Rheumatoid diseases Exercise therapy Systemic autoimmune diseases Rheumatoid arthritis -Juvenile arthritis -Systemic lupus erythematodes -Sclerodermia -Sjogren syndrom - Polymyalgia rheumatica Spondylartritis -Ancylosing spondylitis -Psoriatic arthritis Crystal arthritis -Gout -Chondrocalcinosis (calciumpyrophosphates) Artritis in connection with infection -Lyme´s boreliosis -Septic arthritis Rheumatoid arthritis Chronic autoimmune disease -Chronic polyarthritis -Bone errosions -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 Basic feature: hypervascularisation tissue – pannus formation in a joint leading to damage of hyaline cartilage, decalcination and bone errosions R 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 Deformities in the hand Swan neck deformity Z deformity of the thumb Ulnar deviation of fingers Synovitis of MCPh, DIP joints Digiti telescopici Button hole deformity Ruka- revmatická2 Ruka-revmatická3 Radial deviation of the wrist joint Volar subluxation of the wrist Dorsal prominence of the head of ulna Hand in RA X ray • X ray Ruka- revmatická1 X ray X ray Carpal tunnel syndrom Compresion neuropaty of median nerve Pain Hypotrophy of thenar muscles Limited muscle power Limited pinch and grasp Parestesia, tingling and itching Tenderness Tinnel sign Phalen test Ruka-karp Guyon canal syndrom Compression of ulnar nerve near os pisiforme Symptoms: - Parestesia in ulnar side - Hypotrophy of hypothenar muscles -Tenderness in region of os pisiforme Therapy: local corticoid, NSA surgery Ruka- anatomie2 Therapy of rheumatoid arthritis •Complex •pharmacological: NSAID, glukocorticoids, DMARDs •Physical therapy : to maintain ROM •social program – job, pension •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 -biological: 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 of tendons Th.- synovectomy Rheumatoid arthritis 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) 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 disease 50 times more 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 Obr. 21 Páteř- Bechtěrev Clinical examination Bolesti zad- Bechtěrev 1 Restricted movements in the spine Schober, Thomayer, bending Exspirium- inspirium rib cage circumference less than 4 cm Limited rotation in cervical spine Hyperkyphosis Fleche- distance Th spine- wall Entesitis Daktylitis X ray Bolesti zad- Bechtěrev 2 Bamboo rod Sacroilitis Rectangular shape of vetebras Syndesmophytes Fusion of apophyseal joints Bamboo rod Rhisomelic form Bolesti zad- Bechtěrev3 Obr. 2 Management NSAID Glucocorticoids DMARDs syntetic biologic Physical therapy Surgery: replacement surgery in spine