This document provides information about arthritis and occupational therapy treatment. It defines arthritis as a group of disorders affecting the joints. The main types of arthritis discussed are osteoarthritis, rheumatoid arthritis, gouty arthritis, psoriatic arthritis, septic arthritis, and spinal arthritis. Occupational therapy aims to maintain function and mobility through techniques like splinting, exercises, ergonomics, fatigue management, and assistive devices. Proper evaluation and a multidisciplinary approach are important to arthritis treatment.

1. W.G.A.N.K.UDUGAMA
Higher Dip. In ENG., BSc. in OT, BSc. Psychology (Undergrad), MPhil in OT(reading)

2. CONTENT
• What is arthritis?
• Types of arthritis
1. Osteoarthritis
2. Rheumatoid arthritis
3. Gouty arthritis
4. Psoriatic arthritis
5. Septic arthritis
6. Spinal arthritis
• Medical approach to arthritis

3. • Occupational therapy for arthritis
• OT evaluation
• General objectives
• Treatment precautions
• OT intervention
• Ergonomic principals
• Fatigue management principals
• Assistive devices for arthritis
• Aging and Arthritis
• Falls prevention

4. What is ARTHRITIS?
• Group of disorders that affect joints
• Include both inflammatory and degenerative lesions
• Generally characterized by pain and restriction of movements arising
spontaneously accompanied by a swelling or thickening

5. Types of arthritis

6. 1. Osteoarthritis - OA
• Non inflammatory degenerative disease of wear and tear process in
joints
• Most common in weight bearing joints
• Strongly co-relate with the age
• Basically there are two types as;
I. Primary osteoarthritis
II. Secondary osteoarthritis
Primary
osteoarthritis
Secondary
osteoarthritis

7. Pathophysiology
Articular cartilage soften and loss
elasticity
Hard and glossy subchondral bone
eburnation
Hypertrophy of joint margins
Osteophytes
Recurrent strains leads to synovitis
and degeneration of capsule

9. Radiographic features

10. Clinical features
• Onset is gradual with increasing pain
• Restricted movements
• Crepitation
• Joint enlargement due to osteophytes
• Muscle weakness and wasting
• Deformities in hands
• PIP joints - bouchard’s nodes
• DIP joints – Heber den's nodes

11. 2. Rheumatoid arthritis - RA
• Rheumatoid arthritis is,
Non- suppurative
Systemic
Chronic inflammatory disease of
Unknown cause
Characterized by symmetrical polyarthritis
Affecting peripheral joints and
Extra articular structures with
Exacerbations and remissions

12. Pathophysiology

13. Inflammatory process of RA have 04 stages:
1. Acute stage 2. Sub acute stage
3. Chronic active stage / severe RA 4. Chronic inactive stage / End stage

14. Articular manifestations
• Swelling
• Pain – aggravated with mvts
• Stiffness- in morning
• Warmth over affected joints
• Tenderness
• Muscle weakness and wastage
• Prominent deformities in
hand ( buttonire, swan neck, Z
thumb, ulnar deviation of MCP)
toes ( bunion, hammer toe, claw
toe)
knees ( valgus deformity)
Extra articular manifestations
• Malaise/ fatigue
• Weight loss
• Low grade pyrexia
• Skin –thinning , rheumatoid nodules
• Eyes- episcleritis
• Heart- pericarditis, atherosclerosis
• Lung-chest infections
• Musculoskeletal- osteoporotic
changes, tendon and ligament
rupture
• Hematological- anemia,
thrombocytosis

16. Radiographic features

17. OA
• Degenerative disease that
causes articular cartilage loss
and joint space narrowing
• Develops slowly over years
• Typically asymmetrical
• Nodes are present ( heberden’s
& bouchard’s )
• Morning stiffness more than 30
min.
• Negative on blood tests
• Radiograph: subchondral
sclerosis, osteophytes, joint
space narrowing
RA
• Autoimmune disease that causes
inflammatory synovitis
• Sudden onset
• Symmetrical and polyarthritis
• Nodules are present
• Morning stiffness less than 30
min.
• Positive rheumatoid factor,
elevated ESR & CRP
• Radiograph: diffuse rarefaction,
joint malalignment/dislocation/
ankyloses

19. 3. Gouty Arthritis
• It is a clinical manifestation of disturbed purine metabolism
• Characterized by deposition of uric acid in connective tissues,
• Cartilage
• Ligaments
• Walls of bursa
• Cause is unknown

21. Pathophysiology

22. Radiographic features

23. 4. Psoriatic Arthritis
• A chronic inflammation of the skin (psoriasis) and joints
(inflammatory arthritis).
• It usually causes the joints to become swollen, stiff and painful

24. Clinical manifestations
• Swollen, painful,hot,red joints
• Swollen fingers and toes
• Joint stiffness worse in mornings
• Pitted nails
• Lower back pain

25. 5. Septic Arthritis
• When bacteria it can lead to septic/ pyogenic or infective arthritis
• Common pyogenic bacteria's are,
Staphylococcus
Streptococcus
Pneumococcus
• As pus is formed with in the joint this is
also called suppurative arthritis

