Clinical Cheat Sheet



Rheumatoid ArthritisScreening:Are you stiff in the morning? If yes, how long does this last?Does your stiffness increase after sitting? Does aspirin or ibuprofen help?Where do you think the pain is coming from? If joints, which ones are involved?Do you ever notice any joint swelling or other changes?Does anyone else in your family have RA or other kinds of arthritis?Signs and Symptoms:Abrupt onset of bilateral, symmetrical joint swelling, erythema, and painCommon Sites of Involvement: hands, feet, wrists, shoulders, elbows, hips, knees, ankles. Essentially every joint can be involved. After initial onset, symptoms are insidious and progress slowly. Peak onset 20-50 y/oSoreness, stiffness, tightness in jointsSevere early morning stiffness takes >30-60 minutes to subsideProlonged rest and intense activity aggravate symptomsShort rest and mild activity ease symptomsRed Flags:Joint pain associated with malaise, low-grade fever, anorexia, weight loss, fatigue, nutritional deficiencies, weakness, anemia, enlarged spleen, lymphadenopathyUnexplained joint pain for 1 month or more, especially when accompanied by systemic complaints, skin rash, or extensor nodulesClinical Guidelines:Interdisciplinary approachIncludes: drug therapy, PT and/or OT, and recreational therapyPT examination items:Measurement of independence with functional activities Measurement of joint inflammation and ROMDetermination of limiting factors such as pain, weakness, and fatiguePT intervention items:Energy conservation techniquesTherapeutic positioning to prevent development of deformities (i.e. splinting)Joint protection techniquesPrescription of ambulatory and adaptive devices (may overlap with OT)Pain relief measures: strengthening, exercises for increasing joint extensibility, ice, and heatImprove general fitness and encourage regular exercise at low to moderate aerobic intensityMedical Tests for Screening and Diagnosis:Morning StiffnessArthritis in 3 or more jointsAntinuclear Antibody TiterArthritis of Hand JointsSymmetric ArthritisRadiographic Changes Rheumatoid NodulesSerum Rheumatoid FactorBlood Tests, US, Radiography Squeeze TestMedications:Indications: Aspirins and NSAIDS, corticosteroids, gold, penacillamineDisease Modifying Anti-Rheumatic Drugs - DMARDS (Methotrexate, Sulphasalzine & Hydroxychloroquine)Contraindications:DMARDS blood tests: bone marrow suppression, liver & renal dysfunction Potential Adverse Effects: stomach ulcers (aspirins, NSAIDS), osteoporosis (corticosteroids), impaired renal function (gold, penicillamine), diarrhea and nausea, skin reactions, pneumonitis, immunosuppression (DMARDS) References:Boissonnault WG. Primary Care for the Physical Therapist: Examination and Triage. St. Louis, Missouri: Elsevier, Inc; 2005.Clinical Guideline for the Diagnosis and Management of Early Rheumatoid Arthritis. South Melbourne, Victoria, Australia: The Royal Australian College of General Practitioners; 2009. Available at: . Accessed February 14th, 2015.Dutton M. Dutton’s Orthopaedic Examination Evaluation and Intervention, Third Edition. United States: McGraw-Hill Companies, Inc; 2012: 197-199, 731.Goodman CC. Pathology: Implications for the Physical Therapist, Third Edition. St. Louis, Missouri: Elsevier, Inc; 2009.Rheumatoid arthritis: The management of rheumatoid arthritis in adults. National Institute for Health and Care Excellence Web site. 2014. Available at: . Accessed February 14, 2015.Ryan S. Rheumatoid arthritis diagnosis and management. Practice Nurse [serial online]. June 13, 2014;44(6):36-40. Available at: CINAHL with Full Text, Ipswich, MA. Accessed February 16, 2015. ................
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