The document provides guidelines for treating rheumatoid arthritis, including general principles, exercises, managing daily activities, assistive devices, joint protection, and work simplification. The main objectives of treatment are to reduce pain and swelling, improve function, stop disease progression, and prevent disability. Exercise, assistive devices, joint protection techniques, pacing activities, and simplifying tasks can help patients manage symptoms and maintain independence.

1. RHEUMATOID
ARTHRITIS
TREATMENT
PRINCIPLES
BY,
ELDHOSE BOS

2. CONTENTS
1) INTRODUCTION.
2) GENERAL PRINCIPLES.
3) EXERCISES.
4) MANAGING ACTIVITIES WITH RHEUMATIOD ARTHRITIS.
5) ASSISITIVE DEVICES.
6) JOINT PROTECTION.
7) WORK SIMPLIFICATION.

3. INTRODUCTION
Rheumatoid Arthritis is characterized by Acute and Chronic
inflammation in the Synovium which is associated with a Proliferative
and Destructive process in joint tissues.
The main objectives of the treatment of an RA patient are
• Reducing Pain.
• Reducing joint swelling and constitutional symptoms such as
fatigue.
• Improving joint function.
• Stopping progression of bone-cartilage damage.
• Preventing disabilities; and reducing morbidity and mortality.

4. GENERAL PRINCIPLES
• Induction of remission and its Maintenance : Disease activity is
brought under control by Drugs.
• Preservation of joint function and prevention Of deformities
during the activity of the disease and thereafter by
physiotherapy and splinting.
• Repair of joint damage which already exists, if It will relieve
pain or facilitate function. It sometimes requires surgical
Intervention Eg:-Synovectomy.

5. EXERCISES FOR RHEUMATOID
ARTHRITIS
• Exercises can make the patient stronger ,more flexible and expand their range of motion.
• We suggest regular exercises including cardiovascular exercises or strength and
resistance
Training.
STRETCHING
• Stretching can help improve flexibility ,reduce stiffness and increase range of
motion.
• The ideal stretching routine may differ for each person and depend on which
joints are affected.
A TYPICAL STRETCHING ROUTINE CONSISTS OF
• Warming up by walking in place or pumping the arms while Sitting or Standing
3-5mins. .
• Holding each stretch for 20-30secs before releasing it.

6. • Rotating each stretch 2-3times using a yoga strap mayhelp.
• Stretching daily is important for relieving RA symptoms.
WALKING
• Walking is a low impact form of exercise that can help with
aerobic conditioning ,heart and joint health and mood.
• It is essential to wear proper shoes and stay hydrated
even if the walking is not strenuous.
• It is often sensible to walk slowly initially and then increase
the pace when possible.
• They may want to start a walking routine on flat, even surfaces
before progressing to uphill, downhill, uneven surfaces.

7. TAICHI(OR)YOGA:-
• Both Tai chi and Yoga combine deep breathing, flowing movements,
gentle poses and meditation.
• These help them to increase flexibility ,balance and range of motion
also reduces the stress.
• It may also reduce anxiety and depression while increasing self- motivation
and self esteem.
PILATES:-
• PILATES is a low impact activity that can increase flexibility for enhanced
jointhealth.
• PILATES poses activate core muscles and emphasize movements that help with
stability.
• The patient who are new to PILATES should begin slowly.

8. • Water helps to support body weight by minimizing gravity which means they do
not impact on heavily joints.
• Swimming, water-aerobics can increase flexibility, range of motion, strength and
aerobic conditioning and also reduce joint stress and stiffness.
WATER EXCERSICES:-
CYCLING:-
• Due to RA there is risk of cardiovascular disease it is more important to keep heart
healthy.
• Cycling can improve cardiovascular function.
• Riding a stationary bike can be a safe way to get the joints moving &improve
cardiovascular fitness.
• To improve aerobic conditioning cycling can reduce stiffness, increase range of
motion and leg strength and build endurance.

9. STRENGTH TRAINING:-
• Strengthening the muscles around the affected joints can help increase
strength
while reducing pain.
HAND EXCERSICES:-
They may lose their grip strength or find that they are dropping things:-
1. Bending the wrist up and down.
2. Slowly curling fingers.
3. Spreading the fingers widely on table.
4. Squeezing a stress ball.
This can increase strength and flexibility in the hands.

