Rheumatoid diseases Exercise therapy Rheumatoid diseases Systemic autoimmune and inflammatory diseases -immune system attacks healthy cells in the body -causing inflammation (painful swelling) -mainly attacks the joints, usually many joints at once. Rheumatoid arthritis -Juvenile arthritis -Systemic lupus erythematodes -Sclerodermia -Sjogren syndrom Vasculitis - Polymyalgia rheumatica Spondylartritis -Ancylosing spondylitis -Psoriatic arthritis Other arthritis - Crystal arthritis -Gout -Chondrocalcinosis (calciumpyrophosphates) Artritis in connection with infection -Lyme´s boreliosis -Septic arthritis Rheumatoid arthritis Chronic autoimmune disease -Chronic polyarthritis -Bone erosions -Destruction of joints -Disability- low physical activity -Extraarticular symptoms -Comorbidities, higher mortality -1% of population -Female 4 times more affected -Onset in 4. and 5. decade C:\Users\PC\Pictures\RA inflamace.png Basic feature: hypervascularisation tissue – pannus formation in a joint leading to damage of hyaline cartilage, decalcination and bone errosions R C:\Users\PC\Pictures\RA- panus.jpg Pannus formation C:\Users\PC\Pictures\R.A. postup.jpg Progression of RA C:\Users\PC\Pictures\RA lokalizace.jpg Localisation of RA Hand Oedema Rheumatoid nodes Synovitis, synovial hyperplasia Ulnar deviations of fingers Z deformity of the thumb Swan neck deformity Button hole deformity Volar subluxation of the wrist joint C:\Users\PC\Pictures\RA uzly.jpg Deformities in the hand Swan neck deformity Z deformity of the thumb Ulnar deviation of fingers Synovitis of DIP Digiti telescopici Button hole deformity Ruka- revmatická2 C:\Users\PC\Pictures\RA ruka 2.jpg Ruka-revmatická3 Radial deviation of the wrist joint Volar subluxation of the wrist Dorsal prominence of the head of ulna Hand in RA C:\Users\PC\Pictures\RA ruka 4.jpg X ray • X ray Ruka- revmatická1 C:\Users\PC\Pictures\RA ruka 3.jpg X ray Therapy of rheumatoid arthritis •Complex •pharmacological: NSAID, glukocorticoids, DMARDs •Physical therapy : to maintain ROM •social program – job, rent •surgery : to maintain biological joint • replacement • Management The aim: to achieve long lasting remision or at least low level of activity of the disease NSAID- Cox 1 a Cox 2 DMARD- disease modifying antirheumatic drugs -syntetic: metotrexat, leflunomid, sulfasalazin, hydroxychlorochin -biologic: infliximab, etanercept, adalimumab, golimumab abatacept, tocilizumab Glukocorticoids: hydrocortizon, prednison, dexametason, betametazon, methylprednisolon, triamcinolon Surgery •Synovectomy •Suture of tendons •Artrodesis- fusion •Atlantoaxial fusion •Osteotomy •Joint replacement Ruka- synovectomie Synovectomy of MP joints and capsular plasty Silastik - replacement Ruka- Silastic Silastik - replacement Silastik – replacement Ruka-Silastic po op Silastic joints Preop postop. Wrist fusion •10-15 st. dorsiflexion •5-10 st. ulnar deviation Synovialitis: Elbow Shoulder IV joints C1-C2- axial instability Hips Knee joints Ankle joints Small joints of the foot Tenosynovialitis Rheumatoid arthritis C:\Users\PC\Pictures\RA noha 2.jpg Psoriatic arthritis In 20% of psoriatic patients Seronegative arthritis associated with psoriasis Peripheral joints (artritis DIP, telescoping fingers, oligoarthritis hips, knee, shoulder ) Axial skeleton- spondylarthritis ( sacroileitis, spondylitis, severe destructions) Entesitis ( Achillis tendon, plantar aponeurosis, pelvis) Dactylitis ( Wurstfinger) C:\Users\PC\Pictures\psoriasis 1.jpg C:\Users\PC\Pictures\psoriasis 2.jpg C:\Users\PC\Pictures\psoriasis 3.jpg Localisation Peripheral joints artritis DIP, telescoping fingers, oligoarthritis hips, knee, shoulder Axial skeleton- spondylarthritis sacroileitis, spondylitis, severe destructions Entesitis - Achillis tendon, plantar aponeurosis, pelvis Dactylitis - Wurstfinger C:\Users\PC\Pictures\psoriasis 4.jpg C:\Users\PC\Pictures\psoriasis 5.jpg Management of psoriatic arthritis NSAID Glukocorticoids DMARDs – syntetic (metotrexat, sulfasalazin, leflunomid, cyklosporin) biologic- infliximab, etanercept, adalimumab aj. Surgery- replacement, synovectomy, fusion Ankylosing spondylitis Bechtěrev disease Chronic affection involving SI joints, vertebral column, less peripheral joints Sacroileitis, entesitis Back pain Other locations: uveitis, skin, lung, eye HLA B27 antigen positive increases the risk of AS 50 times 0,5 % of population Female: male 3:1 Symptoms: back pain, gluteal region, entesitis of ligaments and tendons rhisomelic form (hips, shoulders) peripheral arthritis- knee, dactylitis Ancylosing spondylitis Onset in SI joints Progress into lumbar, thoracic, cervical spine Onset- 20-40 years Back pain, heel pain, effusion in knee joints. Progressive limitation of movements in the spine Increased thoracic kyphosis, diaphragma breathing Ancylosis of intervertebral joints Ancylosis of costovertebral joints Ossification of disc, ligaments Páteř- Bechtěrev C:\Users\PC\Pictures\MB 1.jpg Ancylosing spondylitis Onset in SI joints Progress into lumbar, thoracic, cervical spine Onset- 20-40 years Back pain, heel pain, effusion in knee joints. Progressive limitation of movements in the spine Increased thoracic kyphosis, diaphragma breathing Ancylosis of intervertebral joints Ancylosis of costovertebral joints Ossification of disc, ligaments C:\Users\PC\Pictures\MB2.jpg Ancylosing spondylitis Onset in SI joints Progress into lumbar, thoracic, cervical spine Onset- 20-40 years Back pain, heel pain, effusion in knee joints. Progressive limitation of movements in the spine Increased thoracic kyphosis, diaphragma breathing Ancylosis of intervertebral joints Ancylosis of costovertebral joints Ossification of disc, ligaments C:\Users\PC\Pictures\MB10.jpg C:\Users\PC\Pictures\MB8.jpg Clinical examination Bolesti zad- Bechtěrev 1 Restricted movements in the spine Schober, Thomayer, bending Exspirium- inspirium less than 4 cm Limited rotation in cervical spine Hyperkyphosis Fleche Entesitis daktylitis C:\Users\PC\Pictures\MB5.jpg Clinical examination Bolesti zad- Bechtěrev 1 Restricted movements in the spine Schober, Thomayer, bending Exspirium- inspirium less than 4 cm Limited rotation in cervical spine Hyperkyphosis Fleche Entesitis daktylitis C:\Users\PC\Pictures\MB4.jpg X ray Bolesti zad- Bechtěrev 2 Bamboo rod Sacroilitis Rectangular shape of vetebras Syndesmophytes Fusion of apophyseal joints Bamboo rod C:\Users\PC\Pictures\MB9.jpg hyperkyphosis Bolesti zad- Bechtěrev3 C:\Users\PC\Pictures\MB8.jpg Rosary sign Ancylosis Risomelic form Management NSAID Glucocorticoids DMARDs syntetic biologic Physical therapy Surgery: replacement surgery in spine Nik_0011