Rheumatoid arthritis and osteoarthritis are the two most common types of arthritis. Rheumatoid arthritis is an inflammatory condition that typically affects the hands, feet and wrists symmetrically. Osteoarthritis is caused by wear and tear on joints and usually affects weight-bearing joints like the hips and knees asymmetrically. The main goals of treatment are to reduce pain and inflammation, maintain joint mobility and function, and prevent or slow further joint damage.

1. IS A CONDITION OF JOINTS WHERE THERE IS PAIN
AND/OR SWELLING.
ARTHRO means “JOINT” and –ITIS means “INFLAMMATION”
“Inflammation of the joint”

2.  Most important determinants in classifying
arthritis:
INFLAMMATORY or NON-INFLAMMATORY
SYMMETRICAL or NONSYMMETRICAL
SYSTEMIC or NON-SYSTEMIC MANISFESTATION

3. Rheumatoid Arthritis (RA)
- synovial membrane
(structure between 2 bones forming the
joints)
Distal joints
(hands and feet)
BILATERAL
Elderly and obese
Pain is experience when the joints are
moved after prolong sitting/standing
Osteoarthritis (OA)
-articulating portion of the bone
Weight-bearing joints
-(hips, knee, spine)
NOT BILATERAL
No particular age group

4. OA
•Pain occurs usually
in the afternoon
•No swelling
•Weakness & atrophy
of muscles
RA
•Painful even at rest &
usually in the
morning
•Swelling
•Areas around the joints are warm
•Weakness and atrophy
of muscles

5. systemic autoimmune, connective tissue disorder of
unknown etiology that primarily affect the synovial lining of
diarthrodial joint.

6.  Universal and found in all population (possible
genetic/environmental factors)
 RA affects women 2 or 3 times often more than men in
typical years of onset between ages 20-60. Men equally
affected as women over the age 65 appear.
 Men with RA past 60 y/o typically present without stiffness
and swelling in UE.
 Elderly over 50s had features of Polymyalgia rheumatica
(characterized by pain in shoulder & pelvic girdle muscles,
eleveted ESR & absence of muscle dse)
 Dse onset is usually insidious with complaints of gen.
jt.pain & stiffness.
 Acute onset is seen 8-15% of RA px

7.  UNKNOWN etiology.
 Current research into the causes of RA is based on a complex,
but as yet incomplete, appreciation of the functions of the
immune system.
 Briefly, antigen is a substance, usually foreign to the host, which
provoke the immune system into action. The immune system
may respond to the antigen directly (cellular immunity) or by the
production of antibodies that circulate in the serum (humoral
immunity).
 These responses involve two general kinds of lymphocytes: T
cells, which are responsible for cellular immunity, and B cells,
which produce circulating antibodies specific to the antigen.
Antibodies are immunoglobulins, a type of serum protein.
 RA is said to be an AUTOIMMUNE disorder.

8.  It is not clear wheter the abN immune response is a
primary event or is a response to specific antigen from
any external stimulus.
 Proposed Theory includes:
a. Abberant fxning of cell mediated immunity &
defective T-lymphocytes
b. Bacterial organisms
c. Viral etiology
d. Rheumatoid factors (antibodies against IgG)
e. Genetic predisposition demonstrated by Human
Leukocytes Antigen

9.  Long standing RA is characterized by grossly edematous
appearance of the synovium with slender villous or hair-like
projection in the jt. cavity
 Vascular changes: including venous distention, capillary
obstruction, neutrophilic infiltration of arterial walls& areas of
thrombosis & hemorrhage.
 PANNUS – synovial proliferation of vascular granulation tissue;
it dissolve collagen as it extends over the jt. Cartilage.
 Granulation will result in adhesion & fibrous or bony ankylosis
of the jt.
 Chronic inflammation weakens the jt. Capsule & ligaments
altering the jt. structure & fxn.
 Ruptured tendons and fraying of tendon sheaths produce
imbalance in the muscle pull resulting to deformities.

10.  Proteases, collagenase & cathepsin cause synovium to
proliferate & become inflamed. They also cause
cartilage & bone destruction by pannus formation.
 Immune complexes are stored in articular cartilage,
because of lack of limiting membrane between the jt.
Spaces & synovial blood vessels. The storage causes
chronic inflammatory responses.