10. TIPS FOR EXCERCISING:-
1. Be consistent.
2. Accessorize for comfort and protection.
3. Seek variety.
4. Adjust excersices according to symptoms.
5. Listen to the body.
6. Pay attention to small things.
7. Work with a therapist.

11. EXERCISETOAVOID:-
1. RA should avoid strenuous exercise or the exercise
which result in pain.
2. There are no specific exercise that everyone
should avoid which is different for each individual
of RA.

12. MANAGING ACTIVITIES WITH RHEUMATOID
ARTHRITIS
• The purpose of giving activities is to provide some strategies, skills and
tools that you can use to help maintain a better quality of life. By
understanding of how RA affects the body, and learning about simple
adaptations or work-arounds can make, the goal for to remain as active,
productive and healthy as you can be.
• People who live with joint pain, swelling, and damage to weight-bearing
joints (i.e. hips, knees, ankles, feet) caused by arthritis have mobility issues
which affect their ability to work and perform common daily tasks.

13. 1. Walking
• Arthritis medications and other arthritis treatments can reduce symptoms
which interfere with mobility. Joint replacement surgery is an option for many
people with severe arthritis who have not been sufficiently helped by more
conservative treatment options.
• People who have mobility impairments may also find this adaptive
equipment useful: Canes, Walkers and Rolling Walkers, Wheelchairs,
Mobility Scooters.
2. Climbing Stairs
• Stairs can be problematic for people with arthritis who have physical
limitations caused by hip, knee, ankle, foot or even back pain.
• Shifting weight from one leg to the other in order to maneuver steps is at
least challenging and sometimes impossible.
• Wearing foot support, ankle support, knee support, or back support can add
stability and make it safer for some people when climbing stairs.

14. 3. Hygiene
• The rheumatologists to check the progress of a patient's ability to perform
daily living tasks or activities. The questionnaire asks if you are able to
wash and dry your body, take a tub bath, and get on and off the toilet with
ease. use assistive equipment to help you accomplish hygiene tasks.
• Many assistive devices are available which include long-handles,
additional seat height, or grab bars for stability.
4. Eating
• Picking up a fork or spoon and lifting food to your mouth, or picking up a
knife to cut your meat then using the fork to lift the meat to your mouth. It's
just natural for healthy people to eat and not think of every motion
required. Adaptive equipment which improves symptoms associated with
your fingers, wrist, or elbow may help.

15. Lifestyle Strategies
• There are several strategies you can use to help manage your daily life with
RA. Some of these strategies in your daily routine may have a positive impact
on the health and mobility of your joints, and on your ability to function at your
best.
• Besides getting enough sleep and rest, eating with an eye toward good
nutrition, avoiding smoking, and getting regular exercise all play important roles
in maintaining a healthy lifestyle.
• When coping with the pain and fatigue associated with RA, it can be difficult to
find the motivation to exercise. But many people with RA find that regular
exercise is beneficial in many ways: strengthening muscles and bones,
improving stamina and balance, decreasing fatigue and improving mood. But
before beginning to exercise, it’s important to talk to your doctor or physical
therapist.

16. ASSISTIVE DEVICES
• When a certain task becomes too painful or difficult to perform due to joint
pain or weakness, the right assistive device might help you to retain your
independence and quality of life.
• For people with RA, the most difficult activities are often those that involve
resistance, weight, or pressure on the joints.
• Assistive devices can help compensate for decreased grip strength and
joint mobility, minimize stress on painful joints, and increase function with
everyday tasks.

17. ASSISTIVE DEVICES IN
KITCHEN:-
1. Small appliances- A food processor can make chopping, grating, and
assembling ingredients during food preparation much easier for people with RA.
2. Manual jar-opening devices - Any device that can be attached to jar lids to give
a better grip will be an affordable solution. Electric jar and can opener.
3. Adaptive utensils- Upgrade your cutlery to ones with long or adaptive handles,
or try specialized tools, such as rocker knives.
4. Handles and knobs- Replace small knobs on cabinets and drawers with larger
handles that are easier to grip. Larger handles help decrease stress on your hand
joints. You can also replace kitchen faucets and doorknobs with level handles,
which are easier to turn.
5. Step stools and reachers- These can help you reach higher-up items without too
much effort. Choose a step stool that is well balanced and lightweight, so you can
move it around easily.
6. Lightweight cookware- Replace heavy pots, pans, and tableware with lighter-
weight versions to help make both cooking and cleanup easier on your joints.

