Rheumatoid arthritis- Types, Causes, Sign & Symptoms

Rheumatoid arthritis
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Rheumatoid arthritis

Rheumatoid arthritis is a non supportive, idiopathic, systemic inflammatory disease characterized by symmetrical polyarthritis, proliferation and destruction of synovial memebrane, periarticular structure and skeletal muscles. Thus the joints are destroyed fibrous and ankylosed.

 

Etiology

  • Idiopathic
  • Hereditary
  • Autoimmune disease due to formation of IgM antibodies
  • Common in people with HLADR4 gene
  • Psychological stress
  • Allergens
  • Epstein bar virus infection, rubella, herpes zoster
  • Endocrinal and metabolic factors

 

Common joints involved

  • MCP joint in hands
  • PIP joint of finger
  • Wrist
  • Elbow
  • Knee
  • Hip

 

Clincial feature

  • Articular features
  • Common in women in middle age
  • Pain, swelling, stiffness of small joints of hand and feet
  • History of remission and exacerbation of symptoms
  • Morning stiffness
  • Flexion deformity of joints
  • Symmetrical involvement
  • Palindomic presentation. Here pain may last gor few days and then disapper
  • Systemic presentation (common in middle age men characterized by pleurisy, pericarditis fever)
  • Polymyalgia (diffused joint pain and stiffness with no synovitis seen in elderly patients)
  • Mono- arthtis swelling ( pain and swelling in both knees )

 

2. Extra- articular features

  • Subcutaneous nodule formation
  • Vasculitis
  • Vitamin B12, iron deficiency anemia, leucopenia
  • Osteoporosis
  • Eye disorder, conjunctivitis, glaucoma
  • Cardiopulmonary disorder like lung infection, pleural effusion, arrhythmia, rheumatic heart disease.
  • Neuromuscular involvement like carpal tunnel syndrome, mononeuritis multiplex, subluxation at C1- C2

 

Deformities in rheumatoid arthritis

 

A. In hand

Symmetrical joint swelling at MCP, IP joints

Flexion and ulnar deviation of MCP Joint

Trigger finger, trigger thumb due to subcutaneous nodule formation over the flexor tendons

Swan neck deformity

Hyperextension of PIP joint & flexion of DIP joint.

It result due to rupture of central slip of extensor tendons.

 

B. In wirst flexion

Flexion and ulnar deviation of wrist

Subluxataion of head of ulna

 

C. Foot deformities

Hallux valgus deformity of great toe

Claw toes

Widening of forefoot

Vaglus deformity of heel

Callosity over dorsum and sole of foot

 

D. Knee

Flexion deformity

Valgus deformity

Wind swept deformity

Backer’s  eyst

Secondary osteoarthritis

 

E. Hip

Flexion and adduction deformity

Persistent pain

Secondary OA

Trochanter bursitis

 

Diagnosis of Rhematoid arthritis

Synovial fluid analysis ( greensih in color and cloudy)

Rose waaler test ( a test of historical interst when sheep red cells are coated with a concentration of antiserum to sheep red cells which is too low to cause agglutination the addition of serum from patient with rheumatoid arthritis will cause agglutination)

Presence of Rh factor in serum

X-ray

Classical clinical features and history

 

Physiotherapy management of Rhematoid arthritis hand

 

1. Splitting

– Dorsal blocking splint (DBS) with wrist in 20° flexion, MCP joint in 50° flexion an DIP, PIP joint in full extension.

– Tripoint splint (anti-swan neck splint) ring splint to balance finger extension in swan neck deformity and prevent hyperextension of PIP joint

– Night splints

– Dynamic splints

– Anti -boutonniere splint

 

2. Gliding exercises

– Making a full first for maximum gliding of flexor digitorum profundus muscle

– Making a flat fist for maximum gliding flexor digitorum superficialis tendon

– Making hook fist for gliding of both flexor digitorum profundus and flexor digitorum  superficialis tendon.

 

3. To improve and maintain ROM

– Passive exercises to all finger involving the PIP, DIP, and MCP joints

– Passive stretching to intrinsic muscles

– Active assisted and free  exercises to fingers and wrist

– Fingers parting and closing

– Mannual joint mobilization

 

4. To relieve pain

– Moist heat

– Ultrasound

– Proper position

– Progressive relaxtion techniques

 

5. Strengthening exercises

– Mannual resisted exercises to fingers and wrist

– Ball squeezing buttoning if shirt  writing

– Sponge or sorbo rubber can be used

– Putty  clay activities

– Dough making

– Hand re-eductional board

– Improving grip strength and precision handling

 

6. Teach daily activites using hand (Key holding, pen or pencil holding,  writing skills, door knob closing

– Still’s disease

– It is also called as systemic disease

– It is a type of juvenile chronic arthritis

– It affects children below 8years

 

Clinical features

Spiking fever

Enlarged lymph glands

Hepatospleenomegaly

Pericarditis

Pleurisy

Mal- development of limb, finger

Popular pink rashes

Patients is congestive to rhematoid factors

 


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