Differential Diagnosis for Physical Therapy: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary 124
Multiple Sclerosis (MS): Most common demyelinating disease that affects 20- to 40-year-olds. It is most common in colder climates. Pathogenesis of MS is unknown, causing lesions (plaques) in central nervous system (CNS) white matter. • Vision-related MS symptoms ○ Blurred vision or double vision (diplopia) ○ Loss of vision in one eye ○ Moving or “jumping” field of vision • Irregular sensations as MS symptoms ○ Altered sensations, such as itching, burning, parasthesia ○ Electrical shock sensations in the neck and spine ○ Weakness in an arm or leg ○ Feeling heavy ○ Dizziness or vertigo • Diagnosis: Neurological exam, magnetic resonance imaging (MRI), cerebrospinal fluid tests, and/or immunoglobulin G test Rheumatoid Arthritis (RA): Chronic, systemic, inflammatory disorder of unknown etiology. RA affects women two to three times more than men and it is typically seen in 20- to 40-year-olds. • Hormonal implications/environmental trigger: Infection, E. coli (antibodies in synovial fluid) Four stages 1. Synovitis: Inflamed joints; tissue thickens with edema and congestion 2. Pannus formation: Layer of inflammatory granulation forms inside joint ○ Damage to joint and joint capsule ensues 3. Fibrous ankylosis: Subluxation and scar formation prevents joint motion 4. Bony ankylosis: Firm, bony union occurs as fibrous tissue calcifies and changes into osseous tissue Tests • Antibody called rheumatoid factor (RF): Some people with RF never get this
disease, and others with the disease never have RF • Some RA patients and lupus patients share a variation in the STAT4 gene Sjogren’s Syndrome: Chronic inflammatory disorder where the body destroys the exocrine glands, especially the salivary and lacrimal glands
LEARNING TIP! Sjogren’s Syndrome signs and symptoms: • Extremely dry eyes/mouth • Enlarged parotid glands • Fatigue • Aches/pains in muscles and joints
Lupus: Chronic systemic inflammatory disease characterized by injury to skin, joints, kidneys, heart, and blood-forming organs as well as nervous system and mucous membranes • Three forms 1. Discoid: Confined to skin 2. Systemic: More severe; can affect any organ; genetic 3. Drug induced: Occurs after use of certain prescription drugs, particularly HTN and cardiac drugs ■ Symptoms usually subside when meds are discontinued • Signs and symptoms: joint pain, butterfly rash, fever, weight loss, fatigue, progression of symptoms: Mild → severe Scleroderma Progressive Systemic Sclerosis (PSS): Condition where connective tissue produces too much collagen and causes induration, affecting joints, muscles and connective tissue. The pathogenesis of PSS is unknown and typically seen in 30- to 50-year-olds. PSS can be localize, limited or diffused. • Signs and symptoms
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