rehumatoid arthriitis physiotherapy management. physiotherapy management for RA, RA

1. Senthilkumar Thiyagaran, M.P.T(ortho)
Physiotherapist
Rheumatoid Arthritis
Physiotherapy management

2. Objectives
 To know about definition, causes, pathology
and clinical features
 To know about pathomechanics of RA
 To know about the medical management
 To know about the physiotherapist role in RA
management

3. Definition
 RA /rheumatic disease
 It’s a autoimmune disease
 Chronic inflammatory disease
 Crippling and disabling disorder which
affects connective tissues in the whole
body

4. Incidence
 More commonly affects women
 Ratio 2:1
 In the world population 1% to 2%
affected
 Age – 16 years and above

5. Pathology
Uncontrolle
d
inflammatio
n
Exuberant
proliferatio
n of
synovium
Pannus
Formation Consequent
bone and
cartilage
destruction
Involvment of
tendons,
ligaments,
blood vessels

6. Clinical manifestations
 Stiffness
 Tenderness
 Pain on motion
 Swelling
 Deformity
 Limitation of motion
 Extra-articular manifestations
 Rheumatoid nodules

7. American College of Rheumatology uses this list of
criteria:
1. Morning stiffness in and around the joints for at least one hour.
2. Swelling or fluid around three or more joints simultaneously.
3. At least one swollen area in the wrist, hand, or finger joints.
4. Arthritis involving the same joint on both sides of the body (symmetric
arthritis).
5. Rheumatoid nodules, which are firm lumps in the skin of people with
rheumatoid arthritis. These nodules are usually in pressure points of the
body, most commonly the elbows.
6. Abnormal amounts of rheumatoid factor in the blood.
7. X-ray changes in the hands and wrists typical of rheumatoid arthritis, with
destruction of bone around the involved joints. However, these changes are
typical of later-stage disease.

8. PATHOMECHANICS
Genu valgum, hallux valgus, pronation
of the foot, depression of the
metatarsal heads, hammer or claw
toes, and tendocalcaneal bursitis or
subplantar spur formation.
decreased velocity, cadence, and
stride length; poor heel-toe pattern;
and abnormal patterns of weight
bearing.
Gait deviations

9. Conservative managment
 NonSteroidal Anti-Inflammatory Drugs
(NSAIDs),
 Disease-Modifying Antirheumatic Drugs
(DMARDs),
 Immunosuppressants, and
 Corticosteroids.

10. Surgical management
• Persistent pain (from, for example, joint damage or
other soft tissue cause).
• Worsening joint function.
• Progressive deformity.
• Persistent localised synovitis.
 Deformity becomes irreversible:
• Imminent or actual tendon rupture.
• Nerve entrapment (for example, carpal tunnel
syndrome).
• Any stress fracture.

11. Physical therapy Management

12. Assessment/ Evaluation
 Assessment of posture
 Testing muscle strength and power
 Measuring joint movement
 Gait analysis
 Functional test
such as balance, walking, dressing, toileting(ADL),
etc..

13. Treatment Goals
 To protect the joint from further damages
 Provide pain relief
 Prevent deformity
 Prevent disabilities
 Increase functional capacity
 Improve flexbility and strength
 Encourage regular exercise
 Improve general fitnes

14. Management
Cold therapy in acute phases
Dosage
10 – 20 min/ 1-2 times a day

15.  Heat Therapy (chronic phases)
Dosage
20 – 30 mins 1 to 2 times a
day

16.  TENS
 Short term pain relief (6 to 18
hours)

17. Exercise for Acute phase
 Performed at least once a day
 Gentle assisted movement through normal range
(joint Mobilisation)
 Isometric “ static muscle contraction” helps to
maintain muscle tone without increasing
inflammation

19. Exercises for the Chronic Phase
 Can progress the above exercises to include use
of light resistance
 Postural / core stability exercises
 Swimming / walking / cycling to maintain
cardiovascular fitness
 Gentle stretches for areas that become tight,
such as knees & calves

21. Regular Exercises
 Maintaining muscle strength is important for joint
stability & preventing injury
 Muscles can become weak following reduced
activity
 Pain signals from your nerves and swelling can
both inhibit muscles
 Muscle length can be affected by prolonged
positions & immobilization and tightness can limit
daily activities

22. General Body Stretching

23. Joint Protection
 Try to avoid prolonged positions
 Balance activity with rest periods rest should
come before you get fatigued or sore
 Look at your work or home desk set up
 During the acute phase activities such as stair
climbing can put stress through your knees
ankles & hips try to keep the number of trips up &
down to a minimum

24. Common deformities

26. ALTERNATIVE THERAPIES
 THI CHI
 MUSCIAL THERAPY
 YOGA THERAPY
 RELAXATION TECHNIQUES
 PILATES

27. References
 http://ptjournal.apta.org/content/62/8/1148.abstrac
t
 http://www.webmd.com/rheumatoid-
arthritis/guide/diagnosing-ra
 http://rawarrior.com/new-criteria-for-rheumatoid-
arthritis/
 http://emedicine.medscape.com/article/331715-
overview#aw2aab6b2b3

28.  http://www.patient.co.uk/doctor/management-of-
rheumatoid-arthritis
 http://morphopedics.wikidot.com/physical-
therapy-management-of-rheumatoid-arthritis