1. Yr. disease began

2. Joints involved

3. Sudden v. Gradual 

4. Single epi v. Progres remmison

5. Systemic problems

6. Hospitalization

7. Drug Mangement (steroid use)

8. Pian control 

9. Exercise history

10. Previous intervention

11. Surgical 

12. Goals 

1. Duration of morning stiffness 

-how are you when first get up? 

-how are you 5 min later?

-RA last > 1 hr, OA < than 30min

2. Grip strength

-may be affected by time of day

-look for changes in grip 

-BP cuff for grip testing 

3. # of actively inflammed joints

-Effusion, Temp, color, tenderness, stess pain

4. Blood SED rate(inflammation)

5. VAS

6. QOL questionnaire

7. Stress pain(@ limit of ROM)

1. Rist sign is loss of ROM

(stiffness, instability/lossening, bone on bone, damage, deformity)

2. Quantifying Damage

(radioligical, count damged jts)

3. Damage-Duration Index

(#damage/#year had dx) 

ADL-walking, climbing stairs, transfers, self feeding, washing, dressing, grooming, toileting. 

IADL- Hosusework, Work tasks, hobbies, transportation

1. AROM/PROM

-Avoid hyperextesnion, NWB positon, may have hypermobility

2.MMT-grade valid only if no pain

3. Musc. Lenght testing

4. Edema (girth, volumetric)

5. Gen. aeorobic cond ass. 

Common Impairments of Artheritic Joints (4)

1. Impaired mobility

-capsular pattern w/ firm end feel

-dec. jt play

-jt effusion 

-jt damage

2. Impaired mm. performance

-dec. flex, mm length, strength, asymmetrical mm pull 

3. Impaired balance (altered or dec. input from joint mechanoreceptors)

4. Functional limitations (Dec. ability to carry out home, community, work realtaed and social actiites)

Rheumatoid Arthritis

-chronic systemic inflammatory disorder

-symmetical polyarthartis

Clinical Presentation of RA 

Symmetrical Polyarthritis 

1. MCP, PIP hands

2. wrists, elbows, shoulders

3. MTP, talonavicular and ankle

4. Primarily peripheral joints but may involve the spine

5.Cerv spine-atlantoaxial sublux

RA Onset

Abrupt or insidious- btw 15-50

Jt stiffness w/ activity 

Joints Damage (RA) 

Irreversiable, pannus formation

-jt surfaces gets eaten away 

RA Hand Deformities(4)

1. MCP sublux

2. Swan-neck & Boutonniere 

3. MTP sublux- hammer toes 

4. Flexion deformites elbow&knee

Progression of RA(4)

1. Progressive detoriation & decline in functions(mm changes)

2. Fatigue, anorexia, wt loss, low grade fever 

3. Tendon RA nodules 

4. Skin(nodules-ulna, heels, base of skull)

Vascular problems of RA

1. Raynauds

2. Vasculitis-Inflammed BV

3. Ulcers 

Ocular Problems- RA (2)

1. Scleritis 

2. Decreased tears 

Oral- Dec. saliva (1st pt digestion)

Cardiac- pericarditis 

1. inflammation of cricoarytenoid joints (hoarseness, dysphagia)

2. pleurisy 

3. Intrapulmonary RA nodules 

4. Lung fibrosis 

1. Entrapment neuropathy @wrist: carpal tunnel- Median nerve 

2. Entrapment ulnar nerve

3. Peripheral neuropathies