Rheumatoid arthritis is a long term auto-immune condition that causes pain, swelling, stiffness and deformity in the joints. It is thought to occur as a result of interactions between inherited genetic factors and environmental factors that we are exposed to. Although RA is not necessarily handed down to each generation, there is sufficient study to show that familial genetic markers do exist and immediate relatives of an individual with RA are three times more likely to develop it if their environmental exposure remains the same.
RA can affect any joint in the body but is usually first noticed in the small joints of the hands and feet. Pain and stiffness is usually worse in the morning, as it is with Osteoarthritis, except that with RA these symptoms usually last longer into the day.
The joints become swollen and inflamed and the skin over the joints may appear reddened. This occurs because the immune system is attacking the lining of the joints (known as synovial membrane) causing it to deteriorate.
This damage to the membrane causes a release of chemicals into the joint which can further degenerate the bones, cartilage, tendons and ligaments and ultimately causing the joint to deform. If left untreated the destruction of the joint will continue until there is no joint remaining and it becomes fused.
In some cases rheumatoid nodules can appear. These are firm lumps just under the skin which are not usually painful and most commonly occur over joints which bear pressure like the elbow and heels. These nodules can come and go and even appear to move around the joint.
There is no cure for RA however there are treatments to slow down the rate of joint deterioration and reduce exacerbations.
Initially when first diagnosis is made Non Steroidal Anti Inflammatories and Disease Modifying Anti-rheumatic Drugs may be prescribed to slow down the deterioration and control pain. Later immunosuppressants may be required.
Physiotherapy for RA
The primary aims for the Physiotherapist will be to reduce pain using
electrotherapy techniques such as interferential diathermy and TENS.
Heat has been shown to greatly improve pain. This can be applied with short wave diathermy for deep heating, infra red, hot packs and paraffin wax baths are particularly helpful for hands and feet.
Massage and soft tissue stretching will help to reduce pain from muscle spasm and contractions.
The next aim of treatment is the prevention of deformity. A sufferer of RA will adopt the most pain-free posture which can encourage deformity and so postural awareness and frequent exercise is important to maintain joint movement.
Resting splints are useful at night time to discourage deformity and can be custom made for any joint, usually from molded plastic or orthoplast.
If there is already significant loss of movement due to deformity then serial splinting may be helpful to stretch the shortened soft tissue and improve the joint function.
Another important aim of treatment is the assessment of independence.
For example, would the patient benefit from walking aids or joint support to keep them mobile. Are they able to get in and out of the bath or car?
There is an enormous range of useful gadgets and aids available and a home assessment by the Physio or Occupational Therapist is useful to maintain or regain independence.
Tracey Evans – MCSP SRP COFIB 220
The Physiotherapy Centre
Tel: (+34) 609 353 805