Rheumatoid arthritis

1. Rheumatoid arthritis
 Presented by
 Seheli Sinha
 BPT 4th year

2.  Introduction
 Clinical features
 Pathophysiology
 Physical assessment
 Diagnostic criteria
 Deformity
 risk factors
 Goals of treatment
 Physiotherapy management

3.  Rheumatoid arthritis is long term an
autoimmune disease that is characterized by
inflammation of the joints and the subsequent
destruction of cartilage and erosion of the bone
causing deformities.
PREVALENCE – About 0.24 to 1% of Indian
population 75% women

4. Site – small bones of hand affected first .
 MCP ,PIP, DIP -90%
 Knee , Ankle, Wrist -80%
 Shoulder -60%
 Elbow-50%
Causes
A. Exact cause is unknown
B. Genetic factors
C. Environmental factors
D. Viral bacterial
E. Smoking

5. Foreign body
Activation of
macrophages
Production of
cytokines
Subchondral bone
destruction
Production of
destructive
enzymes
Pannus formation
Rheumatoid
arthritis
Accumulation of
the inflammatory
cells
Activation of
endothelial cell
Activation of B-
Cell & T-Cell
Formation of
immune complex
Hyper immune
responses in
blood

6. Contd.

7. 
Articular -
pain
Tender, warm, swollen joints
Decrease range of motion
Morning Joint stiffness
Deformity
Extra articular manifestations
Rheumatoid nodule
Fatigue, fever and loss of appetite
Eyes
Lungs
Heart
Kidneys
Nerve tissue
Bone marrow
Blood vessels

8. Mild Moderate Severe
Joint swelling
Warm
Redness
Pain
Decrease ROM
Tenosynovitis
Less pain
Joint deformity
Muscle contractures
Severe deformity
Joint disorganization
X-ray- not visible X-ray-joint space
narrowing ,cartilage
destruction
X-ray-bone erosion
,joint instability

9.  ASSESSMENT –
General examination -
Skin color-
Temperature
Tenderness – Grading
Edema
Posture
Gait analysis
ON EXAMINATION
Pain – VAS Scale
Muscle power -MMT
Joint range of motion –By goniometry
Deformity
Functional test –Balance ,walking,dressing,toileting

11. Your sex. Women are affected more than men
Age. Around 15-50 year old
Family history.
Smoking.
Excess weight.
Unhealthy lifestyle

13.  GOUT
 OSTEOARTHRITIS
 PSORIATIC ARTHRITIS
 FIBROMYALGIA

14. PHYSIOTHERAPY GOALS
Pain control
Improvement in activities of daily living
Improvement in Joint stiffness
Prevent contractures
Improve muscle strength
Improve fatigue levels and functional activity
To correct deformity
Regular basis exercise
 To educate the patient (Home exercise )

15. o Cold therapy - cold for acute phase
10-15 min/1-2 times a day
o Heat therapy/PWD - for chronic phase
20-30 min ,1 to 2 times a day
o TENS- 15 min 2 times a day
o Balneotherapy - for 10 min for 3 to 4 weeks
o Mirror Therapy
o Desensitization-
 Gentle mobilization -2 times a day
 Acupuncture therapy
 Prehension tasks
 Splint

16. ACUTE STAGE CHRONIC STAGE
 Isometric
 Range of motion
 Mobilization
 Pendulum exercise
 Strengthening
 Range of motion
 Resisted exercise
 Full body stretching

17. Wrist cock-up splint Ankle foot
orthotics
Figure of 8 ring
Silicon orthotics
Ulnar wrist
orthotics

18.  Karati Chauhan; Jagmohan S. Jandu; Mohammed A. Al-Dhahir. Oct 2019 RAAvailable
from:https://www.ncbi.nlm.nih.gov/books/NBK441999/ (last accessed 23.2.2020)Brosseau
L, Yonge KA, Robinson V, Marchand S, Judd M, Wells G, Tugwell P. Transcutaneous
electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand.
Cochrane Database for Systematic Reviews. 2016.
 8. Casimiro L, Brosseau L, Welch V, Milne S, Judd M, Wells GA, Tugwell P, Shea B.
Continuous ultrasound to the hand benefits grip strength in people with rheumatoid
arthritis. Cochrane Database for Systematic Revie SARAH Trial Team et Trial Team et al.
BMC Musculoskeletal Disorders 2012
 National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions about
Rheumatoid Arthritis. 2012.
http://www.niams.nih.gov/Health_Info/Arthritis/arthritis_rheumatic_qa.asp
 Welch V, Brosseau L, Casimiro L, Judd M, Shea B, Tugwell P, Wells GA. Thermotherapy
(heat treatment) for treating rheumatoid arthritis. Cochrane Database for Systematic
Reviews. 2011.
 Davies S, Williams A, Graham A, Dagg a, Longrigg K, Lyons C, Bowen C. Guidelines for
the management of foot health for people with rheumatoid arthritis. North West Podiatry
Services Clinical Effectiveness Group - Rheumatology. 2010.
 Kavuncu V, Evcik D. Physiotherapy in rheumatoid arthritis. Med Gen Med. 2004;6(2).
 Vlieland V TPM. Non-drug care for RA — is the era of evidence-based practice
approaching? Rheumatology. 2007;46:1397-1404.