– 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.
– 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.