What is Rheumatoid Arthritis?
Rheumatoid Arthritis is an autoimmune disease that causes inflammation in your joints. The main symptoms are joint pain and swelling. Rheumatoid Arthritis can also be referred to colloquially as Rheumatism and is best treated by a physiotherapist with a special interest in Rheumatoid Physiotherapy.
Rheumatoid Arthritis causes inflammation in the synovium (covering of the joint which produces a small amount of synovial fluid that nourishes the cartilage and lubricates the joint). This results in red and swollen joints that produce extra fluid and pain. The inflammation is caused by a build-up of fluid and cells in the synovium.
Your joint hurts for two reasons:
- Your nerve endings are irritated by the chemicals produced by the inflammation.
- The capsule is stretched by the swelling in your joint.
When the inflammation goes down, the capsule remains stretched and can’t hold your joint in its proper position. This can make your joint unstable, and it can move into unusual or deformed positions over time.
What are the Symptoms of Rheumatoid Arthritis?
Rheumatoid Arthritis varies from one person to another but it usually starts quite slowly. Symptoms tend to come and go. You may also have flare-ups when your symptoms become worse than normal.
Common symptoms of Rheumatoid Arthritis include:
- joint pain and swelling (fingers, wrists or the balls of your feet)
- stiffness (morning stiffness lasting over 30 minutes)
- tiredness (fatigue), depression, irritability
- flu-like symptoms, such as feeling generally ill, feeling hot and sweating.
- rheumatoid nodules (fleshy lumps below the elbows or on hands and feet)
How is Rheumatoid Arthritis Diagnosed?
Due to the variety of symptoms experienced by patients, diagnosing Rheumatoid Arthritis can be complex. Doctors will confirm the diagnosis based on your symptoms, a physical examination and the results of x-rays, scans and blood tests. You may also be referred to a specialist (Rheumatologist) to confirm the diagnosis and receive treatment.
Blood tests, in this case, are used to measure inflammation. You may have one of these tests:
- Erythrocyte Sedimentation Rate (ESR)
- C-Reactive Protein (CRP).
Both of these may show a high value when inflammation is present. These tests may be repeated from time to time to help monitor your arthritis.
What’s the Treatment of Rheumatoid Arthritis?
There is currently no cure for Rheumatoid Arthritis but there are a variety of treatments available that can slow down the condition and keep joint damage to a minimum.
The three main aspects to the treatment of rheumatoid arthritis are:
Physical Therapies for Rheumatoid Arthritis
Looking after your joints and managing your symptoms is very important in the treatment of Rheumatoid Arthritis. Your physiotherapist can suggest a number of different treatments that may help ease your symptoms and reduce the impact Rheumatoid Arthritis can have on your life.
The following treatments have been shown to help patients with Rheumatoid Arthritis.
- Therapeutic Exercise
- Heat/Cold Therapy
- Pain Management
- Splinting Joints
- Fatigue management
- Manual techniques
Drugs for Rheumatoid Arthritis
Four main groups of drugs are used to treat Rheumatoid Arthritis:
- painkillers (analgesics)
- non-steroidal anti-inflammatory drugs (NSAIDs)
- disease-modifying anti-rheumatic drugs (DMARDs)
Your doctor or rheumatologist is the best clinician to discuss these drugs with and will manage the use of these medications carefully.
Surgery is occasionally needed for rheumatoid arthritis. These may include injections, tendon surgery or in the extreme cases joint replacement. Outcomes for these procedures are successful.
What Can You Do For Yourself?
Understand your condition and how it affects you
- “Knowledge is power”. Educating yourself on the condition will help you manage your symptoms better and empower you when you talk to others (Rheumatologist, GP, family etc) about your condition.
- Self-management courses – can help you build skills and confidence in becoming more actively involved in your healthcare and in managing rheumatoid arthritis day to day.
- Knowing about your medications can help you and your medical provider manage your symptoms more effectively.
- Understanding how your behaviour and activities influence your symptoms can help you reduce the pain and suffering caused by RA. Speaking to a health professional can help you identify aspects of your life that may be aggravating your RA and help address them.
Keep Moving with Respect to Pain and Swelling
- Exercise helps to lessen your pain in the long run by maintaining muscle strength and optimising joint health.
- Well designed activity programs can increase your range of movement, reduce fatigue and help you feel better overall.
- Appropriate low-impact aerobic activities like hydrotherapy, cycling, Tai chi, pilates and walking can help improve your general health and manage your symptoms.
- A strength-training program called progressive resistance training (PRT) has been proven to improve physical function in people with Rheumatoid arthritis.
- Your physiotherapist is an expert in the assessment and prescription of Rheumatoid arthritis exercises. Please ask them what is best for you.
- Managing stress and anxiety with muscle relaxation techniques, distraction, guided imagery and other techniques can help improve your general health and control painful symptoms.
- Activities such as Tai Chi, Pilates and Yoga are a great way to relax and de-stress while conditioning the muscles and joints in the body.
Aids and equipment
- Supports such as walking aids and specialised cooking utensils reduce joint strain and can help you to manage pain and fatigue. Your therapist can give you advice on aids.
Heat and Ice Therapy
- Heat – heat works to reduce muscle tension and stimulate blood circulation. You may find that applying something warm prior to getting up in the morning, or during the day helps reduce discomfort and stiffness in your joint.
- Ice – Ice helps to reduce inflammation in muscles and joints by constricting blood vessels and preventing fluids from leaking into surrounding tissues. You should try icing your joints after any significant activity or at the end of the day. This can minimize the inflammation resulting from the daily activities.
- Being aware of how your daily habits and activities influence your symptoms is very important. Overexertion can increase your pain and symptoms, while under activity can have similar effects. Learning about activity pacing through diaries and activity management strategies can help you achieve what you want to, but with less pain or discomfort.
- Poor sleep pattern, your sleeping environment and sleeping position can have a significant impact on your pain and symptoms. Most people are unaware of the factors that can influence sleep health and so addressing these factors can help you manage your symptoms. A good therapist can assess your sleep health and provide you with aids and education to improve this aspect of your life.
Treat Your Muscles
- A quality remedial massage may be just the relief your muscles need. Treat yourself to a good rub down with someone you trust. The benefits vary from person to person but may include decreased pain and muscle stiffness associated with your arthritis, increased circulation, and an improvement in your sleep and immune functions. Mentally, massage can also decrease stress and depression. Besides all it that, massage just feels good!
For more advice, please ask your Physiotherapist, Doctor or Rheumatologist.