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1. Rheumaticarthritis:{ra}
Auto immune /most common inflammatory dis of joint.
Young & middle- aged adult affect
Proliferative and destructive change in synovial
membrane /periarticular structure/skeletal muscle
/perineural sheath
Male to female ratio 1:3 {mean age 40 year}
Woman 80%
Etiology:
Unknown, but malfunction of the cellular &
humoral immune system
Current: antigen triggers an aberrant response
Predisposing factor -virus: rubella, Epstein -bar
/genetic – HLA DR 4/Psychological stress /
allergic reaction /endocrine /metabolic factor
Synovitis
Granuloma formation vasculitis

2. IG-G-A-E {70 to 90%} trigger
WBCs – engulf – immune complex & elaborate
lysosome
Neutrophils– release procollagen
Pathology:
Synovitis pannus {villus}
destruction & ankylosing, fibrous
C/F:
Pain, swelling, stiffness [morning]
Weight loss/ lethargy/depression
Deformity
DAY TO DAY change symptom
Nodule
Deformity: (peripheral joint more affect & rarely
affects larger joint)
Swelling of MCP & IP joint
Ulnar deviation [rupture of collateral ligament]
Boutonniere’s deformity [rupture of central
extensor expansion -finger at point of PIP joint
flexed]

3. Swan neck deformity [rupture of volar plate of PIP
joint -hyperextension of PIP and flexion of DIP
joint]
Trigger finger & thumb: nodules present over
tendon
Hallux valgus – great toe
Claw toe
Callosity over the dorsum and sole
Heel may be valgus
Widening of forefoot
(stiff knee, ankylosing, thick cartilage)
2* OA develop
Trochanteric bursitis may be
Investigation:
Lab:HB %- anemia
ESR^ lymphocyte
Serological– RA factor
AntiCCPAntibody

4. CRP^
X-ray
Jointexamination(cardinalsign)
Pasthistory
Rx:
NSAID/DMARD/STEROID/NEW/GENE
THERAPY/SURGERY-
synovectomy/osteotomy/arthrodesis/arthroplasty
D. penicillamine
Hydroxy chloroquine
IL1&6 antagonist
TNF A inhibitor
PHYSIOTHERAPY:(acute phase)
1.Cryotherapy
2.heat RX
3.tens
4.isometric exe
5.active ROM
6.deep breathing
7.splint position maintain

5. 8.progressive resistance exe
9.posture
10.hydotherapy
Exercise
Chronic phase:
 Position –
spine/hip/knee/shoulder/elbow/peripheral joint
 Splint – correction & prevention
Self -management
Mentally calm & medication
Exercise
Posture
Help of device {guide}
Good sleep
Massage
Relaxation
Modification
# MAKWANA JAY P