a case report presentation for Physical therapy management of rheumatoid arthritis

1. Physical Therapy Management
for Rheumatoid Arthritis
Case Report
PT. Maryam Mohammed Alasfour
MSc Candidate, KSU

2. Introduction
Rheumatoid arthritis (RA)
• Autoimmune chronic, systemic inflammatory disease.
• Affects activities of daily living (ADL).
• Women affected 3x than men.
• The incidence is highly variable between nations.
Brosseau et al,2014

3. Introduction
Physical therapy management
• Prevent the complications of disease
• To improve the quality of the life

4. Case Report
• A 67 years old Saudi retired female teacher
• Diagnosed with RA two years ago
• Chief complaint:
• Severe pain in both hands especially at night
• Morning stiffness of fingers
• Difficulties in combing her hair / tying her clothes and climbing 2nd
floor

5. Case Report
On examination:
• Pain = 60 for both hands using a 100-mm Visual Analog Scale (VAS)
• Boutonniere and swan neck deformity with ulnar deviation
Huskisson, 1974

6. Case Report
On examination:
The five-times sit-to-stand test:
Complete the test in 34.10 seconds
Score = one point
Guralnik et al, 1994

7. Case Report
On examination:
The 2 Minute Walk Test:
Slow limping gait, fatigue after 45 seconds
Connelly et al, 2009

8. Case Report
On examination:
Arabic version of ADLs scale”
Score = 36
Nasser et al, 2009

9. Case Report
Problem List:
• Pain on both hands
• Muscle weakness
• Poor endurance
• Functional limitation

10. Case Report
Short term goals:
• Reduce pain
• Improve muscle strength
• Enhance the endurance and
functional status level
Long term goals:
• To improve patient’s ADLs,
prevent further
complications and improve
the quality of life as much as
possible

11. Case Report
Treatment plan:
• Three physical therapy sessions weekly for six to twelve
weeks
• Patient education
• Hand therapy (Wax bath - active exercise)
• Aerobic training
Drăgoi et al, 2013
Williams et al, 2015
Rahnama et al, 2012

12. Case Report
Treatment protocol:
1. Wax-bath Treatment:
 Both hands slowly dipped five times wax bath,
wrapped, keep for 20 minutes

13. Case Report
Treatment protocol:
2. Hand exercise program:
 Active ROM: 8 different movements, x5 times
 Balanced resistive exercise: x5 times, 3–5 sec hold, 20 sec rest

14. Case Report
Treatment protocol:
3. Aerobic training:
 Walking on treadmill for about 30 minutes

15. Case Report
Treatment protocol:
Re-assessment will be done at week 6 and 12

16. Case Report
Challenges during treatment:
• Fatigue
• Nature of RA

17. Thank You