1. Conditions in Occupational Therapy 5th edition Ben J
Conditions in Occupational Therapy 5th edition Ben J. Atchison and Diane Powers Dirette _____________________________________________________________________ Chapter 23: Rheumatic Diseases

2. Rheumatic Diseases Description and Definitions
Rheumatoid Arthritis
Usually impacts same joint on both sides
Erosions/ periarticular sinuses in affected joints
Subchondral cysts
Severe periarticular bone fragmentation
Osteoarthritis
Degenerative joint disease
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3. Rheumatic Diseases Description and Definitions, cont’d
Osteoarthritis, cont’d
Inflammation of bone / joints
Primary OA: wear / tear over time
Secondary OA: injury / insult to joint
Fibromyalgia
Widespread pain / tender points
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4. Rheumatic Diseases Description and Definitions, cont’d
Gout
Primary impact: 1st metatarsophalangeal joint
“unwalkable disease”
Also impacts: elbows / interphalangeal joints of hands
Systemic Lupus Erythematosus
Autoimmune disease
Skin rash
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5. Rheumatic Diseases EtiologyRA
Genetic + eviromental factors
Formation of synovitis / tenosynovitis if left untreated
Infectious agents into synovial tissues = chronic inflammation
Formation of pannus; substance that destroys soft tissue
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6. Rheumatic Diseases Etiology
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7. Rheumatic Diseases Etiology
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8. Rheumatic Diseases Etiology, cont’dOA
Polygenic hereditary + environment
General aging
Chondropenia
Degradative enzymes in synovial fluid
Fibromyalgia
Disabling pain / tenderness; muscles, joints, tendons
Unclear etiology
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9. Rheumatic Diseases Etiology, cont’d
Fibromyalgia, cont’d
Theory: genetics + immunological + hormonal
Without joint inflammation
Gout
Crystallization of uric acid in joints
Diet high in purines, rise in blood uric acid
Hyperuricemia
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10. Rheumatic Diseases Etiology, cont’d
Fibromyalgia, cont’d
Theory: genetics + immunological + hormonal
Without joint inflammation
Gout
Crystallization of uric acid in joints
Diet high in purines, rise in blood uric acid
Hyperuricemia
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11. Rheumatic Diseases Etiology, cont’d
Systemic lupus erythematosus
Unclear etiology
Autoimmune disorder
Impact on joints similar to RA
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12. Rheumatic Diseases Incidence and PrevalenceRA
Affects 1% of world pop
Prevalence increases with age
Dx between age 40 – 70
Equally affects all races, ethnic groups, gender
Juvenile rheumatoid arthritis = onset < age 16 OA
10% - 15% world pop
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13. Rheumatic Diseases Incidence and Prevalence, cont’d
OA, cont’d
~ 27 million in US
Knee most common site
47% women vs 40% men
Hands
9.7% women vs 4% men
Hip OA African American men 32.2% (highest)
Knee OA Chinese women 46.6%
Hand + hip OA Caucasians 47%
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14. Rheumatic Diseases Incidence and Prevalence, cont’d
Fibromyalgia
Often accompanied with RA / OA
1% - 4.7% worldwide
More common in women
US: .5% men vs 3.4% women
Gout
Most common form of inflammatory arthritis
1% - 4% worldwide
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15. Rheumatic Diseases Incidence and Prevalence, cont’d
Gout, cont’d
8.3 million in US
Men and African Americans mostly affected
Systemic lupus erythematosus
Frequency decrease of new cases
Northern Ireland highest prevalence
Caribbean descent highest incidence / prevalence
Females 6x > males
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16. Rheumatic Diseases Signs and SymptomsRA
1 joint or polyarticular
Symmetrically / asymmetrically
Fatigue / generalized weakness
Loss of ROM
Joint edema
Joint guarding
Contractures, subluxation, ankylosis
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17. Rheumatic Diseases Signs and Symptoms, cont’d
RA, cont’d
Swanneck deformity
Boutonniere deformity
Abnormal gait pattern, (hip involvement) OA
Localized pain at particular joint
Edema / tenderness
Joint stiffness post prolonged inactivity (sleeping)
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18. Rheumatic Diseases Signs and Symptoms, cont’d
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19. Rheumatic Diseases Signs and Symptoms, cont’d
OA, cont’d
Postactivity flare-up (pain / edema)
Crepitus
ROM guarding
Fibromyalgia
Chronic widespread pain
Point tenderness
Lower abdomen cramps
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20. Rheumatic Diseases Signs and Symptoms, cont’d
Fibromyalgia, cont’d
Depression
Poor sleep, fatigue, headaches
Signs can occur unilaterally / bilaterally
Chest, upper back, neck, buttocks, arms, shoulders
Gout
Joint inflammation
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21. Rheumatic Diseases Signs and Symptoms, cont’d
Gout, cont’d
Symptoms: more intermittent vs progressive
Left untreated = quite destructive
Edema, erythema, increased localized temp
Most often big toe affected
Feet, ankles, wrist, hands, elbows, knees
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22. Rheumatic Diseases Signs and Symptoms, cont’d
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23. Rheumatic Diseases Course and PrognosisRA
Function declines with severity
20% adults remission 1st yr
Majority will dev chronic progressive disease
70% - 90% of JRA satisfactory recovery; small chance of recurrence as adult
Women dx prior age 50 worst prognosis dev severe / chronic form of RA
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24. Rheumatic Diseases Course and Prognosis, cont’dOA
Faster progression in distal joints
Greater BMI = rapid progression
Osteophytes and sclerosis = greater progression
Joint replacement improves prognosis
Fibromyalgia
Non-progressive
Can begin widespread or unilaterally to bilaterally
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25. Rheumatic Diseases Course and Prognosis, cont’d
Gout
Untreated = very progressive / destructive to joints
Tx early = long-term effects can be eliminated
Episodic and chronic
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26. Rheumatic Diseases Medical / Surgical ManagementRA
Managing factors:
Pain / joint stiffness
Reduce edema
Preserve normal joint function
Min medication side-effects
Maintaining ADL independence
Disease-modifying antirheumatic drugs (DMARD)
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27. Rheumatic Diseases Medical / Surgical Management, cont’d
RA, cont’d
Glucocorticosteroids
Tumor necrosis factor (TNF) inhibitor OA
Nonsteroidal anti-inflammatory drugs (NSAIDs)
COX-inhibiting nitric oxide donators (CINODs)
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28. Rheumatic Diseases Medical / Surgical Management, cont’d
Fibromyalgia
NSAID
Opioids
Most effective: antidepressants / neuromodulating antiepileptic medications
Gout
NSAIDs
Xanthine oxidase inhibitors (XOI) tx hyperuricemia
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29. Rheumatic Diseases Impact on Occupational Performance
Mobility
Gripping feeding utensils
Loss of leisure participation
Sexual activity
Pet care
Work performance
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