Phys. Health: Arthritis and Lower Extremity Joint Replacement (Chap. 28)

Arthritis

• Prevalence of Arthritis

• Types of Arthritis

  • Rheumatoid Arthritis

  • Osteoarthritis and Degenerative Joint Disease

  • Gout

Interventions for Arthritis

Arthritis InterventionsMedications:

• NSAIDs – Reduce pain/swelling (e.g., ibuprofen).

• DMARDs & Biologics – Slow autoimmune arthritis (e.g., methotrexate).

• Corticosteroids – Short-term inflammation relief.

• Gout meds – Lower uric acid (e.g., allopurinol).

Surgery:

• Joint replacement – Used for severe arthritis (hip, knee).

• Joint fusion – Stabilizes painful joints.

Arthritis in Occupational Therapy

Occupational therapists (OTs) and occupational therapy assistants (OTAs) use a multi-modal approach to help clients with arthritis by combining:

• Joint protection techniques – Educating on ways to reduce joint stress.

• Energy conservation strategies – Teaching how to pace activities and avoid fatigue.

• Adaptive equipment – Recommending tools like jar openers and ergonomic utensils.

• Exercise programs – Promoting gentle movements to maintain function.

• Pain management – Using heat, cold, and relaxation techniques.

• Environmental modifications – Adjusting home/work setups for easier access.

Occupational Therapy Treatment Process

Assessment of Occupational Performance

• Interview – Discuss daily challenges.

• Observation – Watch movement and function.

• Assessments – Use tools to measure impact.

• Activity Analysis – Identify task barriers.

Intervention Process

• Education – Joint protection, energy conservation.

• Adaptive Equipment – Tools for easier tasks.

• Exercises – Improve mobility and strength.

• Pain Management – Use heat, cold, relaxation.

• Modifications – Adjust home/work setup.

• Task Adaptation – Change activities for comfort.

What Is Arthritis?

• Arthritis can be inflammatory, infectious, metabolic, or autoimmune

• It can be progressive, static, or have periods of remission and exacerbation

• Overall goals of OT intervention

  • Improve/prevent decline in function

  • Reduce/manage pain management

  • Preserve joint integrity

  • Improve quality of life (QoL)

Osteoarthritis vs. Rheumatoid Arthritis

• Osteoarthritis (OA) or degenerative joint disease (DJD)

  • Articular cartilage wears away

• Rheumatoid arthritis

  • Systemic, autoimmune

  • Also affects eyes & internal organs

  • Exacerbation/ remission

Comparison Chart

Characteristic	Rheumatoid Arthritis (RA)	Osteoarthritis (OA)
Age of Onset	Can begin at any age	Usually starts later in life
Speed of Onset	Rapid (weeks to months)	Slow (years)
Joint Symptoms	Painful, swollen, stiff joints	Achy, tender joints, little or no swelling
Pattern of Affected Joints	Often symmetrical (both sides of the body) – hands, wrists, elbows, feet	Often asymmetrical – starts on one side, affects fingers (near nails), thumbs, hips, knees, or spine
Duration of Morning Stiffness	Lasts over 1 hour, very difficult to get going in the morning	Lasts less than 1 hour, returns after activity
Systemic Symptoms	Fatigue, general feeling of illness	No whole-body symptoms

Osteoarthritis vs. Rheumatoid Arthritis
Signs & Symptoms

• OA

  • Joint pain

  • Joint stiffness

  • Decrease ROM

  • Inflammation

  • Difficulty performing daily activities

  • Visible joint changes

  • Muscle weakness

• RA

  • Tender, warm, swollen joints

  • Morning stiffness

  • Rheumatoid nodules

  • Fatigue, fever, and weight loss

Osteoarthritis vs. Rheumatoid Arthritis
Diagnosing

• OA

  • Detailed health history 

  • History of symptoms

  • Physical examination 

  • X-ray/MRI

  • Ruling out other arthritic conditions

    • blood tests

    • joint aspiration

• RA

  • Extensive history

  • Physical examination

  • Blood tests

  • Imaging studies

Osteoarthritis vs. Rheumatoid Arthritis
Treatment

OA:

• Pain management

• Improve function

• Reduce the potential for long-term disability

• Variable medical treatment (NSAIDs, pain relief)

• Body mechanics, lifestyle changes

• Adaptive equipment and environmental modifications

RA:

