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LEARNING OBJECTIVES

  1. Discriminate between the epidemiology, pathophysiology, disease course, and clinical manifestations of two common rheumatic diseases: rheumatoid arthritis and osteoarthritis.

  2. Identify the medical (clinical) diagnostic procedures commonly used in the examination of patients with arthritis, including laboratory tests and imaging.

  3. Apply common principles of medical and rehabilitation management to the plan of care for individuals with rheumatoid arthritis and osteoarthritis.

  4. Identify and understand when, why, and how to apply and interpret clinical examination and outcome measures commonly used in assessing individuals with rheumatoid arthritis or osteoarthritis.

  5. Describe environmental, psychosocial, and other personal factors associated with arthritis that affect participation, adherence to treatment, achievement of anticipated goals, and expected outcomes.

  6. Explain the importance of a team-based chronic disease management approach for persons with arthritis.

  7. Analyze and interpret patient data, formulate realistic intervention goals and outcomes, and develop a plan of care when presented with a clinical case study.

The terms arthritis, rheumatism, and rheumatic disease are generic references to an array of more than 100 diseases that are divided into 10 classification categories. Two major forms of arthritis are considered in this chapter. Rheumatoid arthritis (RA), a systemic inflammatory disease, and osteoarthritis (OA), a more localized process that has been known previously as degenerative joint disease (DJD). Rheumatoid arthritis and osteoarthritis account for most arthritis cases treated by physical therapists.

RHEUMATOID ARTHRITIS

RA is a major subclassification within the category of diffuse inflammatory connective tissue diseases that also includes juvenile idiopathic arthritis, systemic lupus erythematosus (SLE), progressive systemic sclerosis or scleroderma, polymyositis, and dermatomyositis. RA is primarily a disease of the synovium. The first clinical description of RA is attributed to A. J. Landré-Beauvais in 1800, although analysis of pictorial art of the late Renaissance suggests the existence of RA in earlier times. Early descriptions of patient symptomatology were complicated by the lack of uniform agreement about the distinguishing disease characteristics, given its wide spectrum of clinical presentations. The term rheumatoid arthritis was first used by Sir Alfred Baring Garrod in 1858 but was not accepted by the American Rheumatism Association (ARA) as the official terminology until 1941.1 Diagnostic criteria and terminology have been developed and, in some cases, revised based on current data.2,3

Epidemiology

The estimated prevalence of RA among adults in the United States is approximately 1.3 million,4 and its prevalence increases with age. Women are affected two to four times more often than men. Differences in prevalence exist among certain subpopulations, which suggest a possible role for genetic or environmental factors in the etiology of the disease. For example, African Americans have a lower prevalence of RA than Caucasians, whereas several Native American groups demonstrate higher prevalence rates. There also is a lower prevalence of RA in native Japanese and native Chinese peoples compared to Caucasians.4,5

Etiology

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