Change Your World Week Fall 2021 (Archived)

Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. In some people, the condition can damage a wide variety of body systems, including the skin, eyes, lungs, heart, and blood vessels.

An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body's tissues.

Rheumatoid Arthritis affects all people and all races. Approximately 1% - 2% (2.1 million) of the United States adult population is diagnosed with Rheumatoid Arthritis.  

Signs and symptoms of rheumatoid arthritis may include:

• Tender, warm, swollen joints
• Joint stiffness that is usually worse in the mornings and after inactivity
• Fatigue, fever and loss of appetite

Early rheumatoid arthritis tends to affect your smaller joints first — particularly the joints that attach your fingers to your hands and your toes to your feet.

As the disease progresses, symptoms often spread to the wrists, knees, ankles, elbows, hips and shoulders. In most cases, symptoms occur in the same joints on both sides of your body.

About 40% of people who have rheumatoid arthritis also experience signs and symptoms that don't involve the joints. Areas that may be affected include:

• Skin
• Eyes
• Lungs
• Heart
• Kidneys
• Salivary glands
• Nerve tissue
• Bone marrow
• Blood vessels

Rheumatoid arthritis signs and symptoms may vary in severity and may even come and go. Periods of increased disease activity, called flares, alternate with periods of relative remission — when the swelling and pain fade or disappear. Over time, rheumatoid arthritis can cause joints to deform and shift out of place.

Treatment

There is no cure for rheumatoid arthritis. But clinical studies indicate that remission of symptoms is more likely when treatment begins early with medications known as disease-modifying antirheumatic drugs (DMARDs).

Medications

The types of medications recommended by your doctor will depend on the severity of your symptoms and how long you've had rheumatoid arthritis.

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. 
• Steroids. Corticosteroid medications, such as prednisone, reduce inflammation and pain and slow joint damage. Side effects may include thinning of bones, weight gain, and diabetes. Doctors often prescribe a corticosteroid to relieve symptoms quickly, with the goal of gradually tapering off the medication.
• Conventional DMARDs. These drugs can slow the progression of rheumatoid arthritis and save the joints and other tissues from permanent damage.

• Biologic agents. Also known as biologic response modifiers, this newer class of DMARDs 

• Targeted synthetic DMARDs. Baricitinib (Olumiant), tofacitinib (Xeljanz), and upadacitinib (Rinvoq) may be used if conventional DMARDs and biologics haven't been effective.

Therapy

Your doctor may refer you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks that will be easier on your joints. For example, you may want to pick up an object using your forearms.

Assistive devices can make it easier to avoid stressing your painful joints. For instance, a kitchen knife equipped with a handgrip helps protect your finger and wrist joints. Certain tools, such as buttonhooks, can make it easier to get dressed. Catalogs and medical supply stores are good places to look for ideas.

Surgery

If medications fail to prevent or slow joint damage, you and your doctor may consider surgery to repair damaged joints. Surgery may help restore your ability to use your joint. It can also reduce pain and improve function.

Rheumatoid arthritis surgery may involve one or more of the following procedures:

• Synovectomy. Surgery to remove the inflamed lining of the joint (synovium) can help reduce pain and improve the joint's flexibility.
• Tendon repair. Inflammation and joint damage may cause tendons around your joint to loosen or rupture. Your surgeon may be able to repair the tendons around your joint.
• Joint fusion. Surgically fusing a joint may be recommended to stabilize or realign a joint and for pain relief when a joint replacement isn't an option.
• Total joint replacement. During joint replacement surgery, your surgeon removes the damaged parts of your joint and inserts a prosthesis made of metal and plastic.

Surgery carries a risk of bleeding, infection, and pain. Discuss the benefits and risks with your doctor.

Once diagnosed with Rheumatoid Arthritis the ability to normally perform daily functions often becomes harder and can cause frustration. Activities of daily life also known as ADL's become increasingly limited further increasing frustration. 

Rheumatoid Arthritis may cause other symptoms which can play a role in the functional limitations experienced. In many instances, the secondary effects often cause more issues than Rheumatoid Arthritis itself. 

Staying aware of symptoms and being in contact with your primary care physician can help catch and decrease the secondary effects. 

Physical Therapy can have many benefits to help treat Rheumatoid Arthritis! Physical Therapists have a deep understanding of the bones, muscles, and joints that can all be affected by Rheumatoid Arthritis.

Physical Therapy can help diagnose Rheumatoid Arthritis symptoms and determine the best course of action which can include exercise techniques, modalities (Ice, heat, ultrasound, etc.), and home exercise programs. 

EXERCISE is extremely important for treating Rheumatoid Arthritis. Research has shown that exercising with Rheumatoid Arthritis is highly important!

Exercise can increase:

• Strength 
• Functional Ability
• Cardiovascular health
• Joint Mobility
• Bone Density

Rheumatoid Arthritis can cause someone to want to be sedentary, which often can increase the symptoms experienced because the joints stiffen up. Exercise is necessary to keep the affected joints mobile. 

Exercise is important to help maintain a healthy lifestyle! not only can it help with Rheumatoid Arthritis symptoms but can also assist in decreasing the effects of secondary symptoms!

EXERCISE IS MEDICINE!

• Cooney, J. K., Law, R.-J., Matschke, V., Lemmey, A. B., Moore, J. P., Ahmad, Y., Jones, J. G., Maddison, P., & Thom, J. M. (2011, February 13). Benefits of exercise in rheumatoid arthritis. Journal of Aging Research. Retrieved November 12, 2021, from https://www.hindawi.com/journals/jar/2011/681640/.
• Goodman, C. C., & Marshall, C. (2017). Pathology for the physical therapist assistant. Saunders.

• Eurenius, E., & Stenström, C. H. (2005, February 4). Physical activity, physical fitness, and general health perception among individuals with rheumatoid arthritis. Wiley Online Library. Retrieved November 12, 2021, from https://onlinelibrary.wiley.com/doi/full/10.1002/art.20924.

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