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.

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.

Rheumatological assessment by a physio begins with observation of the ability to walk as they attend the appointment and the noting of deformities of the joints. The hands, knees and wrists commonly suffer deformities, particularly bad at the knuckle joints, which interfere badly with hand function and the ability to exert force in grip and manipulating objects. RA can severely impair walking ability due to pain and postural abnormalities of the feet, knees and hips and walking aids are often necessary, although shoulder, elbow and hand problems interfere with the ability to use crutches or a frame.

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.