Friday, 12 September 2014

RHEUMATOID ARTHRITIS : PHYSIOTHERAPY Treatment :

RHEUMATOID ARTHRITIS AND ITS PHYSIOTHERAPY TREATMENT.:
Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that results in a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks flexible (synovial) joints. It can be a disabling and painful condition, which can lead to substantial loss of functioning and mobility if not adequately treated

Rheumatoid arthritis : 


Rheumatoid Arthritis Joint


Rheumatoid arthritis is a disorder in which the body's own immune system starts to attack body tissues. The attack is not only directed at the joint but to many other parts of the body. In rheumatoid arthritis, most damage occurs to the joint lining and cartilage which eventually results in erosion of two opposing bones. Rheumatoid arthritis often affects joints in the fingers, wrists, knees and elbows. The disease is symmetrical (appears on both sides of the body) and can lead to severe deformity in a few years if not treated. Rheumatoid arthritis occurs mostly in people aged 20 and above. In children, the disorder can present with a skin rash, fever, pain, disability, and limitations in daily activities. Often, it is not clear why the rheumatoid arthritis occurred. With earlier diagnosis and aggressive treatment, many individuals can lead a decent quality of life. The drugs to treat rheumatoid arthritis range from corticosteroids to monoclonal antibodies given intravenously.In rare cases, surgery may be required to replace joints but there is no cure for the illness.


Normal Joint-OA Knee- RA Knee



signs and symptoms of rheumatoid arthritis may include:

  •     Tender, warm, swollen joints
  •     Morning stiffness that may last for hours
  •     Firm bumps of tissue under the skin on your arms (rheumatoid nodules)
  •     Fatigue, fever and weight loss
Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.
Hands In RA

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.
When to see a doctor

Make an appointment with your doctor if you have persistent discomfort and swelling in your joints.



CAUSES :


Rheumatoid arthritis occurs when your immune system attacks the synovium — the lining of the membranes that surround your joints. The resulting inflammation thickens the synovium, which can eventually destroy the cartilage and bone within the joint. The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment.

Doctors don't know what starts this process, although a genetic component appears likely. While your genes don't actually cause rheumatoid arthritis, they can make you more susceptible to environmental factors — such as infection with certain viruses and bacteria — that may trigger the disease.

RISK FACTORS

Factors that may increase your risk of rheumatoid arthritis include:

    Your sex. Women are more likely to develop rheumatoid arthritis than men are.
    Age. Rheumatoid arthritis can occur at any age, but it most commonly begins between the ages of 40 and 60.
    Family history. If a member of your family has rheumatoid arthritis, you may have an increa
sed risk of the disease.

   Examination Of RA( RHEUMATOID ARTHRITIS) :
 
        Blood tests for rheumatoid arthritis

          Blood tests can measure inflammation. You may have one of these tests:

    erythrocyte sedimentation rate (ESR)
    C-reactive protein (CRP).

Both of these may show a high value when inflammation is present.

Blood tests can show if you’re anaemic and may be used to detect rheumatoid factor, which is an antibody produced by a reaction in your immune system.



X-RAY :



X-rays will show any damage caused to your joints by the inflammation in rheumatoid arthritis. The changes often show up in x-rays of your feet before they appear in other joints, so your doctor may want to x-ray your feet even if they’re not causing you any problems.
-RHEUMATOID FACTOR TEST


COMPLICATIONS : 

Rheumatoid arthritis increases your risk of developing:

    Osteoporosis. Rheumatoid arthritis itself, along with some medications used for treating rheumatoid arthritis, can increase your risk of osteoporosis — a condition that weakens your bones and makes them more prone to fracture.
    Carpal tunnel syndrome. If rheumatoid arthritis affects your wrists, the inflammation can compress the nerve that serves most of your hand and fingers.
    Heart problems. Rheumatoid arthritis can increase your risk of hardened and blocked arteries, as well as inflammation of the sac that encloses your heart.
    Lung disease. People with rheumatoid arthritis have an increased risk of inflammation and scarring of the lung tissues, which can lead to progressive shortness of breath.


 PHYSIOTHERAPY TREATMENT :

Exercise In Rheumatoid Arthritis


Physiotherapy treatment is important in helping patients with RA manage their disease. In conjunction with occupational therapists, physiotherapists educate patients in joint protection strategies, use of assistive devices, and performance of therapeutic exercises.
  • Rest and Splinting. The joints should be put into rest during the acute stage of the disease. Bed rest relieves the pain in cases of extensive joint involvement


  • Compression Gloves. Patients using compression gloves have reported reduced joint swelling and increased well-being


  • Assistive Devices and Adaptive Equipment. Assistive devices are used in order to reduce functional deficits, to diminish pain, and to keep patients' independence and self-efficiency. Loading over the hip joint may be reduced by 50% by holding a cane.


  • Massage Therapy. Massage is a commonly used treatment tool that improves flexibility, enhances a feeling of connection with other treatment modalities, improves general well being, and can help to diminish swelling of inflamed joints.


  • Aerobic Exercise
Physiotherapy Exercise 


Therapeutic Exercise :


Muscle weakness in patients with RA may occur because of immobilization or reduction in activities of daily living. Maintenance of normal muscle strength is important not only for physical function but also for stabilization of the joints and prevention of traumatic injuries. It may be proposed that exercise therapy has beneficial effects on increasing physical capacity rather than reducing the activity of the disease.

  • There should be no straining exercises during the acute arthritis. However, every joint should be moved in the ROM at least once per day in order to prevent contracture. In the case of acutely inflamed joints, isometric exercises provide adequate muscle tone


  • Moderate contractures should be held for 6 seconds and repeated 5-10 times each day.


  • Low-intensity isokinetic knee exercises (by 50% of the maximum voluntary contraction) were reported to be safe and effective in patients with RA
patients with active arthritis should particularly avoid activities such as climbing stairs or weight lifting. Producing excessive stress over the tendons during the stretching exercises should be avoided. In sudden stretches, tendons or joint capsules may be damaged. Finally, in chronic stage with inactive arthritis, conditioning exercises such as swimming, walking, and cycling with adequate resting periods are recommended. They increase muscle endurance and aerobic capacity and improve functions of the patient in general, and they also make the patient feel better.

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