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Rheumatoid Arthritis

Ever wondered what it’s like to live with a chronic inflammatory autoimmune disorder named Rheumatoid arthritis. Let us understand in detail about the condition and how one can boost their activities of daily living while maintaining a healthy lifestyle.


What is Rheumatoid Arthritis?

It is known as a chronic inflammatory autoimmune disorder that primarily affects multiple joints of your body. It happens when the body's own tissues are mistakenly attacked by the immune system, leading to joint inflammation. Pain, swelling, stiffness, and ultimately joint injury may result from this. Most commonly the heart, blood vessels, lungs, and other organs and systems in the body can all be impacted by RA.


Females are affected more commonly than males in the ratio 3:1 with male counterparts having better prognosis.


Why are females more affected than males? Possibly due to the link with female hormones. In addition, breastfeeding during the postpartum period has been linked with an increased risk for developing RA due to increased prolactin levels (Brennan & Silman, 1996). Similarly, fluctuations in estrogen levels during menopause may also influence the onset of the disorder.


Causes

The actual cause of RA is unknown, but genetic factors clearly play an important role since upto 10% of patients with the condition report a 1st degree relative with the RA.


  1. Genetic factors - Family history of autoimmune disease, certain genetic markers such as HLA-DR4 and HLA- DR1.

  2. Environmental triggers - Infections, cigarette smoking and long-term exposure to certain toxins and pollutants like silica may increase the risk.

  3. Lifestyle factors - Obesity increases inflammatory rate and may further contribute to RA. No physical activity and poor diet can also make the individual susceptible to the disorder.


Rheumatoid Arthritis (RA) has two main types namely - Seropositive and Seronegative This condition can also be seen in young children below the age of 16 years and named as Juvenile Rheumatoid Arthritis (JRA).


Symptoms

  • Persistent joint pain with tenderness and swelling

  • Morning stiffness lasting more than 30 minutes

  • Fatigue with loss of appetite and weakness

  • Fever due to systemic involvement

  • Decreased range of motion

  • Warmth or redness in affected joints

  • Deformity of the joints

  • Extra-articular manifestations affects - The eyes, skin (leading to ulcerations), heart, lungs and the bones.


How is the condition diagnosed?

It is usually based on history, clinical findings, X-ray examinations and blood tests. Your physician may ask you get the following blood markers done -

  1. CBC

  2. Rheumatoid factor (RF)

  3. Anti- CCP antibodies

  4. CRP and ESR levels.


Radiologic examination of X-ray may reveal -

  1. Soft tissue swelling

  2. Deformity

  3. Erosions at joint margins

  4. Reduced joint spaces

  5. Osteoporosis


Management

Most people with RA take medications. According to research, early treatment with drug combinations rather than just one drug may be more successful in reducing or avoiding joint injury. In addition to reducing pain and inflammation, many of the drugs that doctors use to treat RA can halt or even reverse joint degeneration. They could consist of :

  • Nonsteroidal anti-inflammatory drugs (NSAIDS)

  • Corticosteroids

  • Antirheumatic drugs


Physiotherapy plays a crucial role in managing RA by improving joint function, reducing pain, and maintaining mobility. Here’s how physiotherapy helps:

  1. Pain Management - Techniques like manual therapy, heat and cold therapy, and electrical stimulation can reduce pain and inflammation.

  2. Improved Mobility and Flexibility - Stretching exercises help maintain joint flexibility and prevent stiffness.

  3. Strengthening Exercises - Your physiotherapist will design a low-impact exercise program to strengthen muscles around the joints, which helps reduce strain on affected areas.

  4. Posture Correction - Poor posture can worsen joint pain so posture correction exercises like chin tucks and scapular retractions will be helpful.

  5. Education and Self-Management - Patients learn how to perform daily activities in ways that minimize stress on joints and prevent flare-ups.

  6. Assistive Devices - You may be recommended braces, splints, or walking aids to support joints and improve mobility.

  7. Hydrotherapy - Exercises performed in warm water can reduce joint stress and improve flexibility and strength.


Energy conservation techniques for people with Rheumatoid arthritis(RA) :

  • Maintaining an activity diary

  • Regularly reviewing activities listed down in the diary which will help you to prioritise your task/activities throughout the day so that important tasks are completed before fatigue sets in.

  • Pacing of activities

  • Help and support from family members, use of assistive devices.

  • Environmental and job site modifications.


Physiotherapy can be introduced at any stage of RA. However, it’s particularly beneficial when started early to limit joint damage and maintain mobility. Therapy sessions should be tailored to the individual’s condition and personal goals.

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