RHEUMATOID ARTHRITIS

 RHEUMATOID ARTHRITIS 

Arthritis is an inflammation of a joint. 
Rheumatoid arthritis is a chronic non-suppurative inflammation of the synovial joints. Rheumatoid arthritis is a auto immune disease, affects more commonly hand and feet joints and less commonly the other joints of the body. It occurs between the age of 20 to 50 years. Women are affected about 3 times more commonly than men. 

CAUSES: 

The exact cause is unknown. The following factors have been thought to play a role in causation of the disease. 
> A genetic predisposition 
> Some viruses like EB virus ( Epstein Barr virus also called human herpes virus ) and some bacterial agents such as mycoplasma and clostridium have been implicated in causing arthritis. 
This arthritis results from the exposure of a genetically predisposed individual to some infectious agent.

 STAGES OF RHEUMATOID ARTHRITIS: 

From the Clinical view point it can be divided into 3 stages 
1. Potentially reversible soft tissue proliferation’s: 
In this stage the disease limited to synovium ( synovium is a membrane that lines the entire inner surface of the joints ) where occurs synovial hypertrophic and effusion. No destructive changes can be seen on X rays. 
2. Controllable but irreversible soft tissue destruction and early cartilage erosion:  X rays shows a reduction in the joint space , but the outline of the articular surfaced is maintained. 
3. Irreversible soft tissue and bony changes: The joints may become stiff usually in a deformed position. It may be partially or completely dislocated.

 JOINTS AFFECTED IN RHEUMATOID ARTHRITIS: 

> Commonly- Joints of hands, fingers , wrists, knees, elbows, ankles
> Less commonly- Hip joints, Temporo mandibular joont 
> Uncommon- Atlanto axial joint & Facet joints of cervical spine.

 SIGNS AND SYMPTOMS 

> onset may be with fever 
> Pain in multiple joints 
> Morning stiffness 
> Swelling of three or more specified joints 
> Swelling of joints in the hands and wrist 
 > Symmetrical Swellings 
> Rheumatoid nodules 
> Muscle wasting 
> Visceral manifestations of the disease such as pneumonitis 
> Involvement of lacrimal and salivary glands leads to dry eyes and dry mouth. 
> Extra articular features of rheumatoid arthritis: 
1. Systemic: 
a. Nodules 
b. Anaemia
c. Lymphadenopathy 
d. Amyloidosis( means amyloid protein buildup in one or more organs to cause their malfunction, the most commonly affected are heart, kidneys, nervous system and gastrointestinal tract) 
e. Vasculitis ( inflammation of the blood vessels) 
f. Felty’s syndrome ( includes enlarged spleen and an abnormal low white blood cells) 

2. Ocular 
a. Keratoconjunctivitis ( inflammation of cornea and conjunctiva) 
b. Scleritis ( severe ocular inflammation)  and episcleritis ( inflammation of episclera , which is a clear layer on the top of the white part of the eye called sclera) 

3. Bone: 
a. Osteoporosis 

4. Neurological 
a. Peripheral nerve entrapment 
b. Peripheral neuropathy 
c. Cervical spine instability 
d. Cervical cord compression 
e. Nerve root compression 

5. Pulmonary 
a. Pleurisy 
b. Pleural effusion 
c. Pulmonary alvelolitis 
d. Pulmonary fibrosis 

6. Cardiovascular 
a. Pericarditis and myocarditis 
b. Pericardial effusion 
c. Conduction defects 
d. Atherosclerosis

DEFORMITIES IN RHEUMATOID ARTHRITIS: 

1. Hand:  
 > ulnar drift of the hand 
 > Boutonnière deformity 
 > Swan neck deformity 

2. Elbow: 
 Flexion deformity ( bending elbow) 

3. Knee: 
 Early flexion deformity   and subluxation 

4. Ankle : 
 Equinus deformity 

5. Foot: 
 Hallux valgus & 
 Hammer toes 

INVESTIGATIONS: 

1.  X Ray : The following features may be present
• Reduced joint space,
• Subchondral cysts, 
• Erosion of articular margins 
• Deformities of the hands and fingers. 
2. Blood: Elevated ESR & 
               Low haemoglobin
3. Rheumatoid factor test positive 
4. Synovial fluid examination 
5. Synovial biopsy

TREATMENT: 

> Orthopaedician/ Rheumatologist will assess and plan the treatment 
1. The disease brought under control by 
non-steroidal anti inflammatory drugs and by disease modifying anti rheumatic drugs.
2. The preservation of joint functions and prevention of deformities by splinting 
3. Repair of joint by surgical interventions like synovectomy. 

> Occupational therapist is to help the patient to cope with his occupational requirements in the most comfortable way by modifying them. 

> Physiotherapist Proper assessment should be taken initially and he will plan the treatment accordingly 

For Pain management: 
Cold application in acute stages 
Hot pack applications in chronic stage 
Infrared radiation 
Paraffin wax bath to reduce pain and stiffness 
Massage 
Ultrasound therapy 

For joint stiffness: 
• Passive movements and stretching 
• Ultrasound treatment to increase blood supply & to relax the muscles 
• Massage also helps to relax the tight muscles 
• Joint mobilisation techniques  to maintain joint function

For strengthening muscles: 
• Assisted Exercises 
• Active assisted Exercises
• Active exercises
• Resisted Exercises 
• Stretching Exercises 
• Applying splints

For Respiratory and cardiovascular problems: 
• Chest mobilisation Exercises 
• Breathing Exercises 
• Ballon blowing exercise 
• Treadmill exercises
> Walking and aerobics 
> Yoga and meditation to relieve from stress 
>Postural retraining and correction of faulty movement patterns along with orthotic and adaptive seating devices can reduce malalignment and pain. 
> Group Exercise classes can provide valuable motivation and social support 

NOTE: 
Please consult your doctor before starting any exercise program