• NSAIDs, DMARDs, and pain medication

• Joint protection and orthoses

• Pain/inflammation management

• Adaptive equipment during exacerbation

• Remission phase: gentle progressive exercise

Adaptive Equipment

OA:

• Orthopedic supports (knee or wrist braces) to stabilize joints

• Ergonomic tools (specialized kitchen tools, utensils with larger grips)

• Canes or walkers to assist with mobility and reduce joint strain

• Reachers/grabbers to avoid bending or stretching

• Sock aids and buttonhooks for easier dressing

• Shower chairs and handheld shower heads for bathing comfort

RA:

• Splints or orthoses to protect joints, especially during flare-ups

• Ergonomic tools (similar to OA, but with more focus on reducing joint strain during daily activities)

• Adaptive writing tools (pens with cushioned grips)

• Assistive devices for opening jars, doors, or bottles (easy-grip aids)

• Wheelchairs or power mobility aids for when walking becomes too painful

• Splinting for joint stability during exacerbations

Fibromyalgia - a type of arthritis

Symptoms:

• Pain

• Fatigue

• Memory and concentration problems ("fibro fog")

• Sleep issues, mood changes, headaches

Diagnosing:

• No specific test

• Diagnosed using ACR criteria (pain, fatigue, tenderness)

Treatment:

• Pain relief (NSAIDs, meds)

• Exercise (low-impact)

• Acupuncture, massage therapy

• Stress management (biofeedback, meditation)

• Dietary supplements (e.g., vitamin D, magnesium)

• Causes

  • Genetics

  • Infections

  • Physical/emotional trauma

Lupus - arthritic disease

Symptoms:

• Painful, swollen joints

• Extreme fatigue, unexplained fever

• Butterfly-shaped rash, photosensitivity

• Anemia, abnormal clotting

• Headache, confusion, memory loss

• Raynaud’s phenomenon, chest pain, edema

• Can affect multiple body systems

Diagnosing:

• Blood tests

• Urinalysis (UA)

• Other clinical assessments

Causes:

• Genetic predisposition + environmental factors

• Medication-induced lupus

Treatment:

• Medications for symptom management

• Alternative treatments

• Orthoses for joint protection

Gout

Symptoms:

• Intense pain, swelling, redness

• Warmth in the affected joint

• Joint stiffness, deformity

• Tophi (uric acid crystal deposits)

Causes:

• Family history

• Male gender, obesity

• Alcohol abuse

• High-purine foods

• Enzyme defects, organ transplants

• Lead exposure

Diagnosing:

• Blood test (uric acid levels)

• X-rays (bony changes)

• Joint fluid test (uric acid crystals)

• Family history, medication review

Treatment:

• Dietary modifications

• Medications (e.g., uric acid-lowering drugs)

• Lifestyle changes (weight loss, hydration)

• Patient education

Pharmacological Treatment of Arthritis

• Corticosteroids

• OTC analgesics

• Opioids

• DMARDs/biologics

• Antidepressants

• Low dose seizure

• Antimalarial

• Immunosuppressant

• Drugs that affect uric acid

Surgical Treatment of Arthritis

Arthrodesis (Joint Fusion)

• Reduces pain, increases stability

• Common in ankle, wrist, thumb, fingers

Arthroplasty (Joint Replacement)

• Used for hips, knees, shoulders, ankles, wrists, elbows, MCP joints

Osteotomy (For OA)

• Cuts and repositions bone to correct defects

• Improves weight-bearing in lower extremity (LE) long bones

Resection

• Removes all/part of a bone

• Reduces pain, improves function

Synovectomy (For RA)

• Removes diseased synovium

• Decreases pain and swelling

Psychosocial Impact and Safety Concerns

Arthritis & Psychosocial Well-Being

• Pain and fatigue → depression, anxiety, isolation

• Loss of function → low self-esteem, frustration

How OT Helps

• Pain management (joint protection, pacing)

• Energy conservation

• Assistive devices

• Coping strategies

Skills to Teach

• Joint protection

• Adaptive strategies

• Self-advocacy

Why Independence in ADLs/IADLs Matters

• Boosts confidence

• Reduces dependence

• Encourages engagement

Why "No Pain, No Gain" Is Wrong

• Can worsen joint damage

• Teach pacing, graded exercise, and activity modification instead

OT Interventions

• Decreasing pain

• Improving function

• Environmental and lifestyle modifications

• Decreasing the risk of deformity or disability

Client Education

• Decreasing pain

• Improving function

• Environmental and lifestyle modifications

  Decreasing the risk of deformity or disability

  Client education addresses all these areas through instruction and application of principles of:

