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1. Program-B.P.T-thirdYear
B.P.T –305–PT Orthopaedic
Unit-4
RHEUMATOID ARTHRITIS
2021-2022/ Lecture no –(4/4/22)
DrAnshulGarhpale
Asstprofessor,Physiotherapy /SOMPS

2. X-ray overview
Anatomy overview
Introduction
Causes
Sign &symptoms
Diagnosis
Treatment
PT M/N
Learningoutcomes
Refrences
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Outline

3. X RAY IMAGE
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4. INTRODUCTION
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-Rheumatoid arthritis, or RA, is an autoimmune and inflammatory
disease, which means that your immune system attacks healthy
cells in your body by mistake, causing inflammation (painful
swelling) in the affected parts of the body.
-RA affects joints on both sides of the body, such as both hands,
both wrists, or both knees. This symmetry helps to set it apart from
othertypes of arthritis. Over time, RA can affect other body parts
and systems, from youreyesto
yourheart,lungs,skin,bloodvessels, and more.

5. <Subject Code>BPT203 <Page No.>1
CAUSES
The inflammatory process is characterized by infiltration of inflammatory
cells into the joints, leading to proliferation of synoviocytesand destruction
of cartilage and bone. This is a chronic, debilitating autoimmune disease of
unknown etiology affecting diarthrodialjoints. Although the disease is
characterized by synovitis of the joints, tendon sheaths, and bursae,
manifestations that do not involve the synovium are also frequent . These
articular and systemic manifestations are mediated by hyperplasia of the
synovial lining cells and extensive infiltration of macrophages, lymphocytes,
fibroblasts, and leukocytes in joints, where a variety of cytokines,
prostaglandins, and proteolytic enzymes are responsible for the process of
the inflammation.

6. CAUSES :-
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-There are two major subtypes of RA according to the presence or
absence of anti-citrullinatedproteinantibodies (ACPAs).
-The appearance of ACPA is now widely used to diagnose and predict
RA due to its high specificity (>97%) in clinical practice. ACPA occurs
as a result of an abnormal antibody response to a range of citrullinated
proteins, including fibrin, vimentin, fibronectin, Epstein-Barr Nuclear
Antigen 1 (EBNA-1), α-enolase, type II collagen, and histones, all of
which are distributed throughout the whole body. ACPA production
has been associated with genetic and environmental factors. The
strongest genetic risk factor associated with ACPA-positive RA is
found in genes encoding HLA-DR, especially HLA-DR1 and HLA-
DR4, also known as “shared epitopes” (SEs).

7. <Subject Code>BPT203 <Page No.>9
Sign and symptoms
Signs and symptoms of rheumatoid arthritis may include:
•Tender, warm, swollen joints
•Joint stiffness that is usually worse in the mornings and after inactivity
•Fatigue, fever and loss of appetite
Early rheumatoid arthritis tends to affect your smaller joints first —
particularly the joints that attach your fingers to your hands and your
toes to your feet.
As the disease progresses, symptoms often spread to the wrists, knees,
ankles, elbows, hips and shoulders. In most cases, symptoms occur in
the same joints on both sides of your body.

8. <Subject Code>BPT203 <Page No.>9
SIGNS & SYMPTOMS
About 40% of people who have rheumatoid arthritis also experience
signs and symptoms that don't involve the joints. Areas that may be
affected include:
•Skin
•Eyes
•Lungs
•Heart
•Kidneys
•Salivary glands
•Nerve tissue
•Bone marrow
•Blood vessels
Periods of increased disease activity, called flares, alternate with periods
of relative remission —when the swelling and pain fade or disappear.
Over time, rheumatoid arthritis can cause joints to deform and shift out
of place.

9. <Subject Code>BPT203 <Page No.>9
RISK FACTORS
Factors that may increase your risk of rheumatoid arthritis include:
•Your sex.Women are more likely than men to develop rheumatoid
arthritis.
•Age.Rheumatoid arthritis can occur at any age, but it most commonly
begins in middle age.
•Family history.If a member of your family has rheumatoid arthritis, you
may have an increased risk of the disease.
•Smoking.Cigarette smoking increases your risk of developing
rheumatoid arthritis, particularly if you have a genetic predisposition for
developing the disease. Smoking also appears to be associated with
greater disease severity.
•Excess weight.People who are overweight appear to be at a somewhat
higher risk of developing rheumatoid arthritis.

10. <Subject Code>BPT203 <Page No.>9
DIAGNOSIS
•CBC
common blood tests look for rheumatoid factor and anti-cyclic
citrullinatedpeptide (anti-CCP) antibodies.
•ESR
•usually elevated but may be normal in up to few cases

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DIAGNOSIS
-X –ray
-MRI

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TREATMENT
•NSAIDs.
•Steroids..
•ConventionalDMARDs.

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SURGERICAL TREATMENT
•Synovectomy.Surgery to remove the inflamed lining of the joint
(synovium) can help reduce pain and improve the joint's flexibility.
•Tendon repair.Inflammation and joint damage may cause tendons
around your joint to loosen or rupture. Your surgeon may be able to repair
the tendons around your joint.
•Joint fusion.Surgically fusing a joint may be recommended to stabilize
or realign a joint and for pain relief when a joint replacement isn't an
option.
•Total joint replacement.

14. <Subject Code>BPT203 <Page No.>9
PT M/N
Here are a few things you can do to help yourself during a flare-up:
•Keep taking your medication at the doses you’ve been prescribed.
•Do gentle exercises.
•Put heated items on the joint –these can include a hot water bottle or
electric heat pad. See below for more information.
•Put cold items on the joint –these can include a bowl of cold water
with ice cubes, a pack of frozen peas wrapped in a towel, or a damp
towel that has been kept in the fridge. See below for more
information.
•Let people around you know, so they can help and support you.

15. Learning Outcome
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The studies are helpful in diagnosis and assessment for RA cases.

16. References
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1. B.D Chourasia, anatomy of upperlimb
2.John ebnezer, clinical feature, management.
3.Goel’s physiotherapy
4.Tidy’s Physiotherapy