In RA immune system attacks joints of the body
1) Immune cells gather inside the joint lining.
2) They form a layer of abnormal tissues
3) The tissue releases chemicals that cause swelling and inflammation.
You’re more likely to get deformities if you have high levels of two substances in your blood: C-reactive protein (CRP) and rheumatoid factor (RF).
Types of deformities
1) Ulnar drift. Your fingers lean away from your thumb and toward your pinky. Boutonnière deformity.
Also called a buttonhole deformity. Your middle finger joint bends downward (toward your palm),
while your top finger joint bends away from the palm. Swan-neck deformity. The base and top joint of your finger bend downward, but the middle joint is straight.
Hitchhiker’s thumb: Also called a z-shaped deformity. Your thumb flexes at the joint where it meets your palm, then bends backward at the joint below your thumbnail.
Bunion. The base of your big toe (where it attaches to the foot) gets larger and sticks out. This may force your big toe to press against the second toe, forcing it to overlap the third.
Claw toe Toe bends upward from the ball of your foot.Toe bends downward, toward the sole of your shoe, at the middle joint. Toe bends downward at the top joint (by the toenail)
Management of above deformities Surgical interventions includes
1) Arthrodesis- joint fusion
2) Joint replacement
3) Synovectomy- removal of the joint lining.
Medical management includes NSAIDs, DMARDs.
Physiotherapy management
NOTE- Never give hot pack in Acute cases of RA. Start with cryotherapy.
1) splints for deformity correction
2) Tens, Ift for any irritable pain in extremities.
3) soft tissue manual therapy for any taut musculature.
4) ROM of all joints of the body to avoid any adhesions.
5) Avoid stretching in acute cases
6) start strengthening exercises with moderate intensity then progess to high intensity if patients is comfortable doing that
7) Add balance and coordination for the geriatric patients to prevent fall.
8) Advanced techniques like kinesiotaping can be used to correct deformities upto some extent.
9) Dry needling can be done to get painfree movements of daily life.
10) Patient can go for alternative therapies like pilates, yoga, relaxation techniques.