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postheadericon What Is Spondyloarthropathy

Article by Janet Meydam

What Is Spondyloarthropathy – Health

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If you are experiencing joint pain for the first time and have seen a rheumatologist for the first time, you may have received a diagnosis of spondyloarthropathy or spondyloarthrosis. What is it? What type of arthritis do you have?Your doctor may have given you a vague description or may have said you have some symptoms but they don’t quite fit other arthritis diagnoses. That is the case with spondyloarthropathy, usually called undifferentiated spondyloarthropathy. You have some symptoms that fit an arthritis diagnosis, but those symptoms aren’t severe enough or in enough parts of your body to allow your doctor to make another diagnosis. The symptoms are enough, however, to allow your doctor to make the diagnosis of spondyloarthropathy.This diagnosis is often a starting point for patients. As you work with your doctor and he or she gets to know you and your symptoms better, he or she may change your diagnosis. As your symptoms develop, he or she may also change your diagnosis. The results of your lab tests and imaging tests may also affect your diagnosis. It often takes several visits to the doctor and many tests before an arthritis diagnosis is confirmed. This is especially true of a seronegative diagnosis, where no positive results are found in your blood and your diagnosis is made on symptoms and physical changes.A diagnosis of spondyloarthropathy often is changed later on to a diagnosis of one of the spondyloarthritis diseases, including ankylosing spondylitis, psoriac arthritis, or several others. Symptoms of spondyloarthropathy may also be similar to rheumatoid arthritis and your diagnosis may be changed to this later on as well. Some people with this diagnosis never develop more advanced symptoms and they continue to be treated for undifferentiated spondyloarthropathy. Symptoms are usually chronic and regular, but are not severe. Treatment involves conservative medication, plus pain management techniques including plenty of rest, regular exercise, and energy conservation techniques.Receiving this diagnosis may be frustrating, but remember that accurate medical management of arthritis takes time and patience. For more information on spondyloarthropathy and the spondylitis family of arthritic diseases, visit the Spondylitis Association of America at http://www.spondylitis.org.

About the Author

Janet Meydam is an Occupational Therapist with 20 years of experience in the field. View her website, Online Occupational Therapist, for useful information on a variety of health related topics. http://onlineoccupationaltherapist.com

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whereby the original author’s information and copyright must be included.

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postheadericon Various Types of Arthritis

Arthritis is a disease that causes pain and loss of movement of the joints. Joint pain is referred to as arthralgia. Arthritis is the leading cause of disability in people over the age of 55. The causes of arthritis depend on the form of arthritis. Causes include injury (leading to osteoarthritis), abnormal metabolism (such as gout and pseudogout), inheritance, infections, and for unclear reasons (such as rheumatoid arthritis and systemic lupus erythematosus). There are many forms of arthritis .There are about 200 different kinds of arthritis. The most common type is osteoarthritis (or degenerative arthritis), where the cartilage that protects the bones gets worn away. This makes joints stiff, painful and creaky. About 5 million people in the UK have osteoarthritis. OA is a chronic degenerative arthropathy that frequently leads to chronic pain and disability. With the aging of our population, this condition is becoming increasing prevalent and its treatment increasingly financially burdensome. Using radiographic criteria, the distal and proximal interphalangeal joints of the hand have been identified as the joints most commonly affected by OA, but they are the least likely to be symptomatic. Age is the most consistently identified risk factor for OA, regardless of the joint being studied. Prevalence rates for both radiographic OA and, to a lesser extent, symptomatic OA rise steeply after age 50 in men and age 40 in women. Occupation-related repetitive injury and physical trauma contribute to the development of secondary (non-idiopathic) OA, sometimes occurring in joints that are not affected by primary (idiopathic) OA, such as the metacarpophalangeal joints, wrists and ankles.

Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder. Rheumatoid arthritis occurs when the body’s defence mechanisms go into action when there’s no threat and start attacking the joints and sometimes other parts of the body. RA affects 2.1 million Americans, or about 1% of the adult population in the United States. This disease is 2 to 3 times more common in women than in men, and generally affects people between the ages of 20 and 50. However, young children can develop a form of RA called juvenile rheumatoid arthritis. Two of the 100 types of arthritis are rheumatoid arthritis and lupus. There are specific symptoms, distinguishing characteristics, as well as overlapping symptoms associated with rheumatoid arthritis and lupus. Rheumatoid arthritis is an additive polyarthritis, with the sequential addition of involved joints, in contrast to the migratory or evanescent arthritis of systemic lupus erythematosus or the episodic arthritis of gout. Occasionally, patients experience an explosive polyarticular onset occurring over 24 to 48 hours. Morning stiffness, persisting more than one hour but often lasting several hours, may be a feature of any inflammatory arthritis but is especially characteristic of rheumatoid arthritis. Its duration is a useful gauge of the inflammatory activity of the disease.

Psoriatic arthritis is related to the skin condition psoriasis. It occurs more commonly in patients with tissue type HLA-B27. There are five clinical patterns of psoriatic arthritis. First is Asymmetrical mono- and oligoarticular arthritis (30-50% of cases) is the most common presentation of psoriatic arthritis. Second is symmetrical polyarticular arthritis (30-50% of cases) is ultimately the most common form of psoriatic arthritis. Third is distal interphalangeal (DIP) joint involvement (25% of cases) is nearly always associated with nail manifestationsm. Fourth is Arthritis mutilans is affects less than 5% of patients and is a severe, deforming and destructive arthritis. This condition can progress over months or years causing severe joint damage. Fifth is Axial arthritis (30-35% of cases) may be different in character from ankylosing spondylitis, the prototypical HLA-B27-associated spondyloarthropathy. It may present as sacro-iliitis, which may be asymmetrical and asymptomatic, or spondylitis, which may occur without sacro-iliitis and may affect any level of the spine in “skip” fashion. Genetic factors appear to play an important role. There is a 70% concordance for psoriasis in monozygotic twins. There is a 50-fold increased risk of developing psoriatic arthritis in first-degree relatives of patients with the disease. Environmental factors have been implicated. Streptococcal infection can precipitate the development of guttate psoriasis. HIV infection can present with both psoriasis and psoriatic arthritis, as well as worsen existing disease.

Gout is one of the most painful types of arthritis. Gout was once incorrectly thought to be a disease of the rich and famous, caused by consuming too much rich food and fine wine. Gout is a disease due to a congenital disorder of uric acid metabolism. Uric acid is produced when purines are broken down by enzymes in the liver. Purines can be generated by the body itself (via the breakdown of cells in normal cellular turnover) or can be ingested in purine-rich foods (e.g. seafood, beer). Gout usually attacks the big toe (approximately 75% of first attacks), however it can also affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and spine. In some cases the condition may appear in the joints of the small toes which have become immobile due to impact injury earlier in life, causing poor blood circulation that leads to gout. Chronic gout can lead to deposits of hard lumps of uric acid in and around the joints, decreased kidney function, and kidney stones. An acute attack of gout is a highly inflammatory arthritis often with intense swelling, redness and warmth surrounding the joint. The inflammatory component is so intense, an acute attack of gout is often mistaken for a bacterial cellulitis. Gout is mainly treated with anti-inflammatory drugs. Corticosteroids (also called steroids), may be prescribed for people who cannot take NSAIDs. Steroids also work by decreasing inflammation. Steroids can be injected into the affected joint or given as pills. Colchicine is often used to treat gout and usually begins working within a few hours of taking it.

