How to treat Rheumatoid Arthritis | Physiotherapy Guideline Review

Summary

This video discusses rheumatoid arthritis (RA), an inflammatory autoimmune disease primarily affecting joints such as hands, wrists, knees, and feet. The video emphasizes the importance of early intervention to prevent disease progression and disability. Physical therapists play a key role by assessing pain, stiffness, fatigue, and other symptoms through a detailed patient conversation. Additional considerations include skin checks, cardiovascular risk, and comorbidities. The video highlights the necessity of exercise as a treatment and outlines specific clinical assessments to evaluate joint function and mobility in RA patients.

Takeaways

• 💡 Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that primarily affects joints, especially in the hands, wrists, shoulders, elbows, knees, ankles, and feet.
• 📊 RA prevalence is estimated between 0.3% and 1% globally.
• 🏥 Early treatment of RA is crucial as it can slow disease progression and lower the chances of disability.
• 🗣️ A thorough conversation with patients is important to assess general health, disease status, treatment history, and specific issues like pain, functional difficulties, and fatigue.
• 🧑‍⚕️ Physical therapists should assess which joints are affected, the nature of the pain, stiffness, range of motion deficits, and any swelling in RA patients.
• ⚠️ RA is a systemic disease and can lead to complications such as skin problems, fatigue, and cardiovascular issues.
• 📋 In cases of joint deformities or Atlanta-axial instability, patients may experience other symptoms like weakness, balance problems, and muscle twitching, which may require further medical attention.
• 🩺 Check patients for general red flags like weight loss, fever, and assess their skin, blood pressure, and energy levels for a comprehensive understanding.
• 🏋️‍♀️ Exercise is recommended as part of RA treatment, and understanding the patient’s attitude toward physical activity and coping strategies is important.
• 📝 During clinical exams, physical therapists should check for swollen joints, joint deformities, temperature changes, muscle strength, balance, hand function, and overall movement quality.

Q & A

What is rheumatoid arthritis (RA)?

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that primarily affects the joints, particularly in the hands, wrists, shoulders, elbows, knees, ankles, and feet. It can lead to joint pain, stiffness, swelling, and deformities.

What is the estimated prevalence of rheumatoid arthritis?

The prevalence of rheumatoid arthritis is estimated to be between 0.3% and 1% of the population.

Why is early treatment of rheumatoid arthritis important?

Early treatment of rheumatoid arthritis is important because it can inhibit disease progression, reduce the risk of long-term joint damage, and lower the risk of disability.

What should a physical therapist focus on during an initial patient conversation about RA?

During the initial conversation, a physical therapist should evaluate the patient's general health, disease status, current and past treatments, and issues related to RA such as pain, functional difficulties, and fatigue. The therapist should also ask about the patient’s need for assistance and treatment expectations.

What specific joint symptoms should be assessed in patients with RA?

Therapists should ask about which joints are painful, how severe the pain is, and whether the pain progresses throughout the day. They should also assess symptoms such as stiffness, range of motion deficits, swelling, strength, and endurance issues in the affected joints.

What systemic complications are associated with rheumatoid arthritis?

RA is a systemic disease and can lead to complications beyond the joints, including skin problems, fatigue, cardiovascular diseases, and atlantoaxial instability. Physical therapists should also assess for symptoms like 'sandy hands,' twitching legs, muscle weakness, and balance problems.

What comorbidities should be considered in patients with rheumatoid arthritis?

Physical therapists should ask patients about comorbidities such as smoking, being overweight, or having cardiovascular conditions, as these can impact RA and its treatment.

What are common red flags in rheumatoid arthritis patients that may require further investigation?

Red flags include unexplained weight loss, fever, and significant changes in symptoms such as muscle weakness, balance issues, or unexplained pain, which may require further medical investigation.

How should a therapist assess a patient’s activity level in relation to RA?

Therapists should ask about the patient's ability to perform daily activities such as turning in bed, walking, self-care, picking up items, and transportation. They should also assess whether the patient meets physical activity guidelines and their views on exercise.

What should be included in the clinical examination of a patient with rheumatoid arthritis?

The clinical examination should include checking for visibly swollen joints, joint deformities, temperature changes, active and passive range of motion, muscle strength, endurance, balance, proprioception, hand function, aerobic capacity, gait, and overall movement quality.