Case Study: Physiotherapy Management of Rheumatoid Arthritis in a 68-Year-Old Female

Clinical Experience (2010–2012 – Outpatient Setting)

Presenting Complaint:

A 68-year-old female patient attended the physiotherapy outpatient clinic with a primary goal of improving her functional mobility and joint flexibility. Diagnosed with Rheumatoid Arthritis (RA), she experienced generalized stiffness, joint pain, and reduced endurance—particularly in her hands, wrists, knees, and ankles. Her motivation was to maintain independence in her daily routine and reduce morning stiffness.

History and Background:

The patient had been living with RA for several years and was under medical management with a rheumatologist. At the time of referral, she was in a relatively stable disease phase with no acute flare-ups. She presented with mild joint deformities, stiffness in the morning lasting about 30–45 minutes, and difficulty with prolonged walking or gripping small objects.

Despite her age, she was active, mentally sharp, and highly cooperative. She showed enthusiasm toward participating in therapy and expressed willingness to follow a home exercise program, making her a strong candidate for function-focused rehabilitation.

Assessment:

Initial physiotherapy assessment included:

• Observation: Mild ulnar deviation at MCP joints; early swan-neck deformity of fingers; slight valgus at knees

• Palpation: Mild tenderness at wrist and knee joints, no swelling during assessment

• Joint Range of Motion (ROM):

- Fingers, wrists, knees – mildly restricted due to pain and stiffness

- Shoulder and hip ROM – within functional range

• Muscle Strength:

- Generalized weakness in small muscle groups of the hand

- Lower limb strength mildly reduced (MMT: 3+/5 at quadriceps and hamstrings)

• Gait and Balance:

- Independent but slower pace; cautious during turning

• Functional Limitations: Difficulty opening jars, prolonged standing, kneeling, and using stairs

Treatment Plan:

Given the patient’s motivation and ongoing symptoms, I designed a progressive, low-impact rehabilitation program focusing on joint preservation, flexibility, strength, and endurance. Sessions were held three times per week, supplemented by a customized home exercise plan.

Treatment Goals:

• Reduce stiffness and pain

• Improve joint range of motion

• Enhance muscle strength without joint stress

• Promote functional independence

Physiotherapy Intervention:

1. Thermotherapy (Pre-Exercise):

• Warm packs applied to wrists and knees to improve tissue extensibility and ease into movement

2. Joint Mobilization:

• Gentle grade I–II mobilizations at the wrists, MCPs, and knees to maintain joint nutrition and range

3. Range of Motion Exercises:

• Active-assisted and active exercises for fingers, wrists, and knees
• Emphasis on slow, pain-free movement with breathing coordination

4. Strengthening Exercises:

• Low-resistance, high-repetition exercises for major muscle groups using therabands and hand putty
• Focus on grip strength, quadriceps strengthening, and scapular stability

5. Balance and Endurance Training:

• Static and dynamic balance activities (e.g., standing with eyes closed, tandem stance)
• Walking drills and seated pedaling to improve cardiovascular endurance

6. Functional Task Practice:

• Simulated ADLs (e.g., picking up small objects, climbing a step, sit-to-stand transitions)
• Training with assistive devices where needed

7. Patient and Caregiver Education:

• Joint protection techniques (e.g., using larger joints, avoiding tight grasps)
• Energy conservation, pacing strategies, proper footwear advice
• Regular follow-up with the rheumatologist was coordinated for medication review

Outcome Measures:

• Pain and Stiffness: Noticeable reduction in morning stiffness and joint pain after 2–3 weeks

• ROM: Improved flexibility in hands and knees

• Strength: Grip and lower limb strength enhanced, enabling better stair use and object handling

• Function: Patient reported improved ease in dressing, walking longer distances, and light housework

Prognosis:

The patient responded very positively to the therapy. Her consistent participation, willingness to follow home exercises, and positive attitude contributed significantly to her progress. The prognosis remained good for maintaining her current level of function and possibly improving further with continued activity and regular monitoring.

“This case reminded me that successful physiotherapy is not just about clinical skills but about building trust and empowering the patient. Working with this elderly client reinforced my belief that with the right support, education, and encouragement, age or chronic disease need not be barriers to independence and well-being.”