Rheumatoid Arthritis PDF

Rheumatoid Arthritis dr. Amien Suharti, Sp.KFR  Rheumatoid Arthritis Rheumatoid arthritis (RA) is a chronic, systemic inflammatory condition. The disease manifests itself as synovitis, which is inflammation of the synovial membrane that lines the joint capsule of diarthrodial j...

Rheumatoid Arthritis dr. Amien Suharti, Sp.KFR  Rheumatoid Arthritis Rheumatoid arthritis (RA) is a chronic, systemic inflammatory condition. The disease manifests itself as synovitis, which is inflammation of the synovial membrane that lines the joint capsule of diarthrodial joints. RA is characterized by symmetrical polyarticular pain and swelling, prolonged morning stiffness, malaise, fatigue, and low grade fever. Joints most commonly affected are the PIP, MCP, and thumb joints of the hands, wrists, elbows, ankles, MTPs, and temporomandibular joints, with hips, knees, ankles, shoulders, and cervical spine also frequently involved.  Medical Management The major goals in the treatment of RA include 1. Reducing pain, swelling, and fatigue 2. Improving joint function and minimizing joint damage and deformity 3. Preventing disability and disease related morbidity 4. Maintaining physical, social, and emotional function while minimizing long term toxicity from medication  Occupational Therapy Evalation 1) Client history Important details include diagnosis, dates of onset and diagnosis, secondary medical conditions, current medications and medication schedule, alternative or complementary therapies, and surgical history 2) Occupational Profile 3) Occupational Performances Status Once the client typical and preferred occupations are identified, his or her level of independence engaging in these functional activities can be assessed by interview or by observation 4) Cognitive Psychological and Social Status Client’s with arthritis should be screened for cognitive and psychosocial deficits. Psychosocial adaptation is affected by the complex interplay of physical, psychological, and situational factors. 5) Clinical Status For client’s with arthritis the elements of inflammation, ROM, strength, hand function, stiffness, pain, sensation, joint instability and deformity physical endurance, and functional mobility should be included through either brief screening or detailed evaluation. Common hand deformity in arthritis include the following : A boutonniere deformity A swan-neck deformity A mallet finger Nodes Nodules Deviation Subluxation Dislocation Ankylosis Extensor tendon rupture Trigger finger Mutilans deformity Thumb deformities  Occupational Therapy Intervention Treatment methods useful in the remediation of clinical or functional problems include Rest Physical agent modalities Therapeutic exercise and activity Splinting Occupational performance training Client education  Splinting Splinting is often an integral component in the treatment of arthritis. Splints can be used for numerous reasons, with the fundamental goal of maximizing function. A resting hand splint is useful for the treatment of acute synovitis of the wrist and hand. Its primary function is to provide localized rest to the involved joints. It can also serve to relieve pain, decrease muscles spasm, and protect joints vulnerable to contracture or deformity from synovitis.  Occupational Performance Training 1. Assistive Devices The therapist should be familiar with types of available devices and sources where they can be obtained at minimal expense. Having sample equipment on hand for the client to try can be helpful in finding the best device for each client 2. Client and family education Client education ha been shown to empower clients and lead to changes in disease management behaviors and self efficacy. The following are some important educational aspects to cover : disease process, symptom management, joint protection and fatigue management, and community resources  Joint protection and fatigue management Joint protection and fatigue management principles are as follows : Respect pain Maintain muscle strength and joint ROM Use each joint in its most stable anatomical and functional plane Avoid positions of deformity Use the strongest joints available Ensure correct patterns of movement Avoid staying in one position for long periods Avoid starting an activity that cannot be stopped immediately if it becomes too stressful Balance rest and activity Reduce the force and effort Terima kasih