18. ASSISTIVE DEVICES IN
BATHROOM
1. Install grab bars and railings- To help get in and out of the tub safely, and add one
near the toilet as well — or even an arm rest. These can help maintain independence
and safety in the bathroom.
2. Look for easy-to-open medicine bottles and toiletries-Replace kid-safe lids that
can cause trouble for stiff joints. Some manufacturers offer packaging geared toward
people with arthritis.
3. Upgrade grooming supplies- Electric toothbrushes, individual plastic tooth flossers
are also easier on the hands than old-fashioned floss. Electric razors can make
grooming easier. And easy-grip nail clippers are larger and gentler to squeeze.
4. Sit down- Since fatigue is a big issue for people with RA, install a bathtub stool or a
stool near the sink to rest, should you get tired while washing your face, shaving, or
showering.

19. ASSISTIVE DEVICES FOR
EVERYDAY LIVING
1. Getting dressed-buy buttoning aids, such as a button hook, and zipper pulls. Or find
clothing that has Velcro fasteners. To get your shoes on, try a long-handled shoehorn.
2. In the car-get wide key holders to make it easier to maneuver or a push-button start
model, or remote starters. Other helpful features to look for are heated seats to keep
joints warm and a backup camera to avoid craning your neck.
3. In the garden-a foam kneeling pad or short gardening stool to avoid stress on knees.
Choose ergonomic gardening trowels, weeders, and sheers. Opt for a lightweight hose
or install a sprinkler system, so you don’t have to worry about carrying around a
watering can.
4. Crafting-Choose spring-loaded scissors and hands-free frames to stabilize quilting
and embroidery projects you’re working on.
5. Playing cards-Use card holders and automatic shufflers to reduce stress on your
hands.
6. Cleaning up-Use a wheeled cart to transport your laundry to the washer and dryer.
Buy a lightweight vacuum that’s easy to push. Use a long-handled dustpan when

20. ALTERNATIVE INPUT
DEVICES
1. The trackball- requires less motor control.
It has separate buttons for each mouse
action; including scrolling, right- click and
left- click.

21. ALTERNATIVE INPUT
DEVICES
2. The Joystick-Just hold down a joystick to
make it move, which can be helpful in
certain situations such as drawing and
playing games.

22. ALTERNATIVE INPUT
DEVICES
3. Switches- are small devices that
plug into a computer. They let users
control the computer with a series of
movements from a foot or the head or
with an eye blink or a breath.

23. ALTERNATIVE INPUT
DEVICES
4. The camera- Determines where the
user is looking, and the cursor is placed
at the gaze point. Mouse clicks are
performed with a slow eye blink, an eye
dwell, or a switch

24. ENERGY CONSERVATION
• Fatigue is a major component of RA, and it is due to the systemic
nature of the disease.
• The Goal of energy conservation techniques : to save energy
while maximizing function.
• Adaptive equipment is an essential part of this program.
• Other elements include maintaining joint ROM and strength,
improving cardiovascular fitness, and taking short rest periods
during the day.

25. • Use the STRONGEST/LARGEST JOINTS Available for the
Job.
- Instead of using our fingers, use your wrist;
instead of using your wrist, use your elbow; instead of your
elbow, use your shoulder.
- Lift objects by scooping them with both
hands, palms up.
- Push heavy objects using the weight of the
body, rather than pulling or lifting.
• REDUCE THE EFFORT NEEDED to do the Job.
- Add leverage to items to reduce the force to
operate those levered faucets, door handles.

26. PLAN AHEAD.
Gather all items needed before starting an activity or job.
Spread heavy and light tasks throughout the day and
week.
PACE YOURSELF and Avoid Fatigue.
Plan your day to allow for a balance of rest and activity.
Don’t wait until you are tired before you stop and rest.
SIT when Possible.
Sitting eliminates considerable fatigue.
Use a seat in the shower and when dressing

27. JOINT PROTECTION
1. Respect pain
• Pain is a signal from the body that something is wrong.
• Clients should be encouraged to be aware of their limits and stop
activities before pain occurs.
• Disregard of pain can lead to joint damage.

