacing & prioritizing

  • Orthotics

  • An appliance that is applied to a body part to correct a deformity or maintain a body segment (brace, splint innersole)

    • to protect against further injury or pain

    • to assist in movement by reducing the forces placed on a joint


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Why Exercise?

  • Vital to improvement of symptoms

  • Regular physical activity is linked to a wide array of physical and mental health benefits

  • To increase strength, endurance, flexibility, balance and coordination

  • To relieve pain

    • lubricates joints

    • stimulates nerve endings other than pain endings

      Types of exercises

      Range Of Motion Exercises

  • To improve movement, range of joint movement

  • To improve flexibility

    Exercises To Increase Muscle Strength & Endurance

    • Strong muscles maintain good bone position

    • Critical in carrying out everyday activities

  • How To Exercise

  • MODERATION

    • Joint exercised too much->arthritis aggravated

    • Joint exercised too little->motion becomes limited, joints become stiff and more painful


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Aerobic (Cardiovascular) Exercises

  • Persons with arthritis tend to be less fit

  • Evidence to support fitness and endurance

  • Types of exercise:

    • Walking

    • Stationary bicycle

    • Aerobic dancing

    • Aquatic exercise

      • Water pressure and temperature

      • Muscle relaxation

      • Decreased joint compression


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Poor Sitting PostureThe Slouched Position

  • Causes over stretching of posterior spinal ligamentous structures

  • The more flexed the posture the greater the pressure on the discs

  • Causes some back and neck pain and all neck and back pain is aggravated by

    • POOR SITTING POSTURE


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Surgery

  • Patients whose symptoms are not controlled with above interventions and have moderate to severe pain should be considered for surgery.

  • Debridement of the joint.

  • Total/Partial joint arthroplasty.

  • Osteotomy.

  • Arthrodesis.


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