Rheumatoid Arthritis Rehabilitation

Rheumatoid arthritis (RA) is a nonspecific inflammatory disease that occurs in the joints, causing damage to the synovial membrane, articular cartilage and subchondral bone, with a chronic course leading to joint adhesion and deformity.

What causes VKDT?

Rheumatoid arthritis is a very common disease, but its cause is still not fully understood. It is currently believed that rheumatoid arthritis is an autoimmune disease, with the following factors involved:

The causative agent may be a virus, bacteria, or allergen, but it has not been determined with certainty. The disease is clearly related to gender (70-80% of patients are female) and age (60-70% occur in people over 30 years old). RA is familial and is related to the histocompatibility antigen HLA DR4 (60-70% of patients have this factor, while the rate in the community is only 30%). In addition, a humid living environment, a weakened body, cold, surgery, etc. can also be the cause of RA.

VKDT is a social disease because of its high incidence, long-term progression, and disability.

Knee exercises.

Clinical symptoms

In the initial stage, the disease usually starts slowly, gradually increasing, starting with inflammation of only one joint (inflammation of small joints in the hands, knee arthritis or other joints). The inflamed joints are clearly swollen and painful but less red and less hot, with signs of morning stiffness. This stage lasts for several weeks to several months and then moves to the full-blown stage.

The acute phase often presents with pain and inflammation in many joints such as the wrists, proximal interphalangeal joints, metacarpophalangeal joints, knees, ankles, toes, and elbows. The inflammation is mostly symmetrical, with swelling, pain, and limited mobility, with little redness or heat. The pain is worse at night and early morning.

Rehabilitation

For acute arthritis, rest, correct posture, splints or splints are needed to support the muscles. Patients need pain relief and anti-inflammation with medication and physical therapy. In addition, patients need to treat any infections if present.

Rehabilitation of some joints

Hand: The hand includes the most common joints in RA. In the late stages, common joint deformities are: ulnar tilt of the hand due to subluxation of the metacarpophalangeal joint; flexion deformity at the metacarpophalangeal joint accompanied by hyperextension at the proximal interphalangeal joints and flexion at the distal interphalangeal joints, giving the hand a “swan neck” shape. The causes of deformities are destruction of the bone ends, displacement or rupture of tendons, and imbalance between the hand muscles. Physical therapy should focus on protecting and restoring the motor function of the hand, especially the gripping function.

In the acute phase, it is necessary to apply cold compresses, gently move the hand and fingers, place the hand and fingers in a cast or plastic splint in the following position: wrist extended 20 degrees, metacarpophalangeal joint flexed 45 degrees, interphalangeal joint flexed 30 degrees, distal interphalangeal joint flexed 20 degrees, thumb extended and abducted.

In the subacute and chronic stages, patients need pain relief with paraffin baths or whirlpools, active assisted movement to increase the range of motion of the hands and fingers, resistance movement with hands and tools, hand function training, especially gripping function, gentle stretching of spastic tendons but not excessively, and use of splints to support the hands while sleeping.

Patients should be instructed to practice gripping and stretching the joints; avoid clenching the hands for too long, bending the wrists towards the ulna, increasing flexion of the metacarpophalangeal joint, prolonging the time in one position, and overtraining.

Shoulder joint: In the shoulder joint, RA causes inflammation of the joint capsule and synovial membrane, leading to limited joint movement, which can lead to stiffness. Therefore, rehabilitation is mainly aimed at increasing the range of motion of the joint.

In the acute phase, the patient needs to rest, not move the joint; massage, apply ice to reduce pain. In the subacute and chronic phase, the patient can use heat to reduce pain, soften tendons; exercise with assistance to increase the range of motion of the joint, especially extension and rotation; maintain muscle strength.

Instruct the patient to practice shoulder movements, especially swinging movements to increase range of motion.

Hip and knee joints: These are the main weight-bearing joints of the body, so they are susceptible to joint damage and muscle stiffness. Therefore, the purpose of rehabilitation is to maintain joint range of motion and joint strength.

In the acute phase, the patient needs to rest in bed, not put a pillow under the inflamed joint, put a plaster cast behind the knee all day and night. Gentle passive exercise to maintain range of motion, quadriceps muscle contraction. In the subacute and chronic phase, relieve pain for the patient with heat, active assisted exercise to maintain range of motion, quadriceps muscle exercise, practice moving with crutches, put a plaster cast behind the knee every night.

Instruct the patient to maintain good posture, maintain joint range of motion and muscle strength, especially the quadriceps.

Foot: This is a weight-bearing joint so it often has severe deformities: clubfoot, claw-shaped toes affecting gait. The purpose of rehabilitation is to avoid bad deformities.

In the acute phase, the patient needs to rest in bed, maintain the ankle in a plaster cast, and do gentle passive movements. In the subacute and chronic phase: relieve pain with heat, passively move the joints, especially the Achilles tendon, stretch the tendons if contracted, and practice moving with crutches.

Instruct the patient to move the ankle and foot joints using active and passive movements.

According to SKDS