Septic arthritis also known is Pyogenic arthritis. Septic arthritis is infection, usually bacterial, in the joint cavity. Septic arthritis usually affects just one joint, though occasionally it may occur in more than one joint at a time. It is the most dangerous form of acute arthritis. The joint cavity is usually a sterile space, with synovial fluid and cellular matter including a few white blood cells. Many different types of bacteria (germs) can cause septic arthritis. Infection with a bacterium called Staph. aureus is the most common cause. Septic arthritis is inflammation of a synovial membrane with purulent effusion into the joint capsule, usually due to bacterial infection. This disease entity also is referred to in the literature as bacterial, suppurative, purulent, or infectious arthritis. The most common bacterial isolates in native joints include gram-positive cocci, with S. aureus found in 40% to 50% of the cases. Septic arthritis is uncommon from age 3 to adolescence. Children with septic arthritis are more likely than adults to be infected with group B streptococcus and Haemophilus influenza. Young children and older adults are most likely to develop septic arthritis. As the population ages, doctors are finding that septic arthritis is becoming more common. Symptoms of septic arthritis occur suddenly and are characterized by severe pain, swelling in the affected joint along with acute pain. Chills and fever are also common symptoms. Chronic septic arthritis (which occurs less frequently) is caused by organisms such as Mycobacterium tuberculosis and Candida albicans. The knee and the hip are the most commonly infected joints.

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postheadericon Knee Arthritis

Rheumatoid arthritis of the knee

Further information: Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disorder that most typically affects the small joints in your hands and feet. This form of arthritis is the most common and is found in the same areas as RA. It worsens over time and as with RA, there is no cure. RA tampers with the lining of the joints and causes swelling that is painful and can lead to joint deformity in the body. It begins by attacking the smaller joints of the body and progresses into the shoulders, elbows, hips, and knees. Most cases will see the condition affect both knees. Symptoms include joint pain, swelling, red and puffy hands, and fatigue.

Osteoarthritis of the knee

Further information: Osteoarthritis

Osteoarthritis is a joint disease that causes the cushion layer between your bones, or cartilage to wear away. It is also called degenerative joint disease. Symptoms are similar to RA and develop in the same slow manner. They include pain, tenderness in the knee, stiffness when standing or walking, loss of flexibility, and grating sensations that can be heard when the knee joint is used.

Osteoarthritis in the knee begins with the gradual deterioration of cartilage. Without the protective cartilage, the bones begin to rub together, causing pain, loss of mobility, and deformity. It affects approximately 16 million people. The majority of arthritis cases involving the knee are osteoarthritic cases.

Causes

It is not always sure why arthritis of the knee develops. Most physicians believe that it is a combination of factors that can include muscle weakness, obesity, heredity, joint injury or stress, and aging. Cartilage in the knee begins to break down and leaves the bones of the knee rubbing against each other as you walk. Persons who work in a place that applies repetitive stress on the knees are at a high risk of developing this condition. Bone deformities increase the risk for RA of the knee since the joints are already malformed and contain defective cartilage. Having gout, rheumatoid arthritis, Paget’s disease of bone or septic arthritis can increase your risk of developing osteoarthritis.

Treatment

Depending on the level of pain and damage suffered by a patient, a physician will recommend a treatment regimen that will relieve symptoms. Some of the most common recommendations include avoiding activities that make the pain worse, ice the knee for 20 to 30 minutes throughout the day to reduce inflammation, use over the counter anti-inflammatory medications, and physical therapy.

Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Physical therapy and exercise are often effective in reducing pain and improving function. Working with a physical therapist to find exercises that promote function without risking further injury is effective for most patients. Many of the exercises used can be performed while sitting in a chair or standing in place. They are performed so that additional stress or weight is not placed on the knee joint. Water exercises are highly recommended along with the use of elastic bands.

Supportive devices like knee braces can be used. In most cases, the arthritis is centered on a single side of the knee, so braces are effective in providing stability to one side. Two different forms of braces are available. A support brace provides the aid the entire knee requires, where an up-loader brace shifts the pressure away from the specific part of the knee that is experiencing the pain. Shoes or inserts that are considered to be energy absorbing are found useful for some patients as well as walking devices like a cane.

The use of oral steroids and anti-inflammatory medicines help to reduce the amount of inflammation and pain felt in the knee. If over the counter medicines like ibuprofen or naproxen are not strong enough, prescription strength medicines are used. If oral medicine and physical therapy don’t help your knee enough, your doctor may consider giving you an injection with pain medicine. Hyaluronic acid is present in the knee, but injections of it can be used to protect the joint when the acid becomes thinner and can’t do it alone. These injections can provide more pain relief than oral medications lasting from six months to a year.

