Physiotherapy management for rheumatoid arthritis

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

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: Morning stiffness in and around the joints for at least one hour. Swelling or fluid around three or more joints simultaneously. At least one swollen area in the wrist, hand, or finger joints. Arthritis involving the same joint on both sides of the body (symmetric arthritis). 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. Abnormal amounts of  rheumatoid factor  in the  blood . 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

9. Conservative managment N onSteroidal Anti-Inflammatory Drugs (NSAIDs), D isease-Modifying A ntirheumatic D rugs (DMARDs), I mmunosuppressants , and C orticosteroids. 

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

18. 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

19. 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

20. General Body Stretching

21. 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

22. Common deformities

23. ALTERNATIVE THERAPIES THI CHI MUSCIAL THERAPY YOGA THERAPY RELAXATION TECHNIQUES PILATES

24. References http:// ptjournal.apta.org/content/62/8/1148.abstract 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

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