PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

1. 1
RHEUMATOID
ARTHRITIS
MANAGEMENTPROBLEM BASED LEARNING (PBL)
PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN

2. Puan Amira, 42 year-old lady
• Chief Complaint: Pain on the right knee and swelling
for one day duration
• Sudden painful swelling of the right knee
• Unable to walk properly
• Chronic vague pain
• Pain and stiffness of wrist and hand for several years
• Pain and stiffness happen for at least two hours in each
episode and do not seem alleviated by taking drug
prescribed by the general practitioner
HISTORY TAKING

3. Pain and stiffness at the morning

4. Pain and stiffness at the morning
• From trigger 2:the pain and stiffness were
more prominent in the morning which
improved by the afternoon

5. often more severe in
the morning @ after a
period of inactivity
Joint inflammation
causes swelling in
the joint
increases when the
joint is immobile
results in limited
mobility and
tightening of muscles
around the joints.
the stiffness & pain is
often worse when
the joint has been at
rest
this stiffness & pain
improves with
activity.

6. Managing pain and stiffness at the
morning
• Start with gentle movements-move gently
• Try heat therapy.
• Do a few minutes of exercise
• Take your meds from bed
• Rub in a joint cream
• Consult with an occupational therapist.

7. The physical property of
moving with pain or
difficulty

8. Mechanism of actions of joint
stiffness in rheumatoid arthritis
• Abnormal response of the immune system (autoimmune
diseases)
• Lining of the joint become inflamed because the immune
cells mistakenly attack the body’s own tissues. This causes
stiffness, pain, warmth, redness & swelling around the
joint.
• Then rapid division, growth & influx of inflammatory
(WBC) cells causes the synovium to thicken
• The inflammatory cells release enzymes that may digest
bone & cartilage. This will cause more pain, loss of joint
shape & alignment, and loss of movement

9. Therapies for joint stiffness
• Physical therapy & exercises can improve
mobility, reduce pain, and increases flexibility
& strength
• Heat delivered through hot packs, electric
mittens, ultrasound or spas can help relieve
joint stiffness & pain
• Weight control to reduce stress on joint

10. Surgeries (options)
• Replacing of joint with an artificial one
• Commonly performed on hips & knees joints
• Joint fusion will performed when the arthritis
are more severe on fingers or wrists
• In joint fusion, the ends of the bones are
locked together until they heal & become one