Arthritis is inflammation of a joint.

There are many types of arthritis, both inflammatory and noninflammatory, that affect
joints and other connective tissues in the body. The most common types treated by therapists are rheumatoid arthritis
and osteoarthritis.
Arthrosis is limitation of a joint without inflammation. Unless the cause of the joint problems is known, such as recent
trauma or immobility, medical intervention is necessary to diagnose and medically manage the pathology.
Clinical Signs and Symptoms common to all arthritic conditions:
Impaired mobility - secondary to joint involvement
Impaired muscle performance - muscle weakness from disuse or reflex inhibition
Impaired balance - secondary to decreased input from mechanoreceptors and muscle spindle
Functional limitations - activity limitation and participation restrictions are factors to consider.

RHEUMATOID ARTHRITIS

Autoimmune, chronic, inflammatory, systemic disease primarily of unknown etiology.

Affects synovial lining of joints as well as other connective tissues.
Symmetric, erosive synovitis with periods of exacerbation (flare) and remission.
Diagnostic Criteria
Many patients may complain of one or two of the typical signs and symptoms of joint pathology. However, RA is defined
by the presence of at least four (4) of the seven (7) criteria

PRINCIPLES OF MANAGEMENT FOR RA

Patient instruction.
Joint protection.
Energy conservation.
Joint mobility.
Exercise.
Functional training.

Therapeutic exercises cannot positively alter the pathological process of RA.

Can help prevent, retard, or correct the mechanical limitations and deforming forces that occur, especially during the
early stages of the disease, - therefore help maintain function

PRECAUTIONS WITH EXERCISE

Effects of steroidal medications may include osteoporosis and ligamentous laxity.

Joint capsule, ligaments, and tendons may be structurally weakened by the rheumatic process (also as a result of using
steroids).
Implications: exercises should not cause excessive stress to bones or joints; the dosage of stretching and joint
mobilization techniques used to counter any contractures or adhesions must be carefully graded.

CONTRAINDICATIONS

Stretching across swollen joints. Effusion causes limited joint motion.

Overstretching causes hypermobility (or subluxation); may also increase the irritability of the joint and prolong the joint
reaction
Vigorous stretching or manipulative techniques.
Forcing motion on the distended capsule overstretches joints, leading to subsequent HYPERMOBILITY OR
SUBLUXATION

OSTEOARTHRITIS (OA)

Degenerative joint disease

Articular cartilage of synovial joint
Spur formation
Heberden's nodes (DIP)
Bouchard's nodes (PIP)
Weightbearing joints