28. 2. Maintain muscle strength and joint
ROM.
• Joints that are less stiff and have balanced strength will be less susceptible
to further injury.
• Limited motion at one joint transmits force to another and may require
exaggerated motions at other joints to accomplish a task.
• Daily functioning and exercise programs should be done with all joint
protection principles in mind to ensure that they are as least stressful as
possible.

29. 3. Use each joint in its most stable anatomical and
functional plane.
• This plane is the point at which resistance to motion is provided by muscle
rather than ligament.
• Following this principle will minimize excessive stress on ligaments and
allow muscle power to be used with the greatest mechanical advantage.
4. Avoid positions of
deformity.
• The customary way of performing tasks may cause forces to be
applied in directions of deformity.

30. 5. Use the strongest joints available.
• Using larger, inherently stronger joints reduces the stress on
smaller joints.
6. Ensure correct patterns of
movement.
• The client may adopt incorrect patterns because of pain, deformity,
muscle imbalance, or habit.
7. Avoid staying in one position for long periods.
• Prolonged static positions can lead to joint stiffness and muscle
fatigue.
• Positional stress is then transmitted to the joint ligaments, which
may already be in a weakened state.

31. 8. Avoid starting an activity that cannot be stopped immediately
if it becomes too stressful.
• This will prevent the load from going to the joint capsule and ligaments if
muscles tire.
• Continuing a task that causes sudden or severe pain is likely to cause joint
damage, and severe fatigue can cause poor movement patterns and safety
risks.
• Realistic planning of options can help prevent these situations.
• For example:- clients can keep a bath bench available in case they need to
rest while standing in the shower. Clients also can note the location of
benches in a mall in relation to the stores where they plan to shop.

32. 9. Balance Rest and Activity
• Helping the client understand the physiologic need for proper rest can
facilitate this often difficult lifestyle change.
• The key to increasing functional endurance is to rest before becoming
overfatigued, which could mean napping or taking breaks during or
between activities.
• Balancing activities during the day and longer term across the week or
month can be accomplished through planning and establishing priorities.

33. 10. Reduce force and effort.
• Less force and effort equate to less joint stress, less pain, and less
fatigue.
• Using built-up handles, levers, more even distribution of loads, alternative
methods, and other aforementioned joint protection and fatigue
management techniques can help toward this end.
• For example, rearranging the kitchen environment to have everything
within easy reach, planning tasks and gathering all needed items, sitting
down while at the sink or stove, and using assistive devices all contribute
to easier meal preparation.

34. WORK SIMPLIFICATION
• People with rheumatoid arthritis can make tasks around the house
as simple as possible by keeping frequently used items in an easy –
to-reach-location.
• For example; they can use a push-cartor basket to keep essentials
near them wherever they are (such as a tissue box ,remote ,cell
phone or portable phone ).

35. Altering Movement Patterns and Use of Proper Joint and
Body Mechanics .
• In hand activities, two hands can be used, and the load can be spread over the
palmar surface.
• Movement patterns can be changed by,
For example, turning a jar lid using the thumb, index, ring fingers, and thumb
web space. The fingers are kept in correct anatomic alignment and ulnar
forces are to be avoided.
• Objects should be kept closer to the body when lifting andcarrying, and/or a
stronger larger joint can be used.

36. To Distribute load: using two hands
to carry a mug.
• Avoid prolonged sitting and standing.
Change position regularly.
• For people, with knee and foot pain, a perch stool reduces standing when
preparing food or ironing.
• Work surfaces are within the reach envelope of the arms.

37. • Can an activity be done differently?
For example ,rather than taking a kettle to the tap, holding it while sitting and
filling then carrying it back across the kitchen, fill it with a
lightweight jug instead.
Altering working methods: using a
light jug to fill a kettle.

38. • Could shopping be done via the internet to save driving, walking and
carrying bag ?
Reorder the sequence of tasks within activities to increase
efficiency.
 Eliminate unnecessary tasks.
 Keep frequently used equipment within the reach envelope.
 Reorganize work areas to streamline work processes.
 Raise or lower work surfaces to maintain good posture.
 Ensure storage is efficient, e.g., use stepped shelves in
cupboards and sliding racks so jars, cans, and boxes are
easily reached.

40. REFERENCES
1. ESSENTIAL ORTHOPAEDICS
J.Maheshwari
{5th Edition}
2. ORTHOPEDIC MANUAL THERAPY
Chad E Cook {2nd
Edition}