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Rheumatoid Arthritis Treatment with Physiotherapy


Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease which occurs in about 1% of the population, causing a symmetrical polyarthritis and generalized involvement of many tissues such as the skin, eyes, lungs and heart. Due to the system-wide effects patients often feel fatigue, have malaise and marked stiffness in the mornings. As RA causes peripheral joint damage it is the cause of a large amount of disability in sufferers, however recent scientific advances in drug therapy hold out the hope of reducing or preventing joint damage. Infections are often linked with RA but an agreed cause has not been found.

Rheumatoid arthritis is a serious joint and system disease, responsible for large amounts of functional disability, complications from the disease and some reduced life expectancy. About 30% of patients are unable to work after five years with the disease, and half have a marked drop in function after ten, both due to the disease effects on activities of daily living (ADL). Affecting all racial groups and 2-3 times more common in females, RA sufferers have a reduced life span of about five to ten years from the systemic complications and medical treatment side effects. 35 to 50 years of age is the main presenting time for RA but it can occur both in elderly people and in children.

Diagnosis of rheumatoid arthritis is a clinical one with the patients report and the doctors examination being the most important factors. Morning stiffness is a very common complaint, with the stiffness lasting for at least an hour before it gets to its best state. The arthritis, which in this case means pain and swelling in a joint, should be present in at least three joint areas, be symmetrical on both sides of the body and involve the small joints of the hands. The disease mostly comes on slowly and steadily but some patients present with sudden acute onset of joint pain, heat and swelling. Patients may also complain of malaise, weight loss, weakness, fever and muscle pains.

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.

Doctors will initially prescribe analgesics and anti-inflammatory medication to tackle pain and inflammation, moving on to the drugs with attempt to modify the disease process, so-called DMARDS. Scientific research has uncovered a wealth of knowledge about the rheumatoid process for the first time and these drugs are now based on an understanding of the underlying pathology, allowing a direct attack on the disease. DMARDS can disrupt the rheumatoid disease process, holding back or halting the progression of the disease, cutting the chances of the joint damage and functional ability loss and holding out the hope of significantly better lives with RA.

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.

In the acute period of the disease physio treatment includes splinting, ice, analgesia, joint protection, rest and joint movements to keep the functions of the joints as the condition eases. As the acute stage settles the physiotherapy treatment includes increasing joint ranges and strength and returning to normal daily activity. A multidisciplinary plan is necessary for successful RA management due to the complexity of the condition.

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