27. Pathophysiology
A) In the early stage, there is an acute synovitis with purulent joint effusion
B) Soon the articular cartilage is attacked by bacterial and cellular enzymes
C) If infection is not arrested, the cartilage may be completely destroyed
D) Sequel includes necrosis, subluxation, dislocation and ankyloses

28. 6. Spinal Arthritis
• Though we think of arthritis as affecting hands and legs, the truth is
that it can affect any joints in the body including spine
• 95% of people over age 50 will have degenerative osteoarthritis in
their spines ( cervical and lumbar regions)
• In the spine, arthritis usually affects:
• The small facet joints found between the backbones, causing soreness and
stiffness in the neck and back that increases with inactivity.
• The large sacroiliac joints that connect the spine to the pelvis, causing a dull
ache in the buttocks, groin, or the back of the thigh.
• The sites where ligaments and tendons attach to the backbones, leading
to painful bone spurs. Bone spurs can put pressure on a nerve (pinching the
nerve) and create shock-like pain or numbness

29. Signs and symptoms
• Low back pain
• Neck pain
• Loss of flexibility of the spine
• Joint stiffness
• Swelling of the spine
• Tenderness along the spine
• A grating sensation when moving
• Fatigue or weakness
• Pain or numbness that travels down the arms or legs (an indication of nerve
problems)
• One of the first indications that you may be suffering from spine arthritis is that
these symptoms are worse first thing in the morning. Often, your symptoms will
dissipate as the day goes on, only to come back in the evening

30. Radiographic features

31. • Despite the fact there is no ‘cure’ for spinal arthritis, symptoms can
be relived with medical intervention as well as life style changes
through therapy
• In severe cases, doctors will recommend a laminectomy surgery or
spinal fusion to help relieve the pain
• Although most common type of spinal arthritis is osteoarthritis, There
are following less common types of arthritis as well,
• Rheumatoid arthritis
• Psoriatic arthritis
• Reactive arthritis
• Ankylosing spondylitis

32. Medical approach to arthritis
• Medical approaches are followed after proper diagnosis conformation
through client’s medical history, laboratory investigations,
radiographic features and physical examinations
• Differs from condition, stage as well as co morbidities from person to
person
 Pharmacological management
Conservative management with physiotherapy and occupational therapy
Operative treatments
(joint debridement/ arthrodesis/ joint replacement

33. • Arthritis medical approach is consist of a MDT (Multi Disciplinary Team)
• The MDT consists of,
client
Medical
officer
surgeon
Nursing
officer
physiotherapist
Occupational
therapist

34. • Physical therapy will help the clients to persist with the condition with
minimum restrictions to day to day activities
• If the joints have totally degraded beyond the repair, surgeons decide
synthetic replacements

35. Pharmacological
management
(commonly using
drugs)
Analgesics
Ex:
Acetaminophen NSAID’s
Ex: Naproxen
Ibuprofen
Indomethacin
celecoxib
DMARDs
Ex:
Methotrexate
Antibiotics
Ex: doxycycline
Vancomycin
Intra
articular
injections
Corticostero
ids
Ex:
dexamethasone
Local
application
s
Biological and
cytokine
treatments
Ex: infliximab
Rituximab

36. OCCUPATIONAL THERAPY FOR ARTHRITIS

37. Occupational Therapy Evaluation
• Each client is unique in clinical presentation as well as in functional
impairments
• Client centered approach
• Problems of a same person can also be fluctuate
• Evaluation process consist of,
1. Client history
2. Occupational profile
3. Occupational performance status
4. Cognitive, psychological and social status
5. Clinical status

38. CLIENT HISTORY
Diagnosis
Date of onset
Other medical conditions
Medications’
surgical history
OCCUPATIONAL PROFILE
Roles
Occupations
Activity level
Ability to participate in
meaningful activities
OCCUPATIONAL PERFORMANCE
STATUS
Self-care (ADL/IADL)
Productivity (education/ work)
Leisure (rest/sleep/play/social
participation)
COGNITIVE PSYCHOLOGICAL AND
SOCIAL STATUS
Appearance and behavior
Mood
Speech
Thought
Perception
Cognition (memory/ attention/
concentration)
CLINICAL STATUS
Posture ROM
Strength stiffness
Pain swelling
Sensation endurance
Hand functions
deformities

39. General objectives of Occupational Therapy
• Maintain or increase the ability to engage in meaningful occupation
• Maintain or increase joint mobility and strength
• Maximize physical endurance
• Minimize effects of deformity
• Increase understanding of the disease
• Assist with adjustment to disability

40. Treatment precautions related to arthritis
• Respect pain
• Avoid fatigue
• Avoid stresses on inflamed / unstable joints
• Be aware of sensory impairments
• Cautious with pharmacological side effects

41. Occupational Therapy intervention in Arthritis
01. Rest
• An active way of reducing inflammation and pain
• Can be either general or local
Rest
General rest
Bed rest
Rest in
between works
Localized rest
Wearing a
splint
positioning
Modified
activities

