Physiotherapy and Arthiritis

“Arthritis” literally means joint inflam mation. The term arthritis is often used to refer to any disorder that affects the joints. These are diseases characterised by inflammation (signs include redness or heat, swelling, and symptoms such as pain) and loss of function of one or more connecting or supporting structures of the body. Arthritis affects more than 180 million people in India, a prevalence higher than many well-known diseases such as diabetes, AIDS, and cancer. Around 14% of the Indian population seeks a doctor’s help every year for this joint disease. Alarmingly, India will emerge as the capital of osteoarthritis by 2025, with more than 60 million likely to be affected. (Disease burden of rheumatic diseases in India: COPCORD perspective, A. Chopra, published June 1, 2015, Medicine) Indian Journal of Rheumatology). The maiden WHO ILAR COPCORD (community-oriented programme for control of rheumatic diseases) Bhigwan (1996–2014) demonstrated that musculoskeletal (MSK) pain was the commonest self-reported ailment in the community, soft tissue rheumatism, ill-defined MSK symptoms, and osteoarthritis (OA) were the predominant disorders, and about 10% of cases suffered from inflammatory arthritis. The burden of rheumatoid arthritis (RA) was high, with a point prevalence of 0.7%. Bone and joint disease (BJD) India conducted several standardised and uniform surveys (2004–2010) all over India and collected data from over 55,000 people at 12 sites.

The pooled age-sex adjusted (India census population 2001) prevalence reported by the recent surveys was: RA (0.34), OA knees (3.34), undifferentiated inflammatory arthritis (0.22), spondyloarthritis (0.23), ankylosing spondylitis (0.03), psoriatic arthritis (0.01), soft tissue rheumatism (1.39), gout (0.05), lupus (0.01); prevalence percent in parenthesis. Several forms of collagen-vascular disorders and vasculitis are described in hospital-based case series. Classification: There are several diseases where joint pain is primary and considered the main feature. Generally, when a person has arthritis,” it means that they have one of these diseases, which include: hemarthrosis, osteoarthritis, rheumatoid arthritis, gout and pseudo-gout, septic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, and Still’s disease. Psoriatic arthritis. Osteoarthritis is the second most common rheumatologic problem and the most frequent joint disease, with a prevalence of 22% to 39% in India. OA is more common in women than men, but the prevalence increases dramatically with age. Nearly 45% of women over the age of 65 have symptoms, while radiological evidence is found in 70% of those over 65. OA of the knee is a major cause of mobility impairment, particularly among females. OA was estimated to be the 10th leading cause of nonfatal burden.

Epidemiology of knee osteoarthritis in India and related factors Chandra Prakash Pal, Pulkesh Singh, Sanjay Chaturvedi, Kaushal Kumar Pruthi, and Ashok Vij, Indian J Orthop. 2016 Sep; 50(5): 518–522. doi: 10.4103/0019-5413.189608, PMCID: PMC5017174, PMID: 27746495 Rheumatoid Arthiritis, another common athiritis, is an autoimmune disease that mainly affects tissues around the joints. Most frequent in adults, it affects between 0.5% and 1% of the population in India. Women are three to four times more frequently affected than men. Onset generally occurs in the 35–55 age group. Gout is one of the most common causes of inflammatory arthritis. Gout is three to four times more common in men and obese people aged 50 years or older. Symptoms Pain, which can vary in severity, is a common symptom of virtually all types of arthritis. Other symptoms include swelling, joint stiffness, redness, and aching around the joint(s). Arthritic disorders like lupus and rheumatoid arthritis can affect other organs in the body, leading to a variety of symptoms. Symptoms may include an inability to use the hand or walk, stiffness in one or more joints, rash or itching, Malaise and fatigue, Weight loss, Poor sleep Muscle aches and pains, tendernes Decreased mobility, in combination with the above symptoms, can make it difficult for an individual to remain physically active, contributing to an increased risk of obesity, high cholesterol, or vulnerability to heart disease. People with arthritis are also at increased risk of depression, which may be a response to numerous factors, including fear of worsening symptoms. Physiotherapy Physiotherapy (physical therapy) plays a crucial role in the management and treatment of arthritis. It can be highly effective in improving joint function, reducing pain, and enhancing the overall quality of life for individuals with arthritis. Here are some ways in which physiotherapy is commonly used in the management of arthritis: 1. Pain Management: Physiotherapists can employ various techniques to help alleviate the pain associated with arthritis. This may include heat or cold therapy, ultrasound, electrical stimulation, and manual therapies such as joint mobilisation and soft tissue massage.

2. Range of Motion Exercises: Arthritis can lead to joint stiffness and reduced mobility. Physiotherapists can design specific exercises to help maintain or improve joint flexibility and range of motion.

3. Strengthening Exercises: Strengthening the muscles around affected joints can provide better support and stability. Physiotherapists can create customised exercise programmes that target muscle groups to help protect and support arthritic joints.

4. Balance and Coordination Training: Arthritis can affect balance and coordination, increasing the risk of falls. Physiotherapists can design exercises and activities that improve balance and reduce the risk of injury.

5. Joint Protection Techniques: Physiotherapists can educate individuals with arthritis on joint protection techniques, which involve modifying daily activities to reduce stress on the affected joints. This can help prevent further damage and discomfort.

6. Assistive Devices and Orthotics: Physiotherapists can assess the need for assistive devices such as braces, splints, or orthotics to provide additional support and reduce pain in affected joints.

7. Education and Lifestyle Advice: Physiotherapists can offer guidance on lifestyle modifications, including exercise routines, ergonomic adjustments at home and work, and recommendations for managing symptoms during flare-ups. 8. Aquatic Therapy: Water-based exercises in a pool or aquatic environment can be particularly beneficial for people with arthritis. The buoyancy of water reduces the impact on joints while allowing for effective exercise and an increased range of motion.

8. Pain Relief Modalities: Physiotherapists may use modalities like transcutaneous electrical nerve stimulation (TENS) or ultrasound to provide pain relief and reduce inflammation.

9. Post-Surgery Rehabilitation: For individuals who undergo joint replacement surgery due to severe arthritis, physiotherapy is an integral part of the post-operative rehabilitation process. Physiotherapists help patients regain strength, mobility, and function in the replaced joint. It’s essential for individuals with arthritis to work closely with their healthcare team, including physiotherapists, to develop a personalised treatment plan. The specific approach to physiotherapy will depend on the type and severity of arthritis, as well as individual needs and goals. Regular physiotherapy sessions, along with consistent home exercises and self-management strategies, can help individuals with arthritis manage their condition effectively and improve their overall quality of life.