  • Home exercise programs and modalities

  • Joint protection techniques

  • Pain management

  • Stress management/relaxation training

Adaptive Equipment

To Decrease Pain & Protect Joints

• Jar openers – Reduce grip strain

• Large-handled utensils – Easier to hold

• Button hooks, zipper pulls – Reduce finger stress

• Lever door handles – Easier than twisting knobs

To Improve Function & Independence

• Reachers/grabbers – Avoid excessive bending/reaching

• Sock aids, dressing sticks – Assist with dressing

• Built-up pens, and ergonomic keyboards – Reduce hand strain

To Modify Environment & Lifestyle

• Shower chairs, and grab bars – Increase safety

• Raised toilet seats – Reduce knee/hip strain

• Voice-activated devices – Reduce hand use

To Reduce Deformity & Disability Risk

• Splints/orthoses – Support joints to prevent deformity

• Compression gloves – Reduce swelling, improve circulation

Orthoses/Splints

Goals of Orthoses:

• Decrease pain by allowing joints/tissues to rest

• Improve function by supporting weak joints

• Modify environment/lifestyle by enabling safe movement

• Reduce deformity risk by preventing or limiting damaging forces

How Orthoses Help:

• Protect weak/damaged joints → Allows rest and healing

• Support safe joint use → Increases occupational engagement

• Prevent/correct deformities → Reduce long-term disability

Edema

Goals:

• Decrease pain by reducing swelling

• Improve function by addressing edema

• Environmental/lifestyle modifications to prevent swelling

• Reduce the risk of deformity caused by swelling

How Management Helps:

• Controlling swelling → Reduces pain and improves movement

• Lifestyle modifications (e.g., wrist elevation, avoiding overuse) → Prevent future swelling

• Thermal & physical agent modalities (e.g., cold packs, compression, massage) → Used in-clinic for edema control

• Home-use techniques (e.g., contrast baths, elevation) → Clients can manage swelling independently

Therapeutic Exercises and Activities

Goals:

• Decrease pain with movement

• Improve function by increasing strength and range of motion

• Modify lifestyle with exercise

• Prevent deformity by maintaining joint health

How It Helps:

• Graded exercises → Increase intensity gradually

• Home exercise programs → Encourage consistency

• Land & aquatic exercises → Support joint movement

• Leisure activities → Keep clients engaged while improving health

Knowledge Assessment

• Bone Spurs – Osteoarthritis

• Bouchard’s Nodes – Osteoarthritis (middle joints of fingers)

• Boutonniere Deformity – Rheumatoid Arthritis

• Facial Rash – Lupus (butterfly-shaped rash)

• Fatigue – Common in Rheumatoid Arthritis, Lupus, Fibromyalgia

• Fusiform Swelling – Rheumatoid Arthritis (swelling in fingers)

• Heberden’s Nodes – Osteoarthritis (end joints of fingers)

• Swan Neck Deformity – Rheumatoid Arthritis

• Tophi – Gout (urate crystals)

• Trigger Points – Fibromyalgia

Impact of Arthritis & OT Solutions

• ADLs: Pain and stiffness make daily tasks harder.
  OT: Use adaptive tools and joint protection strategies.

• Sexual Activity: Pain, movement limits, and fatigue affect intimacy.
  OT: Teach positioning, energy conservation, and communication strategies.

• IADLs: Difficulties with cooking, cleaning, and finances.
  OT: Offer adaptive tools, energy conservation, and task simplification.

• Health Management: Pain and medication management can overwhelm clients.
  OT: Help organize routines and use reminders or planners.

• Leisure: Physical limits affect hobbies and social activities.
  OT: Provide adaptive equipment and suggest alternate activities.

• Education/Work: Difficulty with tasks at school or work.
  OT: Adjust ergonomics and modify tasks.

• Rest/Sleep: Pain or stiffness disrupts sleep.
  OT: Teach sleep hygiene and relaxation strategies.

• Social Participation: Pain and fatigue limit social involvement.
  OT: Use energy conservation and encourage group participation.