Arthritis is the swelling and tenderness of one or more joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.

1. PHYSICAL THERAPY
TREATMENT FOR
ARTHRITIS
Submitted by :
Mavumnkal biju brincelet
group :733

2. What is arthritis?
• Arthritis is an inflammation of the joints. It
can affect one joint or multiple joints. There
are more than 100 different types of
arthritis, with different causes and treatment
methods. Two of the most common types are
osteoarthritis (OA) and rheumatoid arthritis
(RA).

4. What are the symptoms of arthritis?
• Joint pain, stiffness, and swelling are the most common
symptoms of arthritis. Your range of motion may also
decrease, and you may experience redness of the skin
around the joint. Many people with arthritis notice their
symptoms are worse in the morning.
• In the case of RA, you may feel tired or experience a loss
of appetite due to the inflammation the immune
system’s activity causes. You may also become anemic
— meaning your red blood cell count decreases — or
have a slight fever. Severe RA can cause joint deformity
if left untreated.

5. Disease progression:
Stage 1: No destructive changes on x-
rays
Stage 2: Presence of x-ray evidence of
periarticular osteoporosis,
subchondral bone destruction but no
joint deformity
Stage 3: X-ray evidence of cartilage
and bone destruction in addition to
joint deformity and periarticular
osteoporosis.
Stage 4: Presence of bony or fibrous
ankylosis along with stage 3 features.

7. Pathogenesis of arthritis
• Cartilage is a firm but flexible connective tissue in
your joints. It protects the joints by absorbing the
pressure and shock created when you move and put
stress on them. A reduction in the normal amount
of this cartilage tissue cause some forms of
arthritis.
• Normal wear and tear causes OA, one of the most
common forms of arthritis. An infection or injury to
the joints can exacerbate this natural breakdown of
cartilage tissue.Another common form of arthritis,
RA, is an autoimmune disorder.

8. Etiology
• The cause of Rheumatoid Arthritis remains
unknown and can therefore not be prevented. A
simple disorganisation of the immune system can
be at the origin of the body attacking its own
tissue. The evolution of the disease varies from
person to person; sometimes the inflammation can
become systemic, what means that it will expand
and also affect multiple organs, systems or tissues.
• Systemic inflammation and autoimmunity in RA
begin long before the onset of detectable joint
inflammation.

9. Diagnosis
• Blood tests that check for specific types of
antibodies like anti-CCP (anti-cyclic citrullinated
peptide), RF (rheumatoid factor), and ANA
(antinuclear antibody) are also common diagnostic
tests.
• Doctors commonly use imaging scans such as X-ray,
MRI, and CT scans to produce an image of your
bones and cartilage. This is so they can rule out
other causes of your symptoms, such as bone spurs.

10. How is arthritis treated?
• Rheumatoid arthritis is a chronic disorder that has no cure.
All the currently available treatments are geared towards
improving the symptoms and offering a better quality of life.
Treatments that achieve pain relief and the slowdown of the
activity of RA to prevent disability and increase functional
capacity.
• Physical therapists play an integral role in the
nonpharmacologic management of RA.
• Physiotherapy help clients cope with chronic pain and
disability through the design of programs that address
flexibility, endurance, aerobic condition, a range of motion
(ROM), strength, bone integrity, coordination, balance and
risk of falls.
• All current clinical management of RA recommend the use
of physiotherapy (PT) and occupational therapy (OT) as an
adjunct to drug treatment.

11. The four most common
components of PT/OT for RA are
• Exercise therapy,
• Joint protection advice and provision of
functional splinting and assistive devices
• Massage therapy, and
• Patient education.

12. Hand exercise therapy
• Hand Exercises are used as an intervention that
aims to improve the mobility and strength of the
hand and therefore,improving functional ability.
Hand exercise may include:
• Mobilizing exercise (Increase or maintain range
of motion)
• Strengthing exercise ( that use resistance from
putty, a gel ball, or elastic band to strengthen
hand and wrist muscles).

15. Joint Protection
• Rest & Splinting: Orthosis and splinting prevent the
development of deformities and support joints
• Therapy Gloves: to control and manage hand pain, to
maintain or restore the patient’s hand function and
increase grip strength. Psychologically help to relax or
calm the wearer. worn during the day or at night. Made
of various materials: nylon, wool and elastane fibres.
• Compression Gloves: moderate joint swelling and
consequently reduce the pain
• Assistive and adaptive devices eg easy pour kettle,
ergonomic good grip preparation knives, sock donner.

16. Massage Therapy:
• Massage and the manual trigger of an articular
movement focused on the improvement of function,
pain reduction, reduction of disease activity
improve flexibility and welfare (dimension of
depression, anxiety, mood and pain)

17. Therapeutic Exercise
• Physical exercise helps to increase the physical capacity
of the patient.
• Exercise improves general muscular endurance and
strength without detrimental effects on disease activity
or pain in RA
• Before beginning an exercise program perform a global
evaluation of the situation: joint-inflammation local or
systemic, state of the disease, age of the patient and
grade of collaboration.
• Exercise therapy is aimed of improving daily
functioning and the social participation by means of
improvement of the strength, aerobic condition, the
range of motion, stabilisation and coordination.

