Rheumatoid Arthritis

Defination:

Rheumatoid Arthritis is the most common inflammatory disease of the joints, It is a systemic disease of young and middle-age adults characterised by proliferative and destructive changes in synovial membrane, periarticular structurs, skeletal muscles and perineural sheaths. Eventually joints are destroyed, fibrosed or ankylosed. It is a wide spread vasculitis of the small arteroiles.

Incidence is three percent
Cause: Unknown
Actiology: Femail are more affected because blood loss.
Age: 30-55 years.

Pathlogy

Factor:
1. Obesity
2. diebatics.

Clinical Features:

Rheumatoid Arthritis usually presents in three forms
Classical presentation in this group patient is usually a woman in her mid 30s. Pain, Swelling, stiffness of the small joints of hands and feet are the common presenting complaints. patient also gives history of weight loss, lethergy and depression.

other presentations This consists of palindromic presentation invoiving one or two joints,systemic presentation usually seen in middle aged men presenting with pleurisy,pericardities,etc.it mimicks malignancy.

extra-articular features two or more features are present in75 percent of the cases.Rheumatoid factor is invariably present and indicates abad prognosis.
1.subcutaneous nodules
2.widespread vasculitis
3.blood abnormalities
4.osteoporosis
5.eye changes seen in rheumatoid arthirities are kerato-conjunctivities sicca.
6.lung affections in rheumatoid arthrities are pieurisy,pleural effusion, caplan`s syndrome.
7.heart affections in rheumatoid arthritis are pericardial friction10%, pericardial effusino30%, arrythmias and heart block.
8.neuromuscular system involvement includes carpel tunnel syndrome.
9.reticuloendothelial system affection.

Quick facts
joints involved in rheumatoid arthritis

metacarpophalangeal and interphalangeal joints of the hand and feet.
shoulder,elbow and wrist.
hip,knee and ankle.

Radiological Features of rheumatoid arthritis

Soft tissu swelling.
juxta -articular osteoporosis.
erosion of joint margins.
deformitis.
atlantoaxial subluxation.
subcondral erosions and cyst formation.

fibrous and bony ankylosis developed in the last stages.

Management

Problem list:

pain
swelling
morning stiffness
joint stiffness
muscle weakness
muscle contracture
deformity
deacrse ADL

pain- acute:ice gell pag use

                             isometric contraction
                             wrist joint,elbow joint pulse mode ultrasound
                             rest 5 days.
                  chronic: WAX,IRR,Ultrasound,Short wave.
                               Manupulation
                              Exercise-pain free active movement grade1 mobilisation.

swelling- acute - elevation of the limb. ice compression, crape bandage.,big joint-micromessage.
Morning stiffness- pain free active movement.
Joint stiffness- grade2and3 mobilization.manupulation accessary movement of joint.passive movement.
Muscle weakness-isometric contraction,active assisted,active movement,hydrotherapy.
Muscle contracture- heat therapy,friction message,passive streth.
Deformity-static splint-to maintain joint the anatomical poition and continious active movement.then deformity mobilization-dynamic splint,cochcuff splint-where we force the joint if take the extensor procidure.
DecreaseADL: patient will continue the ADL activity.

Modification of daily activities:

Using western toilets.
Bath aids and railings.
Long handle broomstick and mop to clean the floors.
Use of walking stics while walking,climbing,etc.
High chair
Avoid squatting .
Avoid squeezing cloths after washing.
Avoid allergic food.
TO sleep on aheard surface.

Rheumatoid Arthritis