Rheumatoid Arthritis

Post Rehab Goals and Objectives:

General exercise should be aimed at maximizing range of motion, strength, cardiovascular endurance and joint stability.

Description

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease of unknown etiology, characterized by inflammation of the synovium and connective tissue of diarthrodial joints and to a lesser extent the related tissue – tendons and their sheaths; bursal and periarticular subcutaneous tissues. RA inflammation is similar to that found with psoriatic Arthritis, Reiter's syndrome, juvenile Arthritis and Ankylosing spondylolitis.

RA may be unrelenting in its progression and may have patterns of remissions and exacerbations with a tendency toward incremental deterioration and progressive decline in the client's functional capacity. The loss of functional capacity is associated with selective atrophy of type 2 muscle. This atrophy is a trademark of RA. With mild RA there is atrophy of type 2 fibres, whereas with sever RA, atrophy is seen both in type 1 and type 2 fibres. The loss of type 1 and 2 fibres results in decreased strength, endurance, functional capacity and joint stability.

RA affects the smaller joints in the early stages of the disease. The MCP and PIP joints of the hands are involved. Involvement of the toes in RA frequently begins with synovitis of the MTP joints. In the knee, the early stages are characterized by joint effusion which produces pain at the extremes of flexion and extension. The upper cervical vertebrae may be involved, particularly C1 and C2. Subluxation between C1 and C2 may cause pressure on the spinal cord via the odontoid process. This occurs when the cervical spine is in flexion.

RA should be regarded as a systemic disorder, in which joints are often the primary target. However, the inflammation may involve the pericardium, pleura, and blood vessels. NSAID's play an important role in the management of RA. NSAID's alone will not modify the course of RA.