Rheumatoid Arthritis (RA)
Unlike OA, RA is a systemic autoimmune disease. The body's immune system attacks healthy tissue, leading to inflammation of the synovial joints, which can eventually affect the eyes, skin, lungs, heart, and nervous system. RA typically presents symmetrically (affecting both sides of the body equally) and often impacts the hands, wrists, and knees.
RA progresses through four inflammatory stages: Acute (most severe, high inflammation, systemic symptoms), Subacute (decreased ROM and endurance, stiffness mostly in the morning), Chronic-active (minimal rest pain, but pain with activity), and Chronic-inactive (residual stiffness and weakness, but largely functional).
If left untreated, RA can cause significant joint deformity, such as ulnar drift, swan neck deformities, or boutonnière deformities.
Other Inflammatory and Autoimmune Conditions
- Gout: Caused by high blood levels of uric acid; crystals deposit in synovial tissues, causing intense pain and inflammation.
- Systemic Lupus Erythematosus (SLE): A chronic autoimmune disease where the body attacks healthy tissue, causing widespread inflammation.
- Psoriatic Arthritis: Strongly correlated with family history and characterized by a red, flaky, patchy rash alongside joint pain.
- Juvenile Idiopathic Arthritis (JIA): The most common type of arthritis in children under 16. It is not simply a "childhood version" of RA and can lead to complications like growth problems and eye inflammation.
Bone Density and Spinal Health
Osteoporosis and Osteopenia
Bone health is heavily influenced by weight-bearing activities and muscle contraction.
- Osteopenia: A reversible weakening of the bone that increases the risk of developing osteoporosis.
- Osteoporosis: A condition where bone breakdown outpaces new bone formation, making bones fragile and increasing fracture risk. It can also lead to postural changes like kyphosis.
- Sarcopenia: The age-related loss of muscle mass, which often co-occurs with these conditions.
Degenerative Disc Disease (DDD)
DDD occurs in the neck or lower back due to aging or OA. The deterioration of intervertebral discs can cause pressure on the spinal cord, leading to radiating pain (in arms or legs) and sensations of "pins and needles".
Medical and Pharmacological Interventions
Management of these conditions focuses on pain relief, reducing edema, and preserving joint function.
Pharmacological Management
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Frequently used to manage both inflammation and pain.
- Disease Modifying Antirheumatic Drugs (DMARDs): Such as methotrexate, these are used in RA to slow disease progression and prevent joint damage.
- Corticosteroids: Injections (e.g., methylprednisolone) can provide targeted relief for OA pain by reducing inflammation in a specific joint.
Surgical Interventions
When conservative treatments fail and daily activities are severely impaired, surgery may be indicated.
- Total Joint Arthroplasty (TJA): This involves replacing damaged bone and cartilage with prosthetic components.
- Total Hip Arthroplasty (THA): The femoral head is replaced with a metal stem and ball, and the acetabulum (socket) is replaced with a metal socket.
- Total Knee Arthroplasty (TKA): Replaces the weight-bearing surfaces of the knee to relieve pain.
- Total Shoulder Arthroplasty (TSA): Aims to restore motion and relieve "bone on bone" pain in the shoulder.
- Spinal Fusion: Used for degenerative disc disease to stabilize the spinal column and prevent the narrowing of the spinal canal (spinal stenosis).
💡 Clinical Note: Post-Surgical Precautions
Following a Total Hip Arthroplasty (Posterior Approach), patients must often avoid:
- Hip flexion beyond 90 degrees.
- Hip rotation of the operated leg.
- Hip adduction (e.g., crossing the legs).
Following Spinal Surgery, patients typically follow "No Bending, No Twisting, No Lifting" (often limited to 5-10 lbs).
Occupational Therapy and Management
The primary goal of occupational therapy is to mitigate the impact of orthopedic conditions on Occupational Performance—the ability to engage in meaningful daily activities.
Impact on Function
Patients with arthritis often experience fatigue and difficulty with fine motor tasks (e.g., dressing, bathing, or cooking).
OT Interventions and Strategies
Therapists provide education and training in several key areas:
- Joint Protection: Teaching techniques to reduce stress on joints during tasks.
- Energy Conservation: Strategies to manage fatigue and prevent overexertion.
- Activity Modification: Identifying activities that cause inflammation and modifying them to prevent further joint instability.
- Adaptive Equipment: Recommending tools (e.g., specialized utensils or dressing aids) to assist with ADLs.
- Environmental Modifications: Adjusting the home environment to support independence.
🎓 Exam Tip: Weight-Bearing Status
In orthopedic rehabilitation, understanding weight-bearing orders is critical for patient safety:
- NWB (Non-weight bearing): 0% weight; foot does not touch the ground.
- TTWB (Toe-touch weight bearing): Foot may touch for balance only.
- PWB (Partial weight bearing): A specific percentage (e.g., 20-50%).
- WBAT (Weight bearing as tolerated): Limited only by the patient's pain/tolerance.
- FWB (Full weight bearing): 100% weight; no limitations.
