Senthilkumar Thiyagaran, M.P.T(ortho)

Physiotherapist

Rheumatoid Arthritis

Physiotherapy management

Objectives To know about definition, causes, pathology

and clinical features

To know about pathomechanics of RA

To know about the medical management

To know about the physiotherapist role in RA

management

Definition

RA /rheumatic disease

It’s a autoimmune disease

Chronic inflammatory disease

Crippling and disabling disorder which

affects connective tissues in the whole

body

Incidence

More commonly affects women

Ratio 2:1

In the world population 1% to 2%

affected

Age – 16 years and above

Pathology

Uncontrolled

inflammation

Exuberant proliferatio

n of synovium

PannusFormation Consequent

bone and cartilage

destruction

Involvment of tendons,

ligaments, blood vessels

Clinical manifestations

Stiffness

Tenderness

Pain on motion

Swelling

Deformity

Limitation of motion

Extra-articular manifestations

Rheumatoid nodules

American College of Rheumatology uses this list of

criteria:

1. Morning stiffness in and around the joints for at least one hour.

2. Swelling or fluid around three or more joints simultaneously.

3. At least one swollen area in the wrist, hand, or finger joints.

4. Arthritis involving the same joint on both sides of the body (symmetric arthritis).

5. Rheumatoid nodules, which are firm lumps in the skin of people with rheumatoid arthritis. These nodules are usually in pressure points of the body, most commonly the elbows.

6. Abnormal amounts of rheumatoid factor in the blood.

7. X-ray changes in the hands and wrists typical of rheumatoid arthritis, with destruction of bone around the involved joints. However, these changes are typical of later-stage disease.

PATHOMECHANICS Genu valgum, hallux valgus, pronationof the foot, depression of the metatarsal heads, hammer or claw toes, and tendocalcaneal bursitis or subplantar spur formation.

decreased velocity, cadence, and stride length; poor heel-toe pattern; and abnormal patterns of weight bearing.

Gait deviations

Conservative managment

NonSteroidal Anti-Inflammatory Drugs

(NSAIDs),

Disease-Modifying Antirheumatic Drugs

(DMARDs),

Immunosuppressants, and

Corticosteroids.

Surgical management

• Persistent pain (from, for example, joint damage or

other soft tissue cause).

• Worsening joint function.

• Progressive deformity.

• Persistent localised synovitis.

Deformity becomes irreversible:

• Imminent or actual tendon rupture.

• Nerve entrapment (for example, carpal tunnel

syndrome).

• Any stress fracture.

Physical therapy Management

Assessment/ Evaluation

Assessment of posture

Testing muscle strength and power

Measuring joint movement

Gait analysis

Functional test

such as balance, walking, dressing, toileting(ADL),

etc..

Treatment Goals To protect the joint from further damages

Provide pain relief

Prevent deformity

Prevent disabilities

Increase functional capacity

Improve flexbility and strength

Encourage regular exercise

Improve general fitnes

Management

Cold therapy in acute phases

Dosage

10 – 20 min/ 1-2 times a day

Heat Therapy (chronic phases)

Dosage

20 – 30 mins 1 to 2 times a

day

TENS

Short term pain relief (6 to 18

hours)

Exercise for Acute phase

Performed at least once a day

Gentle assisted movement through normal range

(joint Mobilisation)

Isometric “ static muscle contraction” helps to

maintain muscle tone without increasing

inflammation

Exercises for the Chronic Phase

Can progress the above exercises to include use

of light resistance

Postural / core stability exercises

Swimming / walking / cycling to maintain

cardiovascular fitness

Gentle stretches for areas that become tight,

such as knees & calves

Regular Exercises

Maintaining muscle strength is important for joint

stability & preventing injury

Muscles can become weak following reduced

activity

Pain signals from your nerves and swelling can

both inhibit muscles

Muscle length can be affected by prolonged

positions & immobilization and tightness can limit

daily activities

General Body Stretching

Joint Protection

Try to avoid prolonged positions

Balance activity with rest periods rest should

come before you get fatigued or sore

Look at your work or home desk set up

During the acute phase activities such as stair

climbing can put stress through your knees

ankles & hips try to keep the number of trips up &

down to a minimum

Common deformities

ALTERNATIVE THERAPIES

THI CHI

MUSCIAL THERAPY

YOGA THERAPY

RELAXATION TECHNIQUES

PILATES

References

http://ptjournal.apta.org/content/62/8/1148.abstrac

t

http://www.webmd.com/rheumatoid-

arthritis/guide/diagnosing-ra

http://rawarrior.com/new-criteria-for-rheumatoid-

arthritis/

http://emedicine.medscape.com/article/331715-

overview#aw2aab6b2b3

http://www.patient.co.uk/doctor/management-of-

rheumatoid-arthritis

http://morphopedics.wikidot.com/physical-

therapy-management-of-rheumatoid-arthritis