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.

Rheumatoid arthritis is a serious joint and system disease, responsible for large amounts of functional disability, complications from the disease and some reduced life expectancy. About 30% of patients are unable to work after five years with the disease, and half have a marked drop in function after ten, both due to the disease effects on activities of daily living (ADL). Affecting all racial groups and 2-3 times more common in females, RA sufferers have a reduced life span of about five to ten years from the systemic complications and medical treatment side effects. 35 to 50 years of age is the main presenting time for RA but it can occur both in elderly people and in children.

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.

Anti-inflammatory drugs and painkillers are the first drugs of choice to treat the inflammation and pain, with disease modifying anti-rheumatoid drugs (DMARDS) added to attack the rheumatoid process itself. DMARDS are the product of intensive scientific research into the underlying rheumatoid process, basing the drugs actions on the real pathological process occurring in patients. These drugs are able to interrupt the disease process itself, slowing or stopping the joint damage which has such negative effects on functional abilities, allowing a much brighter outlook for the future for patients with rheumatoid and other arthritic diseases.

Physiotherapy assessment of a rheumatoid patient starts with observing the persons gait as they walk in and observing any joint deformities and movement difficulties as they answer questions about their condition. Joint deformities are common, especially of the metacarpophalangeal joints of the fingers, the wrists and the knees. Hand deformities badly affect hand function and mean the person is unable to manage normal daily tasks. The physio will assess the patients mobility as foot, hip and knee pain and joint deformities are common, limiting the ability to walk, and walking aids are difficult to use because of hand problems.

Acute treatment concentrates on joint protection, splinting, ice, painkillers and very gently range of motion exercises, all aimed at maintaining some joint function while the joints settle down. Once the acute episode is easing, physio treatment moves on to increasing the ranges of motion and muscle strength and regaining functional abilities. A detailed treatment plan is essential for successful management of RA due to the many effects this complex disease has.