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
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
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
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
18.
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
20.
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
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