12. Systemic manifestations:
-HALLMARK SYMPTOM OF RA: morning stiffness lasting more than 3
mins.
- Difficulty moving up & generalized stiffness despite morning activity
hepl to differentiate stiffness from DJD
- Anorexia, fever, weightloss, fatigue
Muscle involvement
-Atrophy around the joints may be present early
- Muscle weakness d/t reflex inhibition 2* to pain or atrophy
Tendons
-Tenosynovitis
-Lag phenomenon

13. Specific Jt. Involvement:
-marked by bilateral symmetrical pattern involvement.
- immobility and the cardinal signs of inflammation: pain, redness, swelling, and heat. I
- arthralgia is used to refer to pain in ajoint.
- crepitus , which is audible or palpable grating or crunching a the joint i moved through it
range of motion (ROM).
 Crepitus is the result of uneven degeneration of the jt. Surface
 ATLANTOAXIAL & MIDCERVICAL REGION – most common site of inflammation
 DIP JOINTS- most uninvolved joint in RA
 KNEES – one of the most frequently affected joints
 COMMONLY AFFECTED JOINTS: CERVICAL, TMJ, SHOULDER, ELBOW,WRIST,
HAND JOINTS (mcp, pip, dip, thumb), HIP JOINTS, KNEES, ANKLES AND FEET

16.  Rheumatoid nodules
 Vascular complication
 Neurologic manifestations
 Cardiopulmonary complication
 Ocular manifestation

17. Is a condition marked by 2 features:
a. DESTRUCTION of articular cartilage
b. FORMATION of new bone at the margins of the joint

18.  The most common arthritis is an assymentrical non-
inflammatory dse. that has no systemic components.
 3 types:
 PRIMARY
 SECONDARY
 EROSIVE INFLAMMATORY
HALLMARK of the dse: Cartilage degeneration

19.  No single factor has been identified.
 Aging strongly associated with OA
 Factors r/t to aging contributes to OA
 Trauma
 Occupational tasks
 Obesity

20.  First OA change in articular cartilage is an increase in
water content
 The increase suggest proteoglycans to swell with water
beyond normal
 Mechanism is unknown
 Later stage: proteoglycans are lost which deminish
water content of cartilage
 Collagen synthesis increase
 As articular cartilage is destroyed, joint space narrows.

21.  Major pathological changes of OA are found in
articular cartilage (concentration of proteoglycan)
 Met changes in rate of enzyme production facilitate
the destruction of cartilage
 Proteoglycan & collagen synthesis increases until late
stages of the disease.

22.  Women are more commonly have OA of small joints –
DIP, PIP, MCP, & 1st MTP, 1st CMC jts.
 Men – often have hip involvement

23. 1. Primary OA – spares the shoulder & elbow, except in
secondary OA
Decreasing frequency:
knee – first MTP – 1st CMC – hips – cervical spine – lumbar
spine
2. Secondary OA – caused by an injury, fx, occupation-related
task or obesity
3. Erosive inflammatory – common in middle aged women

24.  The main impact of OA on fxn result from
involvement of large weight-bearing jts., which can
cause pain & limit mobility.
 Back involvement ranks next.
 OA of hand is not assoc with significant impairment in
ADL, except when there is significanmt OA of the
CMC joint of the thumb.

25.  Monoarticular involvement
 No symmentric signs and symptoms
 Stiffness may be experienced upon awakening or after
a period of rest or inactivity. NOT IN THE ENTIRE
BODY AS RA.
 Pain in the joint – primary reason for physical
limitations; worsen in motion but not at rest (except
late stage)
 KELLGREN’s SYNDROME – generalized OA

26.  Pain in OA is attributed to:
 -incongruent articulation to jt surface
 -periosteal elevation
 -abN pressure on subchondral bone
 -trabecular microfx
 -distention of jt capsule

27.  Specific Joint involvement:
HIP, KNEE, FOOT, CMC

28.  Deformed joints
 Difficulty in doing day-to-day activities
(ex: walking)
 Tightness of joints

30. To relieve or reduce pain
To maintain the integrity of joints
To prevent further deformities of
the joints
To strengthen the muscles around
the joints

31.  Modalities for pain relief
 Joint mobility
 Strengthening
 Joint protection
 Functional training
 Gait training
 Education

32.  When there is swelling
 Hot pack application (20 minutes for 15 day)
 Comfortable joint position without causing deformity
 When there is less pain
 Move joints as tolerated by PWD
What will also help?
1. Good nutrition
2. Reduction of weight for obese
3. Cane usage

33. Thank you for
listening! 
© Abby Girl Carasi Ocado
Cecille Anne Cayetano, BSPT4