Patient Management Strategies in Arthritis
Presented by: Anna Mae Smith, MPAS, PA-C
Lock Haven University of PA
Physician Assistant Program
DJD/Osteoarthritis
* Obesity
o increase in body mass
o altered biodynamics of gait
o genetic predisposition (genetically obese mice are susceptible to osteoarthritis)
o altered metabolism (e.g., estrogens)
Risk Factors
* Occupational
Treatment
* Physical measures may be subdivided into..
o Exercise
o Supportive devices
o Alterations in activities of daily living
o Thermal modalities
Exercise
* Associated with reduced pain & improved function.
o Passive range of motion
o Rest periods
o Active: range of motion, isometric, isotonic, isokinetic
* Improved muscle tone reduces muscle spasm and prevents contractures. It is theorized that improved muscle support of the joint will retard the progression of osteoarthritis.
Which Exercises
* Swimming
* Biking (Stationary)
* Walking
Support Devices & Orhotics
* Devices such as canes, forearm crutches, crutches, and walkers can improve balance and decrease pain.
* The total length of a properly measured cane should be equal to the distance between the upper border of the greater trochanter of the femur and the bottom of the heel of the shoe. This should result in elbow flexion of about 20°.
* The cane should be held in the hand contralateral to and moved together with the affected limb. The healthier limb should precede the affected limb when climbing up stairs; when climbing down stairs, the cane and the affected limb should be advanced first. The cane can unload the affected hip by 60%.
Modified activities of daily living
* Proper positioning and support when sitting, sleeping or driving a car
* Adjusting ways of performing such activities as getting dressed, etc.
* Adjusting furnishings around the house or at work (e.g., raising the level of a chair or toilet seat)
Thermal modalities
* Superficial heat (e.g., hot packs, paraffin baths)
* Deep heat (e.g., ultrasound)
* Cold applications (e.g., cold packs, vapocoolant sprays)
HEAT
* The therapeutic value of applying heat includes decreasing joint stiffness, alleviating pain, relieving muscle spasm, and preventing contractures.
* The use of heat is contraindicated over tissues with inadequate vascular supply, bleeding, or cancer. Heat should also be avoided in areas close to the testicles or near developing fetuses.
Miscellaneous
* Pulsed electromagnetic fields
* TENS
* Acupuncture
* Chiropractic
* Spa, massage, and yoga therapy
Short acting drugs
Long Acting Agents
Hyaluronic Acid Derivatives
DIET
* Avoid coffee, artificial additives, red meats & processed foods
* Limit tomatoes,potatoes,eggplants, peppers, & simple carbohydrates(white flour & refined sugar).
* Fresh fruits & veges, complex carbs, wheat germ & oily fish
* Vit. A 10,000iu/day
* Vit. C 2grams/day
* Vit. E 600iu/day
* Vit. B6 50 mg/day
First-line therapy
* Anti-inflammatories
* Aspirin
* Nonsteroidal anti-inflammatory
Second Line Therapies
* Antimalarials (chloroquine, hydroxychloroquine)
* Sulfasalazine
* Methotrexate
* Gold salts
* Auranofin
* Parenteral gold
* D-penicillamine
* Azathioprine
* Cyclosporin A
* Combination therapies
* Corticosteroids
* Systemic steroids
* Low-dose oral
* Parenteral pulse steroids
* Intra-articular
Investigational
* EPA (eicosapentaenoic) - anti-inflammatory effect of fish oil fatty acid
* Plant seed oils particularly those extracted from evening primrose oil and borage seed oil that contain large amounts of gamma linolenic acid.
Light Therapy
* Extracorporeal photochemotherapy and extracorporeal protein A immunoadsorption
Vitamins
* Vit. C 2grams/day
* Vit. E 600iu/day
* B complex vitamin
* Calcium 1200-1500/day
* Selenium 100mg/day
* Zinc 30mg/day
Hydrotherapy
* Cold compresses when acutely inflamed followed by alternating hot & cold
* Massage - lavender, tiger balm & chamomile oils
Herbs
* Black cohosh
* Wild yam
* Willow bark
* Licorice
Patient Management Strategies in Arthritis.ppt
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