ARTHRITIS

Unit Facilitator: Sylvester Wakulwa

• Arthritis is derived from Greek arthro-, joint and -itis,
inflammation.
• It is a group of conditions involving damage to the joints of the
body.
• There are over 100 different forms of arthritis.
• The major complaint by individuals who have arthritis is joint pain.
• Pain is often a constant and may be localized to the joint affected.
The pain from arthritis occurs due to ;

• Inflammation that occurs around the joint,

• Damage to the joint from disease,
• Wear and tear of joint,
• Strain of muscles caused by forceful movements against stiff,
painful joints
• Fatigue
Anatomy

A joint is composed of;

• Union of two bones

• Joint space
• Synovial membrane
• Synovial fluid
Types of joints

• Fibrous
• Cartilaginous
• Synovial
Physiology

• Joints allow articulation/ movement of bones

• Synovial membrane secretes synovial fluid as other cells
continues removing excessive fluids
• Joints get nutrition from surrounding vessels, they don’t have
direct supply
Etiology

• Congenital e.g. congenital hip dislocation, osteochondritis

dessicans, perthes disease
• Trauma, accounts for over 50%
• Infections e.g. septic arthritis, TB, syphilis, gonorhoea
• Degeneration e.g. osteoarthritis
• Autoimmune e.g. rheumatoid arthritis
• Metabolic e.g. gout, rickets
• Others e,g. charcoats disease, syringomyelia
RHEUMATOID ARTHRITIS

• Is a chronic, systemic, autoimmune disease

• Ligaments are stretched and can become slack due to repeated
inflammation
• Its outstanding feature is synovitis
DEFORMITIES COMMON IN RA

1. Swan neck
• Synovitis of flexor tendon sheaths
• Hyperextension of PIP and flexion of DIP
2. Boutenniere
• Flexion of PIP hyperextension of DIP
• Central tendon is lengthened by bulging synovium and lateral
bands slide
3. Mallet fingers
• Flexion of DIP
4. Trigger finger
• Nodule or thickening of the tendon at entrance of tendon sheath
• Tendon glides and snaps
5. Joints laxity
OSTEOARTHRITIS

• A disease that causes the breakdown of cartilage in joints,

leading to joint pain and stiffness.
• Degenerative, wear and tear due to age or overuse
Pathology

• Smooth cartilage softens and loses its elasticity

• Large sections of cartilage wear away completely and allow
bones to rub together causing pain
• The joint may lose its normal shape
• As the ends of the bone hypertrophy (thicken) spurs (bone
growth) are formed where the ligaments and capsule attach to
the bone
• The joints becomes stiff and unstable
• Joint motion becomes restricted and painful
Clinical manifestations

• Usually affects weight bearing joints

• Stiffness weak muscles
• Crepitus
• Reduced joint spaces
Deformities

• Osteophytes – bone spurs

• Herberdens nodes – DIP
• Bouchards nodes - PIP
JUVENILE ARTHRITIS

• Is a disease in which there is inflammation(swelling) of the

synovium in children aged 16 or younger.
• Its an autoimmune disease
• The disease is also idiopathic, which means that no exact cause
is known.
• Researchers believe juvenile arthritis may be related to genetics,
certain infections, and environmental triggers.
 Types of juvenile arthritis

1. Systemic arthritis, also called Still's disease

2. Oligoarthritis, also called pauciarticular juvenile rheumatoid
arthritis, affects fewer than five joints in the first six months that
the child has the disease.
3. Polyarthritis, also called polyarticular juvenile idiopathic arthritis
(pJIA), involves five or more joints in the first six months of the
disease -- often the same joints on each side of the body.
4. Psoriatic arthritis affects children who have both arthritis and the
skin disorder psoriasis.
5. Enthesitis-related arthritis is a type of arthritis that often affects
the spine, hips, and entheses (the places where tendons attach to
bones).
Goals of treatment

