Physical Therapy for Rheumatoid Arthritis

Rheumatoid Arthritis (RA) is the most common form of autoimmune arthritis. It is a chronic disease that causes pain, stiffness, swelling and limited motion most often in the small joints of the hands and feet.  Inflammation from the disease can affect other organs in the body as it progresses including: skin, eyes, lungs, heart, kidneys, salivary glands, nerve tissue, bone marrow, blood vessels.

Signs and Symptoms

• Symmetrical joint pain and swelling, especially in small joints of the hand, wrist, and foot
• Morning stiffness that usually gets better throughout the day
• Generalized aching, stiffness, depression
• Loss of energy
• Low fevers
• Loss of appetite
• Dry eyes and mouth

Lumps that grow beneath the skin (rheumatoid nodules) often found on elbows and hands.

Causes

RA is an autoimmune disease, which means immune cells in the body do not function properly and attack the body causing damage to healthy tissue, in this case the joints. This then causes inflammation in the synovium, the tissue that lines the joints. The attacking immune cells also release chemicals that cause more inflammation damaging the cartilage that cushions bone.

Who gets it?

Women are more likely than men to develop the disease. RA can occur at any age, most commonly starting between 40-60. Family history may predispose you to getting RA. People who smoke, have been exposed to asbestos or silica, and who are obese have a higher risk of developing the disease.

Diagnosis:

• History significant for inflammatory arthritis involving three or more joints with at least 30 minutes of morning stiffness.
• Lab tests:

• + Rheumatoid factor and/or +anti-CCP antibodies
• Elevated Erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP)

• Imaging: X-rays of hands, wrists or feet that show a characteristic joint erosion pattern.
• Diseases with similar features have been excluded: psoriatic arthritis, viral polyarthritis, gout, and systemic lupus erythematosus.
• Duration of symptoms is more than six weeks

Treatment:

1. DMARD (Disease-Modifying Antirheumatic Drug) therapy is first line treatment. Methotrexate is the most commonly used medication. It is used to suppress synovitis (joint swelling) and other signs of active disease and helps to prevent bone erosions and narrowing of joint spaces. Other DMARDS that can be used if Methotrexate cannot be tolerated include: leflunomide, sulfasalazine, hydroxychloroquine, entercept or adalimumab.
2. NSAIDS (nonsteroidal anti-inflammatory drugs) and glucocorticoids (prednisone) are also used for initial symptomatic control.
3. Acetaminophen can be used for additional pain relief.
4. Physiotherapy for education on activity modification and exercise therapy.

Prognosis:

Long term prognosis is variable for patients. A more favorable disease outcome occurs if they present early in the course of disease and are treated with DMARDS. The outcome is mainly dependent upon the degree of disease activity, joint damage, physical functional status of the patient, psychological health, and presence of other illness.

An adverse prognosis is present in those who have functional limitation, extra articular disease, rheumatoid factor positivity or presence of anti-CCP antibodies.

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