Surgery is the final option but may be required to relieve symptoms. Arthroscopy is performed through tiny cuts where damaged parts of the knee can be removed. Osteotomy is performed to reshape the bones in the knee and is only performed if one side of the knee is damaged. Arthroplasty is a replacement surgery where an artificial joint is used.

Notes

^ Arthritis Causes, Symptoms, Diagnosis and Treatment Information on MedicineNet.com, Retrieved on 2010-01-22.

^ Rheumatoid Arthritis – Mayoclinic.com, Retrieved on 2010-01-22.

^ Osteoarthritis of the knee – familydoctor.org, Retrieved on 2010-01-22.

^ What is Osteoarthritis Retrieved on 2010-02-08

^ How Osteoarthritis Affects Your Knee – WebMD.com, Retrieved on 2010-01-22.

^ Osteoarthritis: Risk Factors – MayoClinic.com, Retrieved on 2010-01-22.

^ Arthritis of the Knee – American Academy of Orthopaetic Surgeons, Retrieved on 2010-01-22.

^ Osteoarthritis of the Knee: Treatment – Familydoctor.org, Retrieved on 2010-01-22.

v  d  e

Musculoskeletal disorders: Arthropathies (M00-M19, 711-719)

Arthritis

(monoarthritis/

polyarthritis)

Inflammation

(Neutrophilia)

Infectious

Septic arthritis  Tuberculosis arthritis  Reactive arthritis (indirectly)

Noninfectious

Seronegative spondyloarthropathy: Reactive arthritis  Psoriatic arthritis  Ankylosing spondylitis

Rheumatoid arthritis: Juvenile idiopathic arthritis  Adult-onset Still’s disease  Felty’s syndrome

Crystal arthropathy: Gout  Chondrocalcinosis

Noninflammatory

Osteoarthritis: Heberden’s node  Bouchard’s nodes

Other

hemorrhage (Hemarthrosis)  pain (Arthralgia)  Osteophyte  Hypermobility  villonodular synovitis (Pigmented villonodular synovitis)  Joint stiffness

joint navs: anat, non-congenital arthropathies/deformities/dorsopathies/soft tissue arthropathy/congenital, eponymous signs, proc

v  d  e

Inflammation

Acute

Plasma derived mediators

Bradykinin  complement (C3, C5a, MAC)  coagulation (Factor XII, Plasmin, Thrombin)

Cell derived mediators

preformed: Lysosome granules  vasoactive amines (Histamine, Serotonin)

synthesized on demand: cytokines (IFN-, IL-8, TNF-, IL-1)  eicosanoids (Leukotriene B4, Prostaglandins)  Nitric oxide  Kinins

Chronic

Macrophage  Epithelioid cell  Giant cell  Granuloma

Processes

Traditional: Rubor  Calor  Tumor  Dolor (pain)  Functio laesa

Modern: Acute-phase reaction/Fever  Vasodilation  Increased vascular permeability  Exudate  Leukocyte extravasation  Chemotaxis

Specific types

Nervous

CNS (Encephalitis, Myelitis)  Meningitis (Arachnoiditis)  PNS (Neuritis)  eye (Dacryoadenitis, Scleritis, Keratitis, Choroiditis, Retinitis, Chorioretinitis, Blepharitis, Conjunctivitis, Iritis, Uveitis)  ear (Otitis, Labyrinthitis, Mastoiditis)

Cardiovascular

Carditis (Endocarditis, Myocarditis, Pericarditis)  Vasculitis (Arteritis, Phlebitis, Capillaritis)

Respiratory

upper (Sinusitis, Rhinitis, Pharyngitis, Laryngitis)  lower (Tracheitis, Bronchitis, Bronchiolitis, Pneumonitis, Pleuritis)  Mediastinitis

Digestive

mouth (Stomatitis, Gingivitis, Gingivostomatitis, Glossitis, Tonsillitis, Sialadenitis/Parotitis, Cheilitis, Pulpitis, Gnathitis)  tract (Esophagitis, Gastritis, Gastroenteritis, Enteritis, Colitis, Enterocolitis, Duodenitis, Ileitis, Caecitis, Appendicitis, Proctitis)  accessory (Hepatitis, Cholangitis, Cholecystitis, Pancreatitis)  Peritonitis

