Key facts

• In 2019, 18 million people worldwide were living with rheumatoid arthritis.
• About 70% of people living with rheumatoid arthritis are women, and 55% are older than 55 years.
• 13 million people with rheumatoid arthritis experience severity levels (moderate or severe) that could benefit from rehabilitation.
• While rheumatoid arthritis is a systemic autoimmune disease that affects multiple body systems, the joints of hands, wrists, feet, ankles, knees, shoulders and elbows are most often affected.

Risk Factors

• Increased prevalence of RA within families resulting from the interaction between patients genotype and environment.
• Increases risk: Female sex; occupational dust (silica); air pollution; high sodium red and iron consumption; low vitamin D intake and levels; Smoking (seropositive RA); Obesity; Low socioeconomic status
• Deceased risk: fish and omega 3 fatty acid consumption; moderate alcohol intake; healthy diet; oral contraceptive/HRT; statin use.

Signs and symptoms

• Rheumatoid arthritis causes inflammation and pain in one or more joints. It can happen in most joints, but it’s most common in the small joints of the hands, wrists and feet.
• RA is chronic and may worsen over time without treatment. It can lead to severe damage to the joint and surrounding tissue. It can also affect the heart, lung and nervous systems.

Early signs and symptoms:

• pain
• stiffness
• tenderness
• swelling or redness in one or more joints, usually in a symmetrical pattern (e.g., both hands or both feet).

The symptoms can worsen over time and spread to more joints including the knees, elbows or shoulders. RA can make it hard to perform daily activities like writing, holding objects with the hands, walking and climbing stairs. People with RA often feel fatigue and general malaise (e.g., fever, poor sleep quality, loss of appetite) and may experience depressive symptoms. Pain and difficulty moving can lead to problems with sexual function and intimate relationships. Trouble moving easily can cause lower physical fitness and lead to loss of independence, inability to work, reduced well-being and mental health problems.

Classification of Functional Status

The American College of Rheumatology classified functional status in Rheumatoid Arthritis as:

• Class I: Completely able to perform usual activities of daily living (self-care, vocational, and avocational)
• Class II: Able to perform usual self-care and vocational activities, but limited in avocational activities
• Class III: Able to perform usual self-care activities, but limited in vocational and avocational activities
• Class IV: Limited ability to perform usual self-care, vocational, and avocational activities

Nutritional Guidelines

Dietary interventions demonstrate substantial benefits in reducing disease symptoms such as pain, joint stiffness, swelling, tenderness and associated disability with disease progression (still an uncertainty about the therapeutic benefits of dietary manipulations for RA). Dietary modification include: Avoiding food that causes inflammation like processed food, high salt, oils, butter, sugar, and animal products. Supplements: Research suggests that there are vitamins and minerals which may have an effect on RA; eg. vitamin D, cod liver oil, and multivitamins. These may help eg reduce joint inflammation, improve bone health. It is recommended to consult your primary care physician.

Physical Therapy Management

Rheumatoid arthritis is a chronic disorder that has no cure. All the currently available treatments are geared towards improving the symptoms and offering a better quality of life.[1] Treatments that achieve pain relief and the slowdown of the activity of RA to prevent disability and increase functional capacity.

The benefits of physical therapy interventions have been well documented.

• Physical therapists play an integral role in the nonpharmacologic management of RA.
• Physiotherapy help clients cope with chronic pain and disability through the design of programs that address flexibility, endurance, aerobic condition, range of motion (ROM), strength, bone integrity, coordination, balance and risk of falls.
• All current UK clinical guidelines for the management of RA recommend the use of physiotherapy (PT) and occupational therapy (OT) as an adjunct to drug treatment.

The four most common components of PT/OT for RA hands are

1. Exercise therapy,
2. Joint protection advice and provision of functional splinting and assistive devices
3. Massage therapy, and
4. Patient education.

The therapy goals in most cases are:

• Improvement in disease management knowledge
• Pain control
• Improvement in activities of daily living
• Improvement in Joint stiffness (~ Range of motion)
• Prevent or control joint damage
• Improve strength
• Improve fatigue levels
• Improve the quality of life
• Improve aerobic condition
• Improve stability and coordination

Patient questionnaires, not joint counts, radiographic scores, or laboratory tests, provide the most significant predictors of severe 5-year outcomes in patients with RA, including functional status, work disability, costs, joint replacement surgery and premature death.

 

Management of flare ups

People who are diagnosed with RA also may experience a phenomenon that is called an “flare up”. Usually happen after eg experiencing a secondary illness, being involved in a high-stress situation, overexerting oneself, What triggers flare ups is currently still unknown. Strategies that can help someone who is experiencing a flare up

• Balance is key, schedule plenty of down time to reduce the likelihood of affected joints from becoming flared up
• Educate family, staff at work, and other people who you interact with, they can help you during flare ups
• Have a backup plan, be prepared in case of a flare up and become familiar with warning signs of a flare up
• Practice relaxation and self calming strategies: Research suggests that regularly practicing these relaxation techniques can reduce stress and lead to a reduction in pain.
• Use modalities such as a cold pack or hot pack: Both of these have various effects on tissues which research suggests can be beneficial in reducing inflammation and pain during a flare up
• Lastly, corticosteroid injections can be used to reduce inflammation and reduce pain in a flared up joint.