42. 02. physical agent modalities
• Helpful in relieving pain or improving ROM
ex: hot and cold therapy
paraffin
hydrotherapy
• Careful monitoring of client response is crucial here

43. 03. Therapeutic exercises
Purposes:
• maintain or improve ROM
• maintain or increase muscle strength
• prevent disuse atrophy
•

44. General guidelines for exercises in Arthritis
• Avoid undue joint stress
• Avoid pain and joint swelling
• Work with the client’s comfortable ROM
• Client should taught to perform exercises slowly, smoothly in proper
techniques
• Typically preferred – assistive exercises
• If pain persist – passive exercises
• Should balance rest and exercises
• Should be done when client feels more fit and having least pain
• Exercise regimes differ:
Good days : 10 repetitions - 3 times per day
Bad days : 3-4 repetitions – At least one time per day

45. 04. Therapeutic activities
• Offers many benefits both physically and psychologically
• Graded activities
• Should be non resistive, avoid patterns of deformity and not over
stress joints

46. 05. Splinting
• Through splinting we can only reduce the progression of the deformity
but cannot be corrected
• Indications for splinting in arthritis:
1. Reduce inflammation
2. Reduce pain
3. Support unstable joints
4. Proper positioning of joints
5. Limit undesired motions
6. Improve ROM
7. Improve functions

47. Commonly using splints for arthritis
1. Resting splints – for acute synovitis
• Resting position:
Slightly wrist extension (0-20’)
Ulnar deviation (10-20)
MCP joint flexed (20’-30’)
PIP & DIP slightly flexed (10’-30’)
Thumb slightly extended and abducted
from CMC joint
MCP and IP joints of thumb slightly flexed
2. Wrist splint

48. 3.metacarpo- ulnar deviation
splint
4. Thumb Spica

49. 5. Swan – neck splint 6. Buttonire splint

50. Ergonomic (joint protection) principals
1) Respect pain
2) Maintain muscle strength
3) Distribute pain over several joints
4) Reduce force and effort required in activities
5) Use correct patterns of movements

51. 6) Use good body positioning, posture, moving and handling
techniques – avoid position of deformity
Ex: squeezing, pinching , twisting motions are stressful and promote
ulnar deviation instead:
Opening jar lid opening door knob coconut squeezing

52. 7) Use strongest and largest joint available for the job
8) Avoid staying one position for too long
9) Use as much as ergonomic equipment's or assistive devices
10) Pace activities
11) Work simplification
12) Modify the environment

55. Fatigue management principals
1. Attitudes and emotions
2. Body mechanics
3. Work pace
4. Leisure time
5. Work methods
6. Organization
7. Plan ahead

56. Commonly used assistive devices for Arthritis
Activity Assistive devices
dressing Dressing stick, shoe horn, sock aid, button hook, zipper pull, elastic shoelaces
bathing Bath bench, grab bars, long handled sponge
toileting Raised toilet seat, grab bars
Hygiene and
grooming
Extended handles in tooth brush, comb
feeding Extended handle utensils
Meal preparation Adapted knives, adapted openers,
miscellaneous Door knob levers, speaker phones, walking aids

59. Aging and Arthritis
• According to records almost half of adults 65 and older are present
with arthritic conditions
• Osteoarthritis - most common

60. Causes leads to arthritis in older adults
• Mechanical stress
• Genetics
• Musculoskeletal degeneration
• Traumatic injuries
• Infections
• Hormonal changes (ex: menopause in women)

61. Fall Prevention
• World Health Organisation defines a fall as:
“An event which results in a person coming to rest inadvertently on
the ground or floor or other lower level”.
• Excluded:
- major internal event e.g. stroke
- being hit by an external force e.g. knocked over
• Ultimate result of a fall is decreasing the quality of life

62. Risk factors for falls
Medical
 Polypharmacy
 Postural hypotension
 Medical conditions e.g. PD
 Poor hydration
 Anaemia
Physical
 Reduced balance
 Walking problems
 Reduced muscle strength in legs and
arms
 Poor vision
 Poor hearing
 Loss of sensation in feet
Psychological
• Reduced motivation/ depression
• Memory problems/ confusion e.g.
dementia
Environmental
 Unsafe walking aids
 Inappropriate footwear
 Home hazards- lighting, dogs, loose mats,
grandchildren, wires, hosepipes
 Transfers- bath, stairs, bed, chair

64. References:
• 1. Hamblen D.,Simpsons A.H.R.W.(2010),Adam’s Outline of
Orthopedics (14th ed.), Elsevier(133-154)
• 2.Radomski M.V.,Latham C.A.T., Occupational Therapy for Physical
Dysfunction(7th ed),Wolters Kluwer /Lippincott Williams & Wilkins
• 3.Pendleton H.M,Winifred Schultz-Krohn,Pedretti’s Occupational
Therapy (practice skills for physical dysfunction)(8th ed), elsevier

65. THANK YOU