Rheumatoid arthritis is an inflammatory arthritis with a frequency in the population of about one percent. It is a chronic systemic disease with gives symmetrical arthritis of many major joints and involvement of many other areas such as the eyes, skin, heart and lungs. Common symptoms are feeling unwell, fatigue and marked morning stiffness. The disease destroys peripheral joints with a significant amount of disability, although modern therapies are progressing rapidly and promise to prevent much joint damage. Many theories connect infections to the onset of RA but this has not yet been proved.
Rheumatoid arthritis is not a benign disease as it is connected with significant disability, increased mortality and disease complications. Activities of daily living (ADL) are limited and after five years since the diagnosis about one third of patients cannot work, with about half having significant reduction in functional ability after 10 years since diagnosis. Life expectancy may be shortened by five to ten years from disease complications and therapeutic side effects. RA affects all racial groups and is two to three times more prevalent in females. Although RA can occur in the elderly and in children it is most common between 35 and 50 years of age.
Rheumatoid arthritis diagnosis is made by the doctors clinical examination and by the self report of the patient rather than laboratory tests. A typical complaint is severe stiffness in the morning, remaining for an hour or longer until it improves as much as it is going to. Three joint areas must be affected by the swelling and pain of arthritis, with a symmetrical joint presentation and involvement of the hand small joints. Usually the disease comes on slowly but sometimes there is an acute, sudden onset of severe joint swelling and pain. Typical symptoms also include losing weight, feeling below par, a fever and muscle pain.
Treatment of rheumatoid arthritis is complex and involves a multi-disciplinary team approach. Patient education is vital so they can understand a complex disease with many and severe consequences which can affect functional abilities profoundly. Physiotherapists work to reduce inflammation and pain, maintain joint ranges of motion and maintain and increase muscle strength. Occupational therapists may teach patients the principles of joint protection in functional activities, suggest aids to daily living, make resting splints for inflamed joints and advise on adaptations to a patients home. Many patients come to joint replacement as the disease process is very destructive.
Initial treatment is often with anti-inflammatory and painkilling medication until DMARDS (disease modifying anti rheumatoid drugs) take effect. These drugs can hold back or prevent progression of the disease, reducing the likelihood of joint destruction with accompanying loss of functional ability. DMARDS have developed over the last few years into the biological agents based for the first time on a scientific understanding of the underlying pathological process. This has raised the hope that the disease process can be stopped, preventing many of the disabling consequences of RA quite apart from the pain. These drugs are having dramatic effects on the lives of people with rheumatoid arthritis.
Physiotherapy assessment of a rheumatoid patient starts with observing the persons gait as they walk in and observing any joint deformities and movement difficulties as they answer questions about their condition. Joint deformities are common, especially of the metacarpophalangeal joints of the fingers, the wrists and the knees. Hand deformities badly affect hand function and mean the person is unable to manage normal daily tasks. The physio will assess the patients mobility as foot, hip and knee pain and joint deformities are common, limiting the ability to walk, and walking aids are difficult to use because of hand problems.
Acute treatment concentrates on joint protection, splinting, ice, painkillers and very gently range of motion exercises, all aimed at maintaining some joint function while the joints settle down. Once the acute episode is easing, physio treatment moves on to increasing the ranges of motion and muscle strength and regaining functional abilities. A detailed treatment plan is essential for successful management of RA due to the many effects this complex disease has. - 14130
Rheumatoid arthritis is not a benign disease as it is connected with significant disability, increased mortality and disease complications. Activities of daily living (ADL) are limited and after five years since the diagnosis about one third of patients cannot work, with about half having significant reduction in functional ability after 10 years since diagnosis. Life expectancy may be shortened by five to ten years from disease complications and therapeutic side effects. RA affects all racial groups and is two to three times more prevalent in females. Although RA can occur in the elderly and in children it is most common between 35 and 50 years of age.
Rheumatoid arthritis diagnosis is made by the doctors clinical examination and by the self report of the patient rather than laboratory tests. A typical complaint is severe stiffness in the morning, remaining for an hour or longer until it improves as much as it is going to. Three joint areas must be affected by the swelling and pain of arthritis, with a symmetrical joint presentation and involvement of the hand small joints. Usually the disease comes on slowly but sometimes there is an acute, sudden onset of severe joint swelling and pain. Typical symptoms also include losing weight, feeling below par, a fever and muscle pain.
Treatment of rheumatoid arthritis is complex and involves a multi-disciplinary team approach. Patient education is vital so they can understand a complex disease with many and severe consequences which can affect functional abilities profoundly. Physiotherapists work to reduce inflammation and pain, maintain joint ranges of motion and maintain and increase muscle strength. Occupational therapists may teach patients the principles of joint protection in functional activities, suggest aids to daily living, make resting splints for inflamed joints and advise on adaptations to a patients home. Many patients come to joint replacement as the disease process is very destructive.
Initial treatment is often with anti-inflammatory and painkilling medication until DMARDS (disease modifying anti rheumatoid drugs) take effect. These drugs can hold back or prevent progression of the disease, reducing the likelihood of joint destruction with accompanying loss of functional ability. DMARDS have developed over the last few years into the biological agents based for the first time on a scientific understanding of the underlying pathological process. This has raised the hope that the disease process can be stopped, preventing many of the disabling consequences of RA quite apart from the pain. These drugs are having dramatic effects on the lives of people with rheumatoid arthritis.
Physiotherapy assessment of a rheumatoid patient starts with observing the persons gait as they walk in and observing any joint deformities and movement difficulties as they answer questions about their condition. Joint deformities are common, especially of the metacarpophalangeal joints of the fingers, the wrists and the knees. Hand deformities badly affect hand function and mean the person is unable to manage normal daily tasks. The physio will assess the patients mobility as foot, hip and knee pain and joint deformities are common, limiting the ability to walk, and walking aids are difficult to use because of hand problems.
Acute treatment concentrates on joint protection, splinting, ice, painkillers and very gently range of motion exercises, all aimed at maintaining some joint function while the joints settle down. Once the acute episode is easing, physio treatment moves on to increasing the ranges of motion and muscle strength and regaining functional abilities. A detailed treatment plan is essential for successful management of RA due to the many effects this complex disease has. - 14130
About the Author:
Jonathan Blood Smyth is Superintendent of a large team of Physiotherapists at an NHS hospital in Devon. He specialises in orthopaedic conditions and looking after joint replacements as well as managing chronic pain. Visit the website he edits if you are looking for physiotherapists in Leeds or elsewhere in the UK.
No comments:
Post a Comment