Physiotherapy Treatment in Rheumatoid Arthritis
by Jonathan Blood Smyth
Rheumatoid arthritis is the commonest inflammatory arthritis
with an incidence of about one percent in the population. A
chronic disease which affects the whole body, it presents
with a symmetrical arthritis of many joints and involvement
of other tissues such as the lungs, heart, eyes and skin.
Prominent morning stiffness, tiredness and malaise are
common due to the systemic nature of the disease and as it
destroys joint structure it can be accompanied by a high
level of disability. Recent advances in scientific
understanding of arthritis and newly developed drug
therapies have improved the outlook for sufferers. The cause
is unknown but infection is often suggested.
As rheumatoid arthritis is responsible for high levels of
disability, disease complications and increased mortality,
it is not a benign process. As activities of daily living
(ADL) can be badly affected about a third of patients are
unable to work after 5 years since their diagnosis and after
ten years 50% typically have an important loss of ability to
function. The rheumatoid complications and therapy side
effects may result in a shorter life span by five to ten
years, RA occurs across ethnic groups and is more common in
women in a ratio of three to one. The peak time for
diagnosis is between thirty-five and fifty years but RA can
be diagnosed in children and in elderly persons.
The clinical examination by the doctor and the patients
subjective report is what mostly establishes the diagnosis
of rheumatoid arthritis. A common symptom is stiffness in
the morning which lasts for an hour or more before it eases
as much as it is going to. The doctor will expect to find
the pain and joint swelling of arthritis in three joint
areas, that the affected joints will be mirrored on both
sides of the body and that the small hand joints will be
involved. Insidious onset (slow and sneaky) is the commonest
but some people can have an acute and very sudden onset of
pain and joint swelling. Other symptoms include loss of
weight, feeling unwell, fever and pains in the muscles.
The management and treatment of RA involves a wide
multi-disciplinary team effort due to the complex nature of
the disease. RA is a serious disease with severe effects
upon an individual so educating the patient about the
condition and how to cope with the problems and the
treatment is vital. Physio treatment concentrates initially
on joint pain and inflammation, moving on to range of
movement and the maintaining of muscle strength.
Occupational therapists give joint protection advice,
provide joint splinting, activities of daily living and home
adaptations. Orthopaedic intervention is common as joint
damage progresses, with joint replacement a common
treatment.
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.
Initially, as the joints are inflamed and painful, physio
treatment aims to rest the joints, reduce inflammation and
pain, protect the joints with splints and to maintain
function by gently joint exercise. When the condition
becomes sub-acute the physiotherapist will include range of
motion exercises and strengthening along with functional
work. Successful management of RA requires a
cross-disciplinary co-operation due to its complex nature. -
15668
Jonathan Blood Smyth is a Superintendent
(http://www.thephysiotherapysite.co.uk) Physiotherapist at
an NHS hospital in the South-West of the UK. 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
(http://www.thephysiotherapysite.co.uk/physiotherapy/physiotherapists/uk/london)
physiotherapists in London.
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New Unique Article!
Title: Physiotherapy Treatment in Rheumatoid Arthritis
Author: Jonathan Blood Smyth
Email: david.ravech@googlemail.com
Keywords: Back pain,injury management,sciatica,Piriformis Syndrome,pain management,sciatica,back injury,back pain relief,Frozen Shoulder,alternative medicine,physiotherapists,physiotherapy,Health and fitness,advice,alternative medicine
Word Count: 715
Category: Health & Fitness:Alternative Medicine
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