Rheumatoid Arthritis (RA) is a chronic disease that is characterized by an inflammation in the lining of the joints. While it can affect many joints in the body, RA most commonly affects the hands and feet. RA is also characterized by its symmetrical pattern – the same joints on both sides of the body become inflamed.
The Arthritis Society estimates that about 300,000 Canadians have RA. Although it can affect people of all ages, it most commonly develops between the ages of 25 and 50. Twice as many women than men will develop the disease. While the cause of RA is unknown, the inflammation occurs when the immune system fails to recognize the soft tissue and tries to destroy it as if it were foreign matter. This process is continuous and results in damage to cartilage, bones, tendons and ligaments. This in turn can lead to permanent joint deformity and significant disability. In some cases, there is damage to organs such as eyes, lungs or heart. The onset of RA varies from a gradual increase in symptoms to a sudden, severe attack. Some people experience periodic flare-ups in symptoms while others are always in pain and the disease progresses over time.
The Arthritis Society lists the following as early symptoms of RA:
Pain, swelling, heat or redness in a joint, usually the joints of the hands or feet;
Morning stiffness lasting longer than 30 minutes;
Pain in three or more joints;
Pain in a joint all night;
Pain in the same joints on both sides of the body;
Low energy and fatigue;
Possible fever and weight loss.
There is no cure for rheumatoid arthritis, but there are effective ways to manage the symptoms and any resulting disabilities. Treatment includes medicine, exercise, and education on joint protection and lifestyle changes. In some cases, surgery is required when joints are too severely damaged. Once the diagnosis of RA is made, a multidisciplinary healthcare team, including a family physician, rheumatologist, social worker, dietician, occupational therapist and physiotherapist will work to find the most effective treatment plan for the individual. Drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDs), steroids, and the recently emerged biologics, have a major role in controlling inflammation and the disease process that occurs in RA.
Physiotherapy has an important role in the management of all stages of RA, helping to prevent physical impairment and restore functional ability through the use of education, exercise, mobility aids, and therapeutic modalities. A Canadian study demonstrated that patients who followed a home-based physiotherapy program were improved following treatment and the improvements were maintained a year later. Physiotherapists can help reduce the pain and disability caused by RA. A physiotherapist will conduct a detailed assessment and prescribe a treatment plan that may include:
A targeted exercise program that will improve or maintain joint mobility and help decrease joint pain by strengthening the muscles surrounding them; and
Recommendations for the use of assistive device such as mobility aids or splints to reduce unnecessary stress and pain