DISEASE TREATED IN PHYSICAL THERAPY: RHEUMATOID ARTHRITIS - page 3

Rheumatoid arthritis is a disease often seen and treated in the physical therapy setting. This article, written from the point of view of a physical therapist, provides an overview of the disease, the prognosis for those afflicted, and common treatments.

Rheumatoid Arthritis - page 3

What other extra-articular effects are common?

  1. Generalized Malaise
  2. Weakness
  3. Flu-like symptoms, including a low-grade fever
  4. Rheumatoid Nodules (20% of cases)
  5. Positive Rheumatoid Factor
  6. Cardiac - inflammatory pericarditis
  7. Anemia
  8. Respiratory- inflammation of cricoaryteroid joint, laryngeal pain, dysphonia, pain on swallowing
  9. Vasculitic lesions
  10. Vision Loss - Scleritis (inflammation of blood vessels in the eye)

What is the prognosis?

Prognosis of Rheumatoid Arthritis is uncertain due to the prolonged nature of the disease, its variability among people affected as well as the difficulty in defining the milder and subclinical forms of the disease.

Factors that may predict a more severe and persistent course of disease

  1. Presence of RH factor
  2. Presence of nodules
  3. HLA-DR4 haplotype (genetic marker)

What is the Treatment for Rheumatoid Arthritis?

The aim of treatment is to provide pain relief, decrease joint inflammation, maintain or restore joint function, prevent bone and cartilage destruction, and to maximize quality of life. Aggressive and early rapid control of inflammation is now the common approach to therapy. Current guidelines recommend that the majority of patients with newly diagnosed RA should be started on DMARD therapy within three months of diagnosis.

  1. Education - understanding the disease, management of symptoms
  2. Rest and exercise -Physical Therapy helpful to manage a good balance
  3. Joint protection - splints, braces, supports, assistive devices
  4. Diet - fish oil supplements containing omega-3 fatty acids help reduce inflammation
  5. Medication
    • NSAIDS (non-steroidal anti-inflammatory drugs) - these drugs decrease joint inflammation and pain. They will help improve joint function by providing analgesic and anti-inflammatory effects. Unfortunately, these drugs do not change the course of the disease or joint damage and, generally should not be used as the sole treatment for RA.
    • SAARDS (slow-acting antirheumatic drugs) / DMARDS (disease-modifying antirheumatic drugs) -these drugs are the only ones that have been proven to control or slow the progression of the RA disease process. Methotrexate is the preferred and most common agent chosen for initial therapy.
    • Biologic response modifiers - drugs that interfere with the autoimmune response in RA
    • Prosorba Column - mechanically removes inflammation antibodies from the blood
    • Oral Corticosteroids - proven to be useful for symptom relief and appear to slow the rate of joint damage in RA. Long-term use can have adverse effects on the patient and therefore limits their use in RA.
  6. Topical pain-relieving creams, rubs, sprays
  7. Hot/Cold
  8. Surgery - most commonly performed on the knee, elbow and shoulder joints


References:

  1. Guidelines for the management of rheumatoid arthritis. 2002 update. American College of Rheumatology Subcommittee on Rheumatoid Arthritis. Arthritis Rheum 2002; 46:328-46.
  2. Carruthers-Czyzewski P. A holistic prescription for rheumatoid arthritis. CPJ 1998; 131:35-9.
  3. Choy EHS, Scott DL. Drug treatment of rheumatic diseases in the 1990's: achievements and future developments. Drugs 1997;
    4. 53:337-48
  4. Reddy I, Robinson B, Khan M. Rheumatoid arthritis: symptoms, diagnosis and clinical management. Drug Store News 1998; 20:27-31.
  5. Lacaille D. Rheumatology: 8. Advanced therapy. CMAJ 2000; 163:721-8.
  6. http://www.apotex.ca/En/ProfessionalAffairs/CEEssentials/Modules/ar/risk_factors_ra.asp


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