DISEASE TREATED IN PHYSICAL THERAPY: RHEUMATOID ARTHRITIS
Rheumatoid arthritis is a disease often seen and treated in the physical therapy setting. This article, written from the point of view of a physical therapist, provides an overview of the disease, the prognosis for those afflicted, and common treatments.
Rheumatoid Arthritis Overview
What is Rheumatoid Arthritis?
Rheumatoid Arthritis (RA) is a systemic autoimmune disorder of unknown etiology. Autoimmune diseases are illnesses which occur when the body tissues are mistakenly attacked by its own immune system. The major distinctive feature is chronic, symmetric and erosive synovitis of peripheral joints. The severity of the joint disease may fluctuate over time but the most common outcome of established disease is progressive development of various degrees of joint dysfunction, deformity and disability.
Who Does Rheumatoid Arthritis affect?
This systemic disease affects 1-2% of the adult population in every part of the world. RA affects more than two million Americans. RA increases with age for both men and women. Peak onset is 20-45 years of age. Prevalence is higher in women. More than 75% of people with RA are women. Rheumatoid factor is found in the serum of approximately 85% of people with RA.
How does Rheumatoid Arthritis affect the body?
The joint inflammation initially starts in the synovium(a thin layer of tissue which lines the joint) which eventually can lead to cartilage destruction. The cartilage damage results in joint space narrowing and resulting bone and joint damage.
Synovitis is potentially reversible and is often dealt with pharmacologically and by other non-surgical means. Synovitis tends to follow a sine wave pattern with fluctuating symptom severity.
Active synovitis is represented by warm, swollen, obviously inflamed joints. The joints affected are usually superficial joints with easily distensible capsules such as the knee, wrist and finger joints.
Structural damage typically begins within the first and second year of the disease. It is characterized by cartilage loss and erosion of periarticular bone. This process is irreversible and progresses as a linear function of the amount of prior synovitis.
Remission usually occurs in the first two years of the disease
What are the signs and symptoms of the Rheumatoid Arthritis?
According to the American College of Rheumatology, four of the seven symptoms indicate a diagnosis of RA.
- Morning stiffness lasting more than 1 hour, present daily for more than 6 weeks.
- Arthritis of 3 joints lasting for at least 6 weeks.
- Arthritis of hand joints lasting for at least 6 weeks.
- Symmetric arthritis lasting for at least 6 weeks.
- Rheumatoid nodules.
- Positive Rheumatoid Factor on blood tests.
- Joint changes on x-ray.
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