Rheumatoid Arthritis Physiotherapy and Hand Therapy Singapore

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.

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:

1. Genetic link of HLA-DR4 + MHC Class 2 Allotypes + T-Cell-associated proten PTPN22.
2. Smoker.
3. Disease slows with use of cytokine TNF.
4. Random patterns.
5. 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

1. Anti-inflammatory Agents to stop/slow down the inflammatory responses, effectively stopping the onslaught of damage.
2. Analgesics to minimize pain, maximize rehabilitation and mobility.
3. Surgical Interventions to remove damaged synovium, correct deformities.
4. Disease Modifying Anti-Rheumatic Drugs (DMARDs) to slow or retard the disease’s progress.
5. Other therapies: weight loss, occupational therapy, podiatry, physiotherapy, joint injections and adaptive tools for function. Regular exercise, joint protection and energy conservation.