Physiotherapy in Rheumatoid Arthritis

Rheumatoid arthritis is the commonest inflammatory arthritis with an incidence of about one percent in the population. A chronic disease which affects the whole body, it presents with a symmetrical arthritis of many joints and involvement of other tissues such as the lungs, heart, eyes and skin. Prominent morning stiffness, tiredness and malaise are common due to the systemic nature of the disease and as it destroys joint structure it can be accompanied by a high level of disability. Recent advances in scientific understanding of arthritis and newly developed drug therapies have improved the outlook for sufferers. The cause is unknown but infection is often suggested.

As rheumatoid arthritis is responsible for high levels of disability, disease complications and increased mortality, it is not a benign process. As activities of daily living (ADL) can be badly affected about a third of patients are unable to work after 5 years since their diagnosis and after ten years 50% typically have an important loss of ability to function. The rheumatoid complications and therapy side effects may result in a shorter life span by five to ten years, RA occurs across ethnic groups and is more common in women in a ratio of three to one. The peak time for diagnosis is between thirty-five and fifty years but RA can be diagnosed in children and in elderly persons.

The clinical examination by the doctor and the patients subjective report is what mostly establishes the diagnosis of rheumatoid arthritis. A common symptom is stiffness in the morning which lasts for an hour or more before it eases as much as it is going to. The doctor will expect to find the pain and joint swelling of arthritis in three joint areas, that the affected joints will be mirrored on both sides of the body and that the small hand joints will be involved. Insidious onset (slow and sneaky) is the commonest but some people can have an acute and very sudden onset of pain and joint swelling. Other symptoms include loss of weight, feeling unwell, fever and pains in the muscles.

The management and treatment of RA involves a wide multi-disciplinary team effort due to the complex nature of the disease. RA is a serious disease with severe effects upon an individual so educating the patient about the condition and how to cope with the problems and the treatment is vital. Physio treatment concentrates initially on joint pain and inflammation, moving on to range of movement and the maintaining of muscle strength. Occupational therapists give joint protection advice, provide joint splinting, activities of daily living and home adaptations. Orthopaedic intervention is common as joint damage progresses, with joint replacement a common treatment.

Anti-inflammatory drugs and painkillers are the first drugs of choice to treat the inflammation and pain, with disease modifying anti-rheumatoid drugs (DMARDS) added to attack the rheumatoid process itself. DMARDS are the product of intensive scientific research into the underlying rheumatoid process, basing the drugs actions on the real pathological process occurring in patients. These drugs are able to interrupt the disease process itself, slowing or stopping the joint damage which has such negative effects on functional abilities, allowing a much brighter outlook for the future for patients with rheumatoid and other arthritic diseases.

Rheumatological assessment by a physio begins with observation of the ability to walk as they attend the appointment and the noting of deformities of the joints. The hands, knees and wrists commonly suffer deformities, particularly bad at the knuckle joints, which interfere badly with hand function and the ability to exert force in grip and manipulating objects. RA can severely impair walking ability due to pain and postural abnormalities of the feet, knees and hips and walking aids are often necessary, although shoulder, elbow and hand problems interfere with the ability to use crutches or a frame.

Acute treatment concentrates on joint protection, splinting, ice, painkillers and very gently range of motion exercises, all aimed at maintaining some joint function while the joints settle down. Once the acute episode is easing, physio treatment moves on to increasing the ranges of motion and muscle strength and regaining functional abilities. A detailed treatment plan is essential for successful management of RA due to the many effects this complex disease has.




About the Author
Jonathan Blood Smyth is a Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He specialises in musculo-skeletal conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Manchester.