This document discusses rheumatoid arthritis, including its clinical features, pathophysiology, assessment, diagnostic criteria, deformities, risk factors, goals of treatment, and physiotherapy management. Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation and destruction, commonly affecting the small joints of the hands and wrists. Physiotherapy treatment includes heat/cold applications, TENS, massage, splinting and exercises to reduce pain, improve function and prevent further joint damage.

1. Presented by Seheli Sinha

2. Contents
 Introduction
 Clinical features
 Pathophysiology
 Physical assessment
 Diagnostic criteria
 Deformity
 risk factors
 Goals of treatment
 Physiotherapy management

3. Introduction
 Rheumatoid arthritis is an autoimmune
disease that is characterized by
inflammation of the joints and the
subsequent destruction of cartilage and
erosion of the bone causing deformities.
PREVALENCE – About 0.24 to 1% of Indian
population 75% women

4. 
SITE – small bones of hand affected first .
 MCP ,PIP-90%
 Knee,Ankle,Wrist -80%
 Shoulder -60%
 Elbow-50%
CAUSES
A. Exact cause is unknown
B. Genetic factors
C. Environmental factors
D. Viral bacterial
E. Smoking

5. CLINICAL FEATURES
Articular -
pain
Tender, warm, swollen joints
Decrease range of motion
Morning Joint stiffness
Deformity
Extra articular manifestations
Rheumatoid nodule
Fatigue, fever and loss of appetite
Eyes
Lungs
Heart
Kidneys
Nerve tissue
Bone marrow
Blood vessels

6. Deformities

7. Foreign body
Activation of
macrophages
Production of
cytokines
Production of
destructive
enzymes Pannus
formation
Rheumatoid
arthritis
Activation of
endothelial cell
Activation of
B-Cell & T-Cell
Formation of
immune
complex
Hyper immune
responses in
blood
pathophysiology

8. Contd.

9. ASSESSMENT –
General examination -
Skin colour-
Edema
Posture
Gait analysis
On examination
Pain –
Swelling
Muscle power -MMT
Joint range of motion –By goniometry
Deformity
Functional test –Balance ,walking,dressing,toileting

10. Diagnostic criteria
Rheumatoid factors –positive
Anti-citrullinated protein antibodies –found 50% of patient
X-ray
MRI & UST

11. RISK FACTORS
Your sex. Women are affected more than men
Age. Around 15-50 year old
Family history.
Smoking.
Excess weight.

12. PHYSIOTHERAPY GOALS
Pain control
Improvement in activities of daily living
Improvement in Joint stiffness
Prevent or control joint damage
Improve muscle strength
Improve fatigue levels and functional
activity
Improve the quality of life
To correct deformity
Regular basis exercise
 To educate the patient

13. PHYSIOTHERAPY TREATMENT
o Cold/Hot Applications: cold for acute phase
10-15 min/1-2 times a day
o heat for chronic phase
20-30 min ,1 to 2 times a day
o Transcutaneous electrical nerve stimulation- 15
min 2 times a day
o Balneotherapy for 10 min
o Massage Therapy-
 gentle mobilization.
 Prehension function
 Splintting
 general body stretching

15. References
 . Brosseau L, Yonge KA, Robinson V, Marchand S, Judd M, Wells G, Tugwell P. Transcutaneous
electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand.
Cochrane Database for Systematic Reviews. 2003.
 8. Casimiro L, Brosseau L, Welch V, Milne S, Judd M, Wells GA, Tugwell P, Shea B. Continuous
ultrasound to the hand benefits grip strength in people with rheumatoid arthritis. Cochrane
Database for Systematic Revie SARAH Trial Team et al., Strengthening and stretching for
rheumatoid arthritis of the hand (SARAH): design of a randomised controlled trial of a hand
and upper limb exercise intervention - ISRCTN89936343, Trial Team et al. BMC Musculoskeletal
Disorders 2012
 National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions about
Rheumatoid Arthritis. 2012.
http://www.niams.nih.gov/Health_Info/Arthritis/arthritis_rheumatic_qa.asp
 3. Welch V, Brosseau L, Casimiro L, Judd M, Shea B, Tugwell P, Wells GA. Thermotherapy (heat
treatment) for treating rheumatoid arthritis. Cochrane Database for Systematic Reviews. 2011.
 4. Davies S, Williams A, Graham A, Dagg a, Longrigg K, Lyons C, Bowen C. Guidelines for the
management of foot health for people with rheumatoid arthritis. North West Podiatry Services
Clinical Effectiveness Group - Rheumatology. 2010.
 5. Kavuncu V, Evcik D. Physiotherapy in rheumatoid arthritis. Med Gen Med. 2004;6(2).
 6. Vlieland V TPM. Non-drug care for RA — is the era of evidence-based practice approaching?
Rheumatology. 2007;46:1397-1404.