Rheumatoid Arthritis

It is an autoimmune disease that affects joints.The immune system of our body protect us from the attack of various organisms and foreign bodies but in Rheumatoid arthritis it starts attacking the lining of joints. It is a chronic inflammatory disease which affects the joints. No specific cause known yet but scientific evidence shows the involvement of various factors like-genes, hormones and environmental factors .

American Rheumatism Association(ARA) Diagnostic Criteria for RA

- RA criteria: (if 5 out of following are present for > 6 weeks);

    - morning stiffness;

    - pain on motion, or tenderness in at least one joint;
   - swelling (soft tissue thickening or fluid, not bony overgrowth           alone) in at least one joint;
   - swelling of at least one other joint (any interval free of                      joint symptoms between the two joint);
    - poor mucin precipitate from synovial fluid
    - characteristic histologic changes in synovium

    - characteristic histologic changes in nodules

- Exclusion Criteria:
    - rash of systemic lupus erythematosus
    - high concentration of LE cells, or other clear-cut evidence of lupus
    - histologic evidence of periarteritis nodosa
    - clinical features of dermatomyositis, scleroderma;
    - acute rheumatic fever;

    - gouty arthritis

    - infectious arthritis

    - Reiter's syndrome

    - shoulder-hand syndrome

    - hypertrophic osteoarthropathy

    - neuroarthropathy

    - alkaptonuria

    - sarcoidosis

    - multiple myeloma

    - erythema nodosum

    - leukemia, lymphoma, or agammaglobulinemia

 Symptoms

-Joint –pain,swelling , tenderness ,warmth. Stiffness  in the joint especially early morning.

-Small joints involvement  like wrist, hand,feet etc. As the disease progresses  other joints like hip ,knee,shoulder and elbows can also get affected.

-Fatigue and weight loss.

Other  organs and body systems affected are:

·         Blood vessels

·         Mouth

·         Eyes

·         Skin

·         Lungs

·         Salivary glands

·         Heart

Symptoms of Rheumatoid arthritis are never constant. They can persists for sometime and then disappear or reappear after sometime .A flare (periods of high disease activity) can lasts for few days \months. The symptoms can come and go.

By: Pooja Dhamija PT  

Physiotherapy in Rheumatoid Arthritis

PHYSIOTHERAPY IN RHEUMATOID ARTHRITIS

Rheumatoid Arthritis is an inflammatory autoimmune disease affecting the joints .As it is progressive and causes pain ,swelling,tenderness and sometimes deformities in the joint.

AIM OF  PHYSIOTHERAPY TREATMENT:

       1. Pain relief                          

       2. To prevent joint damage

       3. To prevent functional loss

       4. To improve strength and flexibility

PHYSIOTHERAPY ASSESSMENT:

•   Assessment of posture
•  Assessment of muscle strength
•  ROM of joints
•  Functional assessment or assessment of daily activities.

PHYSIOTHERAPY TREATMENT:

  

PAIN RELIEF

       

1. Transcutaneous Electrical Nerve Stimulation(TENS)- It is  used for pain relief. It is applied on   

the area of pain. It is fast acting and non invasive. It is a good alternative to analgesic drugs.   

2. Hot / Cold  Application-Different  heat modalities can be applied like hot packs ,infrared lamp,   paraffin wax bath ,hydrotherapy etc. Heat is generally applied in chronic conditions as it will relax the tissues and muscles which will further increase the ROM of joint and also relieve pain. Heat applied before exercise will be more beneficial to the patient. Cold packs or cryotherapy is helpful in acute cases as it will reduce the swelling and is also helpful in relieving pain.

3. Hydrotherapy                

 JOINT PROTECTION

·        

      Posture correction along with gait analysis and correction plays a major role in the treatment of  rheumatoid arthritis.

·           Rest and splinting (orthosis)-In acute stages rest to the affected joint is very important. It will relieve stress on affected joint that will in turn decrease pain.

 Splints and orthosis-Supports the joint  and helps in preventing the development of deformities. Splints can be given either in functional  position or at resting position depending upon the clinical condition of the patient.

·         Use of assistive devices like cane ,crutches or walker while walking will improve the gait pattern and will prevent the further damage to the joint due to stress. It will also provide stability by increasing the base of support and also helps in balancing . Assistive devices for the other affected joints can also be used.

 IMPROVE MUSCLE STRENGTH AND FLEXIBILITY

Due to lack of mobility and reduction of activities muscles may  get weak and tight .Exercise regime should be such that it should strengthen the weak muscles  and stretch the tight muscle groups. Exercises that prevent deformities should also be included as an integral part of exercise regime. Exercise to  increase the  ROM should be added.

Along with the above mentioned treatment Patient education and counseling  is also important so that patient can deal with the  socio--psychological factors effectively.

By: Pooja Dhamija