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Rheumatoid Arthritis
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Rheumatoid Arthritis Physiotherapy and Hand Therapy Singapore
Rheumatoid arthritis, often abbreviated to RA, is a long-term disorder that causes inflammation within the system, and they more often than not affects joints with synovium. What happens is that an inflammation happens at the synovium (this is called synovitis), destroying the cartilage of the affected joints.
But the damage is not just limited to the joints – rheumatoid arthritis also can cause inflammation to the lungs, the heart’s muscles, in the sclera and in the pleural matters of the human body. The exact cause of RA is not sure, but one thing that we’re sure of is that everyone’s autoimmunity influences the disease’s pathology, affecting the length of the disease and its progression rate.
About 1 percent of the population in the world has rheumatoid arthritis, and the ratio of women to men affected is 3:1. Onset is often at around 40, but we have seen those in their 20s coming in for treatment and diagnoses of RA.
It has the possibility of being a very debilitating and painful life-long disease, causing loss of mobility and function if not treated. Medical practitioners will diagnose base on symptoms, physical examinations, X-Rays, rheumatoid factors found in lab results, based on guidelines established by bodies dedicated to the research and management of rheumatoid arthritis, such as the American College of Rheumatology (ACR). In fact, every country will have their own rheumatology research and clinic centers to facilitate and manage the treatment of rheumatoid arthritis.
There are a selection of treatments available, ranging from pharmacological and non-pharmacological. Pharmacological interventions often employ the use of painkillers and anti-inflammation drugs, as well as anti-rheumatic drugs to slow the progression of the disease. Non-pharmacological includes interventions by physiotherapy, occupational therapy, hand therapy, nutritional therapy and orthoses, though we primarily do not stop joint destruction. Education and management helps to prevent progression by limiting destructive behaviors and protect the joints.
Signs And Symptoms Of Rheumatoid Arthritis
RA affects other parts and/or organs of the human body as well; such as anemia (which occurs in about 1 or 5 persons with RA). This causes a difficulty to treat this anemia as the doctors would then need to determine if it was caused by RA or it is a byproduct of the medications used to treat the RA, or is it a from the patient’s own genetic pool and/or lifestyle factors etc.
RA Affecting The Joints
Refer to the diagram which demonstrates how RA affects a joint. The synovial membrane inflames, causing swelling, pain and warmth, and the increased pain and pressure from swelling hinders joint movements. RA also almost always affects more than one joint, and more commonly affected are the small joints within the hands, feet and the neck bones. This inflammation can cause joint surface erosion, causing deformity and immobility.
Typical manifestations of rheumatoid arthritis are pain, swelling, increased localized temperatures, stiffness more in the mornings or after a period of immobility or inactivity. Most of our patients share that they have to take a longer time in the morning to warm up and ‘thaw out’ the stiffness, and by gentle active movements to relieve the symtoms.
As the disease progresses, more joint erosion occurs, further impairing movement and causes both dysfunction and deformity. The deformity in the fingers varies according to level and intensity of joint erosion that occurs. Some specific deformities are identified by medical professionals such as boutonniere deformity, swan neck deformities and ulnar deviated joints, which are primarily a medical description of the deformity or deviation.
The Skin
Rheumatoid nodules that are just beneath the skin can form, measuring from a few millimeters to a few centimeters in diameter. They can be usually found on body prominences of the elbow, the knuckles or any other areas that often get consistent mechanical stress. These nodules are associated with a positive rheumatoid factor (RF) as found in lab results.
A list of other manifestations caused by RA includes:
The Skin
pyoderma gangrenosum, Sweet’s syndrome, sensitivity to pharmaceutics, erythema nodosum, lobular panniculitis, skin shrinking, erythema on the hands, thinning of the skin to the point it becomes brittle, and skin fragility (that is aggravated by corticosteroid use).
The Lungs
lungs fibrosis, pleural effusion and rheumatoid lung disease.
The Kidneys
Renal amyloidosis
The Blood Vessels And The Heart
Increased risks to atherosclerosis, heart attacks, stroke incidences, heart infections, heart failures, valvular infections and fibrosis.
The Eye And Related Eye/Visual Structures
Infection of the sclera, scleromalacia, infection of the conjuctiva, eye and mouth dryness, keratitis
Hepatic
Hyperactivity of hepatocytes increases enzyme releases into the blood.
Blood
Common problems are anemia, warm autoimmune hemolytic anemia, low white blood count, increased platelet count.
Neurological
Peripheral neuropathy, mononeuritis multiplex, carpal tunnel syndrome, atlanto-axial subluxation.
Constitutional symptoms
Fatigatibility, malaise, low grade temperatures, aching and stiffness in the morning, loss of appetite and weight.
Osteoporosis
Local and general osteoporosis may occur.
Pathophysiology And Causes
Though its exact causes are unknown, what we do know that it is a form of autoimmunity disorder, affecting the whole body and primarily the synovial tissues.
Six associated evidences of rheumatoid arthritis:
- Genetic link of HLA-DR4 + MHC Class 2 Allotypes + T-Cell-associated proten PTPN22.
- Smoker.
- Disease slows with use of cytokine TNF.
- Random patterns.
- Presence of IgGFc (auto-antibodies, known as rheumatoid factors) as well as ACPA (antibodies to citrullinated peptides.
Possible infectious triggers
Researches suspects the case of “mistaken identity” in some cases of RA, where the body mistakes a part of the body as a threat, and moves to remove the source of threat.
Psychological factors
Research doesn’t find any correlation between RA flare-ups/occurrences with physical and/or emotional stresses or trauma.
Treatment
- Anti-inflammatory Agents to stop/slow down the inflammatory responses, effectively stopping the onslaught of damage.
- Analgesics to minimize pain, maximize rehabilitation and mobility.
- Surgical Interventions to remove damaged synovium, correct deformities.
- Disease Modifying Anti-Rheumatic Drugs (DMARDs) to slow or retard the disease’s progress.
- Other therapies: weight loss, occupational therapy, podiatry, physiotherapy, joint injections and adaptive tools for function. Regular exercise, joint protection and energy conservation.