Rheumatoid arthritis is an autoimmune disease and inflammatory disease. RA commonly afffects joints in the hand, wrist and knees. In a joint with RA the linings of the joint becomes inflamed, causing damage to the joint tissue. This tissue damage leads to severe joint pain and deformities. RA can affect other tissues throughout the body and can cause problems in organs such as lungs,heart and eyes.
1) pain in more than one joint
2) stiffness in more than one joint
3) tenderness and swelling in one or more than one joint.
4) deformities
5) the same symptoms on both sides of the body
6) weight loss
7) fever, fatigue, weakness.
1) age- RA can begin at any stage , but the likelihood increases with advanced age. Most common in sixties.
2) sex- women are more prone to this than men
3) genetics- people born with certain genes are more likely to develop RA . These genes are HLA ( human leukocyte antigens) class 2 genotypes, can also make your arthritis worse.
4) smoking- smoking increases a person's risk of developing RA and can make the disease worse.
5) history of giving birth- women who have never given birth may be at a greater risk of developing RA.
6) obesity- being obese can increase the risk of developing RA.
Rheumatologists will look for sign and symptoms and medical history. 1) looking for swelling and redness.
2) examining joint function,ROM
3) to check warmth and tenderness
4) examining for skin nodules.
5) testing for reflexes and muscle strength.
Since no single test can detect RA. They may also request certain imaging test such as x ray, MRI, Ultrasound. Blood test for RA:
1) rheumatoid factor test- this check for a protein called rheumatoid factor. High level of rheumatoid factor are associated with autoimmune disease .
2) Anticitrullinated peptide antibody test- this test looks for an antibody thats associated with RA . People have this antinody usually have this disease . The anti ccp test is more specific for RA then RF blood test and is often positive before the RF test.
3) Erthrocyte sedimentation rate: The ESR helps to determine the degree of inflammation anywhere in your body. However it doesnot indicate the cause or site of inflammation.
4) C reactive protein test: A severe infection or significant inflammation anywhere in your body can trigger your liver to make C reactive protein. Higher levels are associated with RA.
Note- There is no cure for RA. Treatment aims to reduce the inflammation and symptoms.
1) NSAIDS- it can releive pain and lessen inflammation . It includes ibuprofen and naproxen sodium. Side effects could be heart problems, kidney damage, stomach irritations.
2) Steroids: prednisone reduces inflammation and slow joint damage side effects may include thinning of bones, weight gain, diabetes.
3) Conventional DMARDs : these drugs can slow the process of joint damage. Common DMARDs are methotrexate, lefluonomide, hydroxychloroquine. Side effects may include liver damage and lung infections.
4) Surgery includes synovectomy, tendon repair, joint fusion, total joint replacement.
5) Exercises can improve joint range of motion, apply heat or cold to ease pain.
1) Boutonniere deformity- it occurs when the middle or proximal interphalangeal joint of a finger is flexed and the distal joint is extended.
2) swan neck deformity- the most common in RA . It occurs when there is weakness or tearing of ligament due to inflammation . This laxes the joint of the finger and flexion of the distal joint.
3) Hitchhiker's thumb: it occurs when the thumb flexes at the metacarpophalangeal joint hyperextends at the interphalangeal joint. It is also called z shaped deformity.
4)Rheumatoid nodules: these are hard lumps that form under the skin near the joints. They can occur in multiple areas, most commonly near your elbows. Usually these are not painful.
Assesment and evaluation
1) Assesment of posture
2) Testing muscle strength and power
3) Measuring joint movement
4) gait analysis
1) cold therapy in acute phase for 10 to 20 mins twice a day.
2) Heat therapy in chronic phase for 20 to 30 mins twice a day
3) TENS will give short term pain releif.
1) assisted movement through normal range .
2) static muscle contraction helps to maintain muscles tone without increasing inflammation.
3) for chronic cases we can progress the above exercises to include light resistance.
4) postural, core stability exercises.
5) Swimming, walking, cycling to maintain cardiovascular fitness.
6) gentle stretching of tight muscles.
7) maintaining muscle strength is important for joint stability & preventing injury.
8) Muscles can become weak following reduced activity.
9) Muscles length can be affected by prolonged positions and immobilization and tightness can limit daily activities.
10) Splints will be provided for every deformity to keep the joint in correct position.
11) Advanced physiotherapy techniques like dry needling, manual muscle release will be unbeatable in correcting muscle stiffness and releiving joint pains.
12) Iontophoresis is believed to work through the transcutaneous deleivery of charged medications like lidocaine,corticosteroids, salicylate, antibiotics. It is used for deleivery of substances that need local penetration in order to avoid systemic effects.
13) orthotic devices can make activities of daily living much easier, leading to a greater degree of independence.