How Can Physiotherapy Help Rheumatoid Arthritis?

What is Rheumatoid Arthritis?

Arthritis is an umbrella term given to a group of conditions that primarily affect the joints of the body, causing pain and stiffness. Rheumatoid arthritis, also known as RA, is one type of arthritis characterised by inflammation and pain in the joints. Although it can occur in any joint in the body. It is most common in the ‘small’ joints such as the feet, ankles, hands, and wrists. Often, but not always, RA presents bilaterally and symmetrically. Affecting the same joints on both sides of the body. RA can also affect other tissues in the body, such as the tissue around the heart, potentially leading to pericarditis. As well as the tissue of the lungs, causing inflammation and scarring.

Rheumatoid arthritis is considered an autoimmune disease and the exact cause is not yet known. Similarly to other autoimmune diseases, RA is thought to be triggered by a combination of genetic predisposition and a likely environmental factor, for example a virus or infection. This is perceived to cause an autoimmune response whereby the body ‘attacks’ its own synovial structures.

RA is a progressive condition and early treatment is essential to slow progression.

What Are Common Symptoms of Rheumatoid Arthritis?

Most people with RA experience a combination of some of the following symptoms:

• Stiffness on a morning usually lasting more than one hour
• Throbbing and aching pain, worse after a period of inactivity
• Joint inflammation involving swelling, warmth, and erythema
• Tenderness on palpation of the affected joints
• Joint pain affecting both sides of the body symmetrically
• In the majority of patients with rheumatoid arthritis there is involvement of the cervical spine. This can cause instability leading to headaches and sometimes tingling in the fingers.
• Fatigue
• General high temperature and sweating
• Decreased appetite and weight loss
• Dry eyes can occur if the tissue of the eyes becomes affected
• Chest pain and eventual shortness of breath can occur if the lungs and heart are affected and not properly managed with treatment.

How is RA diagnosed?

Rheumatoid Arthritis is diagnosed by a combination of tests, as there isn’t one conclusive test to determine its presence.

If you present with a combination of the characteristic symptoms of RA. Your primary care health practitioner will likely carry out a physical examination as well as utilise blood tests to determine whether you have rheumatoid arthritis.

• Blood tests including ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) can be utilised to determine inflammation levels in the body which can be an indication of RA. Additionally, blood tests for antibodies and rheumatoid factor can be used, but it is important to note that not everyone with RA will be positive on these tests.
• X-rays will often only be considered in the later stages of the disease as joint changes will likely not be detectable in the early stages on X-ray imaging.

Women are more commonly affected than men – 70% of people with arthritis are female. And RA typically begins in people in their sixties, although it can begin earlier.

Treatment for Rheumatoid Arthritis

Your doctor will determine the best pharmacological management for your specific case and stage of rheumatoid arthritis. The medication that your doctor prescribes may include disease modifying anti-rheumatic drugs (DMARDs) such as Methotrexate. And biological medicines (bDMARDs) such as Infliximab to help to control your immune system. Additionally, corticosteroids may be prescribed to help to manage inflammation. As well as analgaesics and non-steroidal anti-inflammatories (NSAIDs) for pain management.

In conjunction with pharmacological treatment. Management of RA involves exercise to maintain flexibility, strength and overall fitness, physiotherapy, and occupational therapy, as well as a healthy diet and optimal nutrition. Lifestyle modification may be considered, such as stopping smoking or weight-management, if relevant.

How physiotherapy can help manage symptoms of RA?

According to the World Health Organisation, 13 million people living with rheumatoid arthritis experience severity levels (moderate or severe) that could benefit from rehabilitation.

Although there is no cure for RA. Physiotherapy plays an integral role in symptom improvement and provision of an overall better quality of life.

Your physiotherapist will assess your areas of concern and build a tailored programme specific to your needs.

Your physiotherapist may utilise a combination of myofascial release, manual techniques, and modalities to aid with stiffness, flexibility, and pain management. Exercise therapy will also likely be a part of your rehabilitation programme to help you to build strength and support for your joints in a comfortable way. Exercise therapy is also highly important in improving your proprioception, balance, and your cardiovascular endurance. Your physiotherapist may recommend hydrotherapy which is a great way to strengthen with less force through your joints.

Advice and education are also an integral part of physiotherapy, which will help you to move comfortably and safely in your daily life. Your physiotherapist may recommend adaptive equipment to reduce strain on your joints and promote proper body mechanics. Adaptive equipment may include shoehorns, supportive pillows, bed raisers and other ergonomic

devices. They may also recommend pain management tools such as heat and ice packs, and TENS (transcutaneous electrical stimulation) machines which provide comfortable electrical currents to block pain signals.

What is the prognosis for Rheumatoid Arthritis?

According to the NHS UK, although Rheumatoid Arthritis is a progressive condition, it is still possible to live a full life with periods of remission.

Early treatment is key in the management of RA and prevention of joint damage – Johns Hopkins Arthritis Center states that the brunt of joint damage occurs in the first two years of the disease. If you suspect you may have Rheumatoid Arthritis, seek advice from a healthcare professional as soon as possible.