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LEARNING OBJECTIVES
Describe the epidemiology, pathophysiology, disease course, and clinical manifestations of two common rheumatic diseases, rheumatoid arthritis and osteoarthritis, and be able to differentiate between these two conditions.
Identify the medical (clinical) diagnostic procedures commonly used in the examination of patients with arthritis, including laboratory tests and radiography.
Describe the medical management of individuals with rheumatoid arthritis and osteoarthritis.
Identify clinical examination and outcome measures commonly used in examining individuals with rheumatoid arthritis or osteoarthritis.
Discuss the rehabilitation management of individuals with arthritis.
Describe psychosocial, environmental, and other personal factors associated with arthritis that affect participation, achievement of anticipated goals, and expected outcomes.
Explain the importance of a team approach for persons with arthritis.
Analyze and interpret patient data, formulate realistic goals and outcomes, and develop a plan of care when presented with a clinical case study.
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The terms arthritis, rheumatism, and rheumatic disease are generic references to an array of more than 100 diseases that are divided into 10 classification categories. Two major forms of arthritis are considered in this chapter. Rheumatoid arthritis (RA), a systemic inflammatory disease, is considered in detail; osteoarthritis (OA), a more localized process that has been known previously as degenerative joint disease (DJD), is also discussed. Rheumatoid arthritis and osteoarthritis account for the majority of arthritis cases treated by physical therapists.
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RA is a major subclassification within the category of diffuse inflammatory connective tissue diseases that also includes juvenile arthritis, systemic lupus erythematosus (SLE), progressive systemic sclerosis or scleroderma, polymyositis, and dermatomyositis. Rheumatoid arthritis is primarily a disease of the synovium. The first clinical description of RA is attributed to A. J. Landre-Beauvais in 1800, although analysis of pictorial art of the late Renaissance suggests the existence of RA in earlier times. Early descriptions of patient symptomatology were complicated by the lack of uniform agreement about the distinguishing disease characteristics, given its wide spectrum of clinical presentations. The term rheumatoid arthritis was first used by Garrod in 1858, but was not accepted by the American Rheumatism Association (ARA) as the official terminology until 1941.1 Diagnostic criteria and terminology have been developed and, in some cases, revised based on current data.2,3
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The estimated prevalence of RA among adults in the United States is approximately 1.3 million,4 and prevalence increases with age. Women are effected two to four times more often than men. Differences in prevalence exist among certain subpopulations, which suggest a possible role for genetic or environmental factors in the etiology of the disease. For example, African Americans may have a lower prevalence of RA than whites, whereas several Native American groups demonstrate higher prevalence rates. There also is a lower prevalence of RA in native Japanese and native Chinese peoples compared to whites.4,5
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