18. Programs for Patients with RA
• Includes; ROM-exercises; aerobic exercise:
stabilisation/coordination exercises.
• Start with a moderate-intensive exercise
program
• Progress to a high-intensive exercise program if
possible aimed at improving aerobic capacity,
strength and endurance.
• The duration and intensity of the exercises
should be based on the individual patient and
their assessment

19. Patient Education:
Information about their condition and the
different therapies disposed to improve their
quality of life. eg Patients are taught how to
protect the joints during routine daily life;
adjusting their movement-behaviour; behavioural
change by your patient (a process with 3 phases:
the motivation-phase, the initial-behavioural
change phase and the phase where the intended
behaviour is continued).

20. physical modalities
•Cold/Hot Applications: cold for acute
phase; heat for chronic phase and used
before exercise.
•Transcutaneous electrical nerve
stimulation (TENS) is used to relieve
pain.
•Hydrotherapy-Balneotherapy: exercise
with minimal load on the joints.

22. The therapy goals in most
cases are:
• Improvement in disease management knowledge
• Pain control
• Improvement in activities of daily living
• Improvement in Joint stiffness (~ Range of motion)
• Prevent or control joint damage
• Improve strength
• Improve fatigue levels
• Improve the quality of life
• Improve aerobic condition
• Improve stability and coordination

23. Recommendations
• When the patient experiences an exacerbation and the
joints are acutely inflamed then isometric exercises
should be done.
• Avoid stretching in acute cases.
• Revise the exercise program if pain persists 2 hours after
the activity or there is an increase in joint swelling.
• Patients with active RA in their knees should avoid
climbing stairs or weight lifting as it could lead to intra-
articular pressure in the knee joint.
• Avoid excessive stress over the tendons with stretches
and avoid ballistic movements.

24. Exercises examples
In acute phase: isometric/static exercises -> be held for 6
seconds and repeated 5–10 times each day ; load = 40%
1RM. Chronic phase -> minimum 4 repetitions for each joint
in 2 to 3 days These exercises increase the mobility of the
joint, but the concerned joint will not be loaded during this
exercises.Contractures can be held for 6seconds and
repeated 5-10 times daily.
Stretching: Avoid in acute cases.
Strengthening: Moderate-intensive exercise therapy where
a minimum of 8-10 exercises is necessary for the major
muscle groups. Each exercise has to be repeated 8-10 times
and a minimal start intensity of 30-50 percent of 1
repetition maximum (RM). Use light weights important for
stabilization of the joint and prevention of traumatic
injuries.

25. Aerobic condition exercises: There are two types of exercises
to improve the aerobic condition: Intensive exercises and
moderate-intensive exercises. The intensive exercise therapy
has a minimum duration of 20 minutes per session and this 3
times a week with an intensity of 65 to 90 percent of the
maximal heart rate. The moderate-intensive exercise therapy
has a minimum duration of 30 minutes per session and this 5
times a week with an intensity of 55 to 64 percent of the
maximal heart rate. The aim of this exercises is to improve the
muscle endurance and aerobic capacity. eg: swimming,
walking, cycling
Stabilizing and coordinating exercises: The improvement of
stabilization and coordination of a certain joint will be
achieved by doing exercises that stimulate the sensorimotor
system. For example, standing on a balance board. Important
aspects during this exercises are motion control, balance and
coordination.

26. Conditioning exercises in people with chronic inactive
RA: swimming walking, cycling (include adequate rest
periods).
Routine daily activities: SARAH (Strengthening and
stretching for rheumatoid arthritis of the hand) The
SARAH trial tests an intervention against the usual
hand care. The main aim of the exercise program is
increased hand function, which is suggested to be
mediated by increases in strength, dexterity and
range-of-movement. The exercise program consists of
the usual care plus a hand and wrist exercise program
which includes seven mobility exercises and four
strength exercises against resistance (i.e. therapy
putty, theraband or hand exerciser balls).

27. physical therapy exercises
focusing on different parts
of body

32. Conclusion
• The disorder has frequent relapses and remissions, and at least
40% of patients will become disabled within ten years.
• Some patients have mild disease, others may have a severe
disease that severely affects the quality of life.
• Worse outcomes are usually seen in patients with a high titer of
autoantibodies, HLA-DRB1 genotypes, age younger than 30,
multiple joint involvement, female gender, and extra-articular
involvement.
• The drugs used to treat rheumatoid arthritis also have potent
side effects which often are not well tolerated. As the disease
progresses, many patients will develop adverse cardiac events
leading to death.
• The overall mortality in patients with rheumatoid arthritis is
three times higher than in the general population.
• Despite advances in care, mortality from infection, cancer, and
ongoing vasculitis remains unchanged