Integumentary

Dermatitis (Folliculitis)  Cellulitis  Hidradenitis

Musculoskeletal

Arthritis  Dermatomyositis  soft tissue (Myositis, Synovitis/Tenosynovitis, Bursitis, Enthesitis, Fasciitis, Capsulitis, Epicondylitis, Tendinitis, Panniculitis)

Osteochondritis: Osteitis (Spondylitis, Periostitis)  Chondritis

Urinary

Nephritis (Glomerulonephritis, Pyelonephritis)  Ureteritis  Cystitis  Urethritis

Reproductive

female: Oophoritis  Salpingitis  Endometritis  Parametritis  Cervicitis  Vaginitis  Vulvitis  Mastitis

male: Orchitis  Epididymitis  Prostatitis  Balanitis  Balanoposthitis

pregnancy/newborn: Chorioamnionitis  Omphalitis

Endocrine

Insulitis  Hypophysitis  Thyroiditis  Parathyroiditis  Adrenalitis

Lymphatic

Lymphangitis  Lymphadenitis

Categories: Aging-associated diseases | Arthritis | Inflammations | Rheumatology | Skeletal disorders

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postheadericon How Experts Erase Heel Pain

The diagnosis of heel pain is best done by looking at the location of the pain… “where does it hurt?”

Heel pain can occur in two major locations: the back of the heel and the bottom of the heel.

Pain at the back of the heel has three major causes.

Achilles tendonitis is the most common. It is usually the result of injury or overuse. An example is the weekend warrior who decides to go out and run 4 or 5 miles going up hills… or a person who goes on a long walk in flat shoes, shoes with little or no heel. In both cases, stress is placed on the Achilles tendon- the large thick cord located in the back of the heel.

This tendon- the largest in the body- connects the gastrocnemius (calf) muscle to the back of the heel.

The likelihood of Achilles tendonitis developing is increased if a person has flat feet. Older patients taking corticosteroid medications and people treated wtih quinolone antibiotics like ciprofloxacin (Cipro) also are at increased risk of Achilles tendonitis and even Achilles tendon rupture.

Haglunds syndrome presents with a bony bump located at the back of the heel. A bursa (small sack of fluid) located near the bump may contribute to the swelling. The Achilles tendon insertion near the bony swelling may become inflamed. Because of the location, this syndrome is often referred to as “pump bumps” and the cause often attributed to womens’ shoes.

Inflammation of the Achilles tendon at its insertion into the heel can be seen with certain types of arthritis, specifically the spondyloarthropathy group which consists of Reiter’s disease, psoriatic arthritis, and ankylosing spondylitis. Other signs of disease such as low back pain and stiffness, rash, and joint swelling may provide clues to diagnosis.

Pain in the bottom of the heel is usually due to plantar fasciitis.

Pain in the plantar fascia presents with sharp stabbing pain in the bottom of the heel. Plantar fasciitis is a common problem that is due to repetitive trauma to the soft tissue in the heel.

Typically a patient will feel fine so long as they are lying down or sitting. But if they get up to walk, the pain feels like an ice pick is being jammed into the bottom of the heel.

This pain gets better over several minutes but occurs again after inactivity followed by weight-bearing.

Causes of plantar fasciitis include:

? An abrupt increase in activity
? Worn footwear,
? Footwear with no arch support (eg., flip-flops)
? Obesity
? Recent rapid weight gain such as with pregnancy
? Overuse as in excessive running and over-training
? Systemic inflammatory arthritis (particularly ankylosing spondylitis and other spondyloarthropathies such as Reiter’s disease and psoriatic arthritis).

Treatment involves first establishing the diagnosis. Most of the time, the diagnosis can be suspected by the history and physical examination.

Imaging tests such as diagnostic ultrasound and magnetic resonance imaging can confirm the diagnosis, if necessary. X-rays may reveal the presence of a heel spur. A heel spur, by itself, is not the cause of pain in the bottom of the heel and heel pain should not be attributed to “a heel spur”.

Once the diagnosis has been made, treatment options include:

? Identifying likely causative factors such as excessive weight, inappropriate footwear, and errors in training.

? Non-steroidal anti-inflammatory drugs (NSAIDs) sometimes provide symptomatic relief.

? Therapeutic taping gives short-term symptom relief.

? Exercises to stretch the heel cord and plantar fascia.

? Orthotic devices can help in the short-term reduction of pain. These can be off-the-shelf or custom made. For people with Achilles tendonitis, having the patient wear a lift in the shoe to elevate the heel will help reduce symptoms.

? Glucocorticoid (steroid) injection may also work for plantar fasciitis and should be used if the patient has not responded to conservative measures. The use of diagnostic ultrasound to guide the injection is recommended.

Caution should be observed with the Achilles tendon as far as steroid injection. The tendon can be weakened if steroids are directly injected. This then can lead to Achilles rupture.

The bursitis that occasionally accompanies Achilles tendonitis (retrocalcaneal bursitis) will respond to steroid injection.

If a patient is taking a quinolone antibiotic (such as ciprofloxacin), it should be discontinued and the patient should be monitored for tendonitis and tendon rupture.

Night time braces are sometimes used for plantar fasciitis.

Often the best treatment for heel pain, whether it is located in the back or on the bottom, is rest.

A surgical solution should be considered for those patients with intractable pain which remains despite conservative treatment.

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postheadericon Ankylosing Spondylitis and Physiotherapy

Physio Treatment in Ankylosing Spondylitis
by Jonathan Blood Smyth

Ankylosing spondylitis is an inflammatory arthritic disease or spondyloarthropathy, classified with reactive arthritis, bowel disease arthritis and psoriatic arthritis. The underlying relationships between these diseases are complex but they are connected by enthesitis (inflammation of the ligament/bone junctions) and by possession of the HLA B27 gene on white blood cells. The enthesitis process at the joint edges can cause fibrosis and then ossification of the area (bone formation).

AS is the commonest of the spondyloarthropathies and its occurrence varies with the occurrence of the HLA B27 gene in the population, AS being less common in the tropics and more common in northern European countries. 0.1 to 1.0% of people are affected but this varies with latitude and is more common in white people. About 1-2% of people with the HLA B27 gene actually develop AS but this becomes 15-20% likelihood if they have a first degree relative with the disease.

Three males to every one female is the ratio of patients with Ankylosing spondylitis, as female patients may have much less obvious symptoms and so be missed from the diagnosis. Young men are the commonest presenting group with most consulting a doctor before they are 40 and up to 20% before they are sixteen years old. 25 years is the average age that someone goes down with the symptoms and is uncommon to find a diagnosis of AS in a person over fifty. It is easily overlooked as it can look like mechanical back pain if care is not taken. On questioning how they are in the morning, a typical answer is very stiff.

Ankylosing spondylitis has similarities but distinct differences from the much more common low back pain:

Morning stiffness in the lumbar spine, lasting at least 30 minutes or longer  Exercise improves the back pain and stiffness  Rest worsens the pain and stiffness  Pain is usually worse in the second half of the night, after a time of rest  Peripheral joints are affected in 30 to 50% of patients  Tiredness is common  AS has systemic affects from its inflammatory nature which can include feeling unwell, fever and loss of weight.

Physiotherapy examination of the spine in an AS patient usually uncovers significantly reduced ranges of spinal movement from normal, with perhaps a reduced lumbar lordosis and an increased thoracic curve. Neck movements may also be limited in later stages and a reduction in chest expansion noted due to rib joint involvement. Peripheral symptoms occur in around a third of patients and the physio will palpate the tender areas, searching for evidence of enthesitis in the insertions of the Achilles tendon and plantar ligament of the foot. These are areas of high mechanical stress and commonly affected.

Postural analysis of the AS patient is the first thing a physiotherapist notes after the subjective examination, recording spinal abnormalities, flexed knees, rounded shoulders or poking head posture. The ranges of movement of the cervical, thoracic and lumbar spine are measured and a battery of standard measures taken which allows assessment of the disease progression. The hips or other peripheral joints may be affected and these need to be measured also, with the physio likely testing out sites where the enthesis is likely to be painful and inflamed. If the disease is active then the patient may also have joint effusions and may appear unwell, be sweating and not have slept well.

Physiotherapists will concentrate on treating the inflamed areas first such as the areas where the ligaments insert into the bone, using insoles, cold, ultrasound and stretching techniques. Routine spinal range of motion exercises are taught to patients with an emphasis on getting to end ranges, concentrating initially on the anti-gravity muscles such as thoracic and lumbar extensors. Neck rotation and retractions and thoracic rotations are also important functional movements not to lose. Patients should rest themselves in good postures such as prone or supine with only one pillow, to avoid accentuating the typical spinal deformities. Treatment for AS in a hydrotherapy pool is beneficial and soothing and patient education important so they keep up their programme.

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postheadericon Arthritis of the Hip ? Types, Signs and Symptoms, Treatment

Arthritis literally means “inflammation of a joint.” In some forms of arthritis, such as osteoarthritis, the inflammation arises because the smooth covering (articular cartilage) on the ends of bones wears away. In other forms of arthritis, such as rheumatoid arthritis, the joint lining becomes inflamed as part of a systemic disease. These diseases are considered the inflammatory arthritis.

The three most common types of inflammatory arthritis that affect the hip are:

Rheumatoid Arthritis – a systemic disease of the immune system that usually affects multiple joints on both sides of the body at the same time
Ankylosing Spondylitis – a chronic inflammation of the spine and the sacroiliac joint (the point where the spine meets the pelvic bone) that can also cause inflammation in other joints
Systemic Lupus Erythematosus – an autoimmune disease in which the body harms its own healthy cells and tissues

Signs and Symptoms

The classic sign of arthritis is joint pain. Inflammatory arthritis of the hip is characterized by a dull, aching pain in the groin, outer thigh, or buttocks. Pain is usually worse in the morning and lessens with activity; however, vigorous activity can result in increased pain and stiffness. The pain may limit your movements or make walking difficult.

Treatment

Treatment depends on the diagnosis.

Nonsurgical Treatment

If you have an infection in the hip joint, it must be eliminated, either through the use of medications or through surgical draining. Nonsurgical treatments may provide some relief with relatively few side effects or complications:

Anti-inflammatory medications, such as aspirin or ibuprofen, may help reduce the inflammation.
Corticosteroids are potent anti-inflammatories, part of a drug category known as symptom-modifying antirheumatic drugs (SMARDs). They can be taken by mouth, by injection, or as creams applied to the skin.
Methotrexate and sulfasalazine may be prescribed to help retard the progression of the disease. These medications are part of a drug category called disease-modifying antirheumatic drugs (DMARDs). For example, tumor necrosis factor is one of the substances that seem to cause inflammation in people with arthritis. Newer drugs that work against this factor seem to have a positive effect on arthritis in some patients as well.
Physical therapy may help you increase the range of motion, and strengthening exercises may help maintain muscle tone. Swimming is a preferred exercise for people with ankylosing spondylitis.
Assistive devices, such as a cane, walker, long shoehorn, or reacher, may make it easier for you to do daily living activities.
Surgical Treatment

If these treatments do not relieve the pain, surgery may be recommended. The type of surgery depends on several factors, including your age, the condition of the hip joint, the type of inflammatory arthritis you have, and the progression of the disease. Your orthopaedic surgeon will discuss the various options with you. Do not hesitate to ask why a specific procedure is being recommended and what outcome you can expect. Although complications are possible in any surgery, your orthopaedic surgeon will take steps to minimize the risks.

The most common surgical procedures performed for inflammatory arthritis of the hip include:

Total hip replacement is often recommended for patients with rheumatoid arthritis or ankylosing spondylitis because it provides pain relief and improves motion.
Bone grafts may help patients with systemic lupus erythematosus to build new bone cells to replace those affected by osteonecrosis. People with systemic lupus erythematosus have a higher incidence of this disease, which causes bone cells to die and weakens bone structure.
Another option for patients with systemic lupus erythematosus and osteonecrosis is core decompression, which reduces bone marrow pressure and encourages blood flow.
Synovectomy (removing part or all of the joint lining) may be effective if the disease is limited to the joint lining and has not affected the cartilage.

 

A brief synopsis of the Spondyloarthropathy known as Marie Strumple disease. An assignment for PTA 240.
Video Rating: 5 / 5

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postheadericon Ankylosing Spondylitis and Physiotherapy

Physio Treatment in Ankylosing Spondylitis
by Jonathan Blood Smyth

Ankylosing spondylitis is an inflammatory arthritic disease or spondyloarthropathy, classified with reactive arthritis, bowel disease arthritis and psoriatic arthritis. The underlying relationships between these diseases are complex but they are connected by enthesitis (inflammation of the ligament/bone junctions) and by possession of the HLA B27 gene on white blood cells. The enthesitis process at the joint edges can cause fibrosis and then ossification of the area (bone formation).

AS is the commonest of the spondyloarthropathies and its occurrence varies with the occurrence of the HLA B27 gene in the population, AS being less common in the tropics and more common in northern European countries. 0.1 to 1.0% of people are affected but this varies with latitude and is more common in white people. About 1-2% of people with the HLA B27 gene actually develop AS but this becomes 15-20% likelihood if they have a first degree relative with the disease.

Three males to every one female is the ratio of patients with Ankylosing spondylitis, as female patients may have much less obvious symptoms and so be missed from the diagnosis. Young men are the commonest presenting group with most consulting a doctor before they are 40 and up to 20% before they are sixteen years old. 25 years is the average age that someone goes down with the symptoms and is uncommon to find a diagnosis of AS in a person over fifty. It is easily overlooked as it can look like mechanical back pain if care is not taken. On questioning how they are in the morning, a typical answer is very stiff.

Ankylosing spondylitis has similarities but distinct differences from the much more common low back pain:

Morning stiffness in the lumbar spine, lasting at least 30 minutes or longer  Exercise improves the back pain and stiffness  Rest worsens the pain and stiffness  Pain is usually worse in the second half of the night, after a time of rest  Peripheral joints are affected in 30 to 50% of patients  Tiredness is common  AS has systemic affects from its inflammatory nature which can include feeling unwell, fever and loss of weight.

Physiotherapy examination of the spine in an AS patient usually uncovers significantly reduced ranges of spinal movement from normal, with perhaps a reduced lumbar lordosis and an increased thoracic curve. Neck movements may also be limited in later stages and a reduction in chest expansion noted due to rib joint involvement. Peripheral symptoms occur in around a third of patients and the physio will palpate the tender areas, searching for evidence of enthesitis in the insertions of the Achilles tendon and plantar ligament of the foot. These are areas of high mechanical stress and commonly affected.

Postural analysis of the AS patient is the first thing a physiotherapist notes after the subjective examination, recording spinal abnormalities, flexed knees, rounded shoulders or poking head posture. The ranges of movement of the cervical, thoracic and lumbar spine are measured and a battery of standard measures taken which allows assessment of the disease progression. The hips or other peripheral joints may be affected and these need to be measured also, with the physio likely testing out sites where the enthesis is likely to be painful and inflamed. If the disease is active then the patient may also have joint effusions and may appear unwell, be sweating and not have slept well.

Physiotherapists will concentrate on treating the inflamed areas first such as the areas where the ligaments insert into the bone, using insoles, cold, ultrasound and stretching techniques. Routine spinal range of motion exercises are taught to patients with an emphasis on getting to end ranges, concentrating initially on the anti-gravity muscles such as thoracic and lumbar extensors. Neck rotation and retractions and thoracic rotations are also important functional movements not to lose. Patients should rest themselves in good postures such as prone or supine with only one pillow, to avoid accentuating the typical spinal deformities. Treatment for AS in a hydrotherapy pool is beneficial and soothing and patient education important so they keep up their programme.

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