Rheumatoid arthritis (RA) is the most common autoimmune disease in Australia, affecting about 2 per cent of the Australian population. Women are affected by RA about 2.5 times more than men. The onset of RA usually occurs between the ages of 40 and 50 years, which are usually the peak income-earning years. Living with RA between the ages of 30-50 can be particularly difficult for women who are often navigating a pathway to parenthood.
--How is rheumatoid arthritis characterised?
RA is characterised by systemic (all around the body) inflammation, which has implications for many body systems. Most commonly RA affects the lining of the joints, particularly of the hand and feet. The shoulders, knees and neck may also be affected. In cases of high disease activity that are left untreated, the inflammatory processes associated with RA can damage the joint surfaces and nearby structures, leading to irreversible joint deformities. The systemic nature of inflammation can also affect other body systems, particularly the cardiovascular system.
--How do I know if I have rheumatoid arthritis?
The cause of RA is unknown. However, there are contributory risk factors, including genetic factors such as a family history of RA and environmental factors including smoking, gum disease and obesity.
Early diagnosis and initiation of treatment for RA is critical for minimising the risk of joint and other organ damage in the long term. Early treatment can reduce mortality risks and increase the likelihood of a full and active life. Diagnosis is usually made on the basis of symptoms and results of blood tests. Rheumatologists are medical specialists who are experts in the management of RA. Your GP can refer to you a rheumatologist if RA or some other form of inflammatory arthritis are suspected.
Symptoms of RA include:
- joint pain, swelling and stiffness usually affecting the wrists, fingers and toes on both sides. Other joints including the shoulders, elbows, knees, ankles and the neck may be affected
- pain that is typically worse after rest or early in the morning
- joint stiffness in the morning that is greater than 30 minutes, and stiffness after rest
- feeling generally unwell and losing weight
- reduced ability to do daily activities important to you including work, home and recreational interests
- skin lumps (nodules), eye dryness or redness
- fatigue that isn’t relieved by rest.
--I’ve had pain for three months, if it’s not rheumatoid arthritis what could it be?
There are many different musculoskeletal health conditions that can have similar features to RA. It is important to seek an opinion from your health professional to get an appropriate diagnosis. A rheumatologist is often the best person to make this diagnosis and to check if you have a different health condition.
--What are the risks to my health if I have rheumatoid arthritis?
RA is a serious condition and is associated with a higher risk of death and cardiovascular problems. The impact of RA on your physical and mental health can be substantial if the disease is not well managed. It’s important to have a skilled team of health professionals available to support you, including a physiotherapist. They can develop a treatment plan that is right for you.
RA is not just a condition that affects the joints. Other body systems can be affected too, such as the eyes, lungs, heart and skeleton. Attention to the health of these other body systems is an important component of care in RA. Smoking significantly increases the risk of poor outcomes in people with RA, so establishing a plan to stop smoking is very important.
--How can physiotherapy help with rheumatoid arthritis?
Best-practice management of RA involves care from a team of health professionals—usually your GP, a rheumatologist, a physiotherapist and possibly other practitioners like a rheumatology nurse, occupational therapist, podiatrist and psychologist.
The components of care required to effectively manage RA will depend on individual circumstances and the person’s disease activity. For most people, management with disease modifying medication is essential.
Physiotherapy is helpful for maintaining and improving joint movement and integrity, muscle strength, education about joint protection and managing flares, and support for developing a self-management program. Physiotherapists can also guide you in strategies to manage painful and swollen joints, handle fatigue and manage functional problems such as breastfeeding or lifting and changing an infant.
For more information about the role of physiotherapy in RA, refer to these resources:
--How effective is physiotherapy for treating rheumatoid arthritis?
Physiotherapy forms a component of an overall management plan for RA. In this context, physiotherapy should be combined with medical management and care from other professionals, as required.
All clinical guidelines for the management of RA recommend physical therapy, including strengthening exercise, aerobic exercise (exercise that makes you ‘huff and puff’) and non-pharmacologic strategies to manage pain and mood. Physiotherapy has a role in all these areas. Physiotherapists can also help to manage conditions commonly associated with RA, including osteoporosis, osteoarthritis, shoulder pain, and tendinitis.
It is important to involve a physiotherapist in your care who has experience with inflammatory arthritis conditions.
--What can I do at home?
Effective management of your RA requires that you take a central role in management. Learning about your conditions is really important so that you can identify and take action during flares in fatigue, pain and swelling. Speak to your health professionals about how to develop a self-management plan that works for you, particularly a plan for managing flares and ceasing smoking (if relevant).
Arthritis organisations like Arthritis Australia and MOVE: muscle, bone and joint health can assist you with education, peer support and a nurse helpline. At a minimum, your management plan should include:
- a plan for managing flares
- a plan for ceasing smoking (if relevant)
- a physical activity plan that includes strengthening and aerobic exercise and exercise to maintain joint movement
- joint protection strategies which might including using assistive devices for some tasks (e.g. chopping vegetables, opening jars, lifting infants)
- a pain and mood management plan
- a plan to manage fatigue which might include sleep strategies and strategies to pace (or ‘chunk’) your activities.
