Rheumatoid Arthritis

By Drew Heideman, PT, ATC

What is Rheumatoid Arthritis?

Definition: Rheumatoid Arthritis (RA) is considered an autoimmune disorder. RA causes the immune system to attack and inflict damage on itself by mistake. This condition damages the lining of the joints, which causes painful swelling that can ultimately result in joint deformity and bone erosion. Read how osteoarthritis and rheumatoid arthritis differ here. While RA can affect any joint, the small joints in the hands and feet are most commonly affected.  Unlike osteoarthritis, which is caused by mechanical wear and tear of your joints.  Please read more about the knee in this article on arthritis. Additionally, Rheumatoid Arthritis typically affects the joints in a symmetrical pattern. RA usually affects both hands or both knees.

A normal joint and one with rheumatoid arthritis. Rheumatoid Arthritis (RA) is an inflammatory type of arthritis that usually affects knees. the auto immune disease. The body’s immune system mistakenly attacks healthy tissue. Osteoarthritis affects only your joints in your body.  RA affects your entire body including your joints.  OA and RA have different causes and progression.  There are 1.5 million people in the US who have RA and there are 27 million people in the US that have OA.  OA also gets worse later in the day due to fatigue of your muscles and weight bearing.  Early intervention for RA is so important to prevent the progression of the disease.

RA of the Hands and Fingers

The most common pictures of RA are of the hands and fingers.  Often, RA can cause deformity of the fingers and severe pain.  It is important to seek out the advice of a physician.  You physician and Certified Hand Therapist can certainly help to stop the progression of the disease and manage the pain.   There are several specific hand conditions related to RA.  Boutonniere Deformity and Swan Neck Deformity are just a couple of the conditions that we treat on a regular basis.

RA Symptoms

Early signs of rheumatoid arthritis can be subtle and may include weakness, achy, painful joints or minor stiffness in the morning. Smaller joints tend to be affected first, especially the joints that attach your toes to your feet and your fingers to your hands. However, larger joints like your hips, knees, and shoulders can be affected as well. Read more about what may be causing your hips to hurt here. Additional signs include tender, warm to touch, fever, swollen joints, weight loss, and overall fatigue.  RA nodules can also be a warning sign.  These are small bumps under the skin.

RA Flares and Remission

Flare-ups and remissions are common in RA.  Flares are when the RA symptoms are magnified and painful.  The goal of any treatment plan is to keep the disease in remission.  Therefore, it is so important to make an appointment with your physician if any of these signs are persistent.  Early intervention of a treatment plan significantly improves the prognosis.

It is so important to know the symptoms of RA.  These symptoms are warning signs that you may have Rheumatoid Arthritis.  RA can cause permanent irreversible joint damage.  Early detection and treatment can significantly decrease the amount of joint damage in your body.

What Are The Causes of Rheumatoid Arthritis?

Rheumatoid Arthritis is an autoimmune disease and occurs when the synovium (the lining of membranes that surround your joints) are attacked by the immune system. The synovium is inflamed by the attack and thickens, which eventually damages the cartilage and bone inside the joint. As a result, the ligaments and tendons that hold the joint together weaken and stretch which causes the joint to lose its shape and alignment.  RA can affect your entire body, not just your joints.

Risk Factors of Rheumatoid Arthritis 

• Genetics (sex, family history)
• Age: Although it may occur at any age, RA mostly occurs in those ages between 30 and 60