Rheumatoid arthritis is a chronic, autoimmune, progressive, inflammatory disease , affecting joints and periarticular tissues.

– Inflammatory mediators are released in joints which initiates inflammatory process.

– Earliest lesion is vasculitis, then synovial edema and infiltration with inflammatory cells .

– Local prostaglandin synthesis occurs which causes vasodilation and pain

– bones and cartilage are damaged.

* Criteria for Rheumatoid arthritis

√ Morning stiffness

√ Arthritis of 3 or more joints

√ Arthritis of hand joints.

√ Symmetrical arthritis

√ Rheumatoid nodules

√ serum rheumatoid factor.

* Clinical features

– Common between age group of 35 -55 years.

– Women are more affected than men

– Pain , swelling , redness, warmth and stiffness.

* Joint involvement

– MCP , Proximal IP joints , wrist and knees are commanly affected.

– Joints are warm, swollen and tender in early stages.

– Weakening of joint capsule and tendon along with ligament damage can lead to instability of joint.

– Subluxation or dislocation.

* Types of deformities in Rheumatoid arthritis:

1) Ulnar drift

2) Boutonniere or buttonhole deformity

3) Swan neck deformity

4) Hitchhiker’s thumb / 2- shaped deformity

5) Claw toe.

* Physiotherapy Management

• Principles of physiotherapy

1) Pain relief and relief of inflammation.

2) Prevention and correction of deformity

3) Joint ROM : restoration and Maintainance

4) Improvement in muscle strength and endurance.

5) Guidance to achive optimum function

6) Education : provide information on disease and its therapy

• Acute phase

√ It is important to maintain a properly supported position of the involved joint and correct bed posture.

√ Additional support to limb can be given by splints and sandbags.

√ Deep breathing exercises

√ Active / passive movements of free joints

√ encourage functional mobility.

√ Encourage activities which do not put any extra strain on affected joints.

√ Isometrics to muscles like quadriceps and deltoid.

√ Speedy Isometrics to affected limb in Elevation helps in reducing swelling and effusion

√ Heat therapy should be avoided as the joint is already warm.

√ TENS, Ultrasound, ice massage, reduce muscle spasm and pain.

• Chronic phase

– Vigorous activity to train patients

– Independent sitting by the use of hands can be started by 4-5 weeks.

– It includes standing and walking

– Weight bearing should be deferred till pain and discomfort subsides.

– Stretching

– Efforts should be made to improve strength and endurance.

– Education and assistance is provided in adopting functional positions, speed and proper gait.

– Job oriented performance.




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