MU PT 7890 - Case Management I
Topic: Rheumatology
Objectives: The student will be able to:
1.
Compare and contrast rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis in terms of:
 incidence in the population
 age at onset
 basic pathology
 joint distribution
 clinical features (subjective complaints, objective joint findings, radiological findings)
extraarticular manifestations
 key laboratory tests that support diagnosis
2.
Demonstrate familiarity with the following diseases by a) describing the population affected, b) basic
pathology c) common clinical symptoms, and d) PT management concerns. Be able to write a short
explanatory paragraph suitable for patient education.
1. Systemic Lupus Erythematosus (SLE)
2. Systemic Sclerosis (SSc) “Scleroderma”, and limited cutaneous systemic sclerosis (lcSSc or
“CREST” syndrome)
3. Polymyositis, Dermatomyositis
4. Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA), Temporal Arteritis
5. Fibromyalgia
3.
Associate the following tests or laboratory procedures to common rheumatic diseases with
which they may be strongly associated: (course website: “Lab - Tool Kit”)
1. Rheumatoid factor: RF
2. Antinuclear Antibodies: ANA (Fluorescent ANA = FANA)
3. HLA B27: Human Leukocyte Antigens
4. ESR Erythrocyte Sedimentation Rate & CRP (C-reactive protein):
Uric Acid Crystals (synovial aspiration)
5. WBC levels
4.
Select appropriate evaluation tools, given a patient or case description of a person with a rheumatic
disease. Determine when a comprehensive baseline examination is appropriate. Formulate an
intervention plan that takes into consideration: joint pain, swelling and stability, ROM, joint deformity in
the wrist, hand, knee, ankle, foot; special tests, strength, gait, assistive devices, splints, functional mobility,
footwear, posture, etc.
5.
Demonstrate recognition of categories of drugs commonly prescribed in rheumatic disease, and
problems associated with usage or side effects that should be recognized, discussed with the patient, or
reported by a physical therapist. Appreciate the issue of cost of newer RA drugs, as well as the issue of
inconvenience for medicines given by infusion or injection.
(Arthritis Foundation pamphlets, O’Sullivan p.1070-1071)
6.
Given a patient with signs and symptoms associated with a rheumatic disease, suggest appropriate goals
and long term management strategies that may be worked out with the patient. Outline an appropriate
patient/family education program that would be undertaken by a physical therapist as part of a healthcare team.
Describe general principles of appropriate activity, exercise and rest for an arthritis patient.
 Minor M. Westby M. (2001). Rest and Exercise. Clinical Care in the Rheumatic Diseases. 2nd
ed. ARHP. 26;179-184.
7.
Describe appropriate footwear for a person with arthritis, and accommodations for common deformities.
 Foot and Ankle. Clinical Care in the Rheumatic Diseases. ARHP 3rd ed. 40;267-268:
 O’Sullivan p.1076, p.1079
 course website document
8.
Given a patient with acute pain or with chronic pain and stiffness associated with a rheumatic condition,
suggest modalities. Emphasize modalities that are adaptable for home use. Discuss contraindications.
 Thermal and Electrical Agents. Clinical Care in the Rheumatic Diseases. ARHP. 3rd ed.
38;255-258.
 O’Sullivan p.1077-1078
9.
Outline principles of joint protection, adaptive equipment, energy conservation and work
simplification; discuss contributions made by the occupational therapist, physical therapist or other team members
to patient, family, or employer relating those principles to ADL'S, work, recreation.
Given a case study, perform an analysis of the home and the workplace setting, and recommend modifications to
the environment that make these areas more accessible and functional, as well as modifications to the patient’s
activity, task, or role.
 Luck J. (2001). Enhancing Functional Ability. Clinical Care in the Rheumatic Diseases. 2nd
ed. Association of Rheumatology Health Professionals. 29;197-202.
 O’Sullivan C.26 and Appendix B
 O’Sullivan C.12: environmental assessment
10.
Supply information and resources to the employed person with a disability regarding the
workplace, relationship with employer, disability accommodations, disability insurance, and government programs.
On the course website’s left navigation bar, go to: “Reimbursement”  Consumer information: Employment,
Disability, Insurance (sponsored by the Arthritis Foundation). See the following topics (linked in the right margin)
o Talking to Employer
o Laws that Can Help
o Accommodations
o Changing Jobs
o Work Disability
o Health and Disability Health Insurance
o Disability Insurance
o Government Plans
Supply information about medication assistance for a person with a chronic condition like rheumatic
disease. Go to “Tool Kit - Pharmacy”  Partnership for Prescription Assistance
11.
Recognize when a person with arthritis is unable to continue employment outside the home.
Demonstrate familiarity with the process of applying for Social Security Disability Income (SSDI).
 Obtaining Disability Benefit. Clinical Care in the Rheumatic Diseases. 3rd ed. ARHP. 46;299-301.
12.
Reflect on attitudes of caregivers (family, aides, physicians, therapists) who are working with
persons with refractory forms of arthritis, and whose disease progresses. Examine personal feelings about
working with a person with arthritis or similar chronic disease.
13.
Explain a rationale for when joint mobilization methods may be indicated in the presence of
specific forms of arthritis, given contrasting case descriptions. (Kisner and Colby 5th ed. p.310-314)
14.
Chart three types of juvenile rheumatoid arthritis including major contrasting features of each, and
primary considerations for management. Demonstrate understanding of the significance of a diagnosis of
each form of juvenile arthritis on the adult with such a history.
 Pediatric Rheumatic Diseases. Clinical Care in the Rheumatic Diseases. 3rd ed. Association of
Rheumatology Health Professionals. 22;141-142.
15.
Using the AF Supplement Guide (given to each group) recognize herbal and nutritional supplements
that have demonstrated a level of effectiveness in addressing pain or inflammation in joint or muscle (on
the final exam there will be an identifying question).
Explain the pharmacological possibilities of drug-to-drug interactions, i.e. potentiation or inhibition.
16.
Demonstrate awareness of unproven arthritis treatments, why they are a particular challenge due
to the natural course of rheumatoid arthritis (flares and quiescent periods being a typical presentation).
Recognize the role that health professionals have in helping patients make informed decisions, by
recommending reliable sources of health information. Become familiar with reliable web resources on the
use of herbs and supplements by going to the “Tool Kit - Pharmacy”  Resources on Herbs and
Supplements:
 Memorial Sloan-Kettering Integrative Medicine Service
 National Center for Complementary and Alternative Medicine (NCCAM)
 Evaluating Web-Based Health Resources (NCAAM)
17.
Promote optimal health by providing public information on risk factors for osteoarthritis
associated
with obesity.
Explore local community resources for persons with arthritis at http://easternmissouri.arthritis.org
18.
Describe Industrial PT as a specialized application of physical therapy.
MSH/MM/MUPT rev W85, 89, 95, 00, 03, 05, 06, 09