• To relieve pain
• To reduce swelling
• To increase joint mobility and strength
• To prevent joint damage and complications
GOUT
 Caused by deposition of uric acid crystals in the joint, causing
inflammation.
 There is also an uncommon form of gouty arthritis caused by the
formation of rhomboid crystals of calcium pyrophosphate known as
pseudogout
 In the early stages, the gouty arthritis usually occur in one joint,
but with time, it can occur in many joints and be quite crippling.
 The joints in gout can often become swollen and lose function
COMPARISON OF SOME MAJOR FORMS OF ARTHRITIS
OA RA GOUT

onset Gradual Gradual Sudden

Main locations Weight bearing joints e.g. hip, Peripheral joints e.g. hand Big toe, elbow, knee
knee, spine joints, toes

Inflammation No Yes Yes

Radiological Narrowed joint space Narrowed joint space Punched out bone erosions
Local Bone erosions
Osteophytes
Osteosclerosis

Laboratory findings None Rheumatoid factor Crystals in joints

Elevated ESR

Other features Bouchards nodes Wrist deviations Tophi

Herbedens nodes Boutonniere Nephrolithiasis
Swan neck
Mallet fingers
Lupus
This is a common collagen vascular disorder that can be present with
severe arthritis.
Other features of lupus include a skin rash, extreme photosensitivity,
hair loss, kidney problems, emotional lability, lung fibrosis and
constant joint pain.
OSTEOPOROSIS
Is a health condition that weakens bones, making them
fragile and more likely to break. It develops slowly over
several years
Treatment

Treatment aims to:

• Slow or prevent the development of osteoporosis
• Maintain healthy bone mineral density and bone
mass
• Prevent fractures
• Reduce pain
• Maximize the person’s ability to continue with
their daily life
OCCUPATIONAL THERAPY MANAGEMENT IN ARTHRITIS

• Application of splints and braces

• Hand Therapy
• Provision of assistive devices
• Adaptation of tools
• Environmental modification
• Training in self care activities
• Improving self esteem
• Health Education
Splinting

• Hand resting splint –maintains functional position, discourages

ulnar drift and rests inflamed joints.
• Wrist cock-up splint- provides support during ADLs
performances
• Thumb immobilization splint
• Finger splints
• Knee braces and other braces
Energy conservation principles

• Use the strongest/ largest joints available

• Reduce the effort needed to do the job
• Plan ahead
• Pace yourself
• Sit when possible
• Use good posture
• Use good body mechanics
Joint protection techniques

• Respect pain
• Maintain muscle strength and joint range of motion
• Wear splints and braces where necessary
• Avoid position of deformity
- Avoid tight grasp
- Avoid pressure against your fingers
- Avoid strong and constant pressure
- Avoid prolonged periods of holding the same position
Adaptation of tools

• Building up tools to change their structure or shape, to enable a

client use them to perform occupations
• you can increase their length, width, shape etc

Use of assistive devices

• Devices such as wheelchairs, crutches, bathing aids, toileting

aids (commode), feeding aids.
• these assistive aids helps the clients with arthritis to bridge the
gap between disability and function
Environmental modifications

• replacing stairs with ramps

• widening doors
• change of floor texture
• bed adjustment
• change of storage of equipments
• modifying bath tabs/areas
• change switches, sinks etc
Self care tasks

•Dressing
- Replace buttons with Velcro, or button hook
- Use a long handled shoe horn
- Wear shoes with Velcro closures
- Build zipper heads and attach rings
•Bathing
- Wash with a loop handled sponge
- sit while bathing
- install grab bars
•Cutting and chopping
- Position knives parallel to knuckles and keep fingers as straight
as possible
- Pull the knife through the meat and towards the body
•Bed making
- Make one side at a time
•Reading
-use a book stand for heavier books
-avoid holding books, newspapers for long
•Writing
-built up pens
-use pens that require less pressure
-sit comfortable
•Movie/TV
-use good sitting posture
-walk around during intermission or commercials
WORK

• Occupational Therapist will assess the work environment of

rheumatological clients, to ensure they perform their duties
with minimum difficulty.
• Assess tools, posture, working heights and space, the physical
structure of the working place as well as the complexity of the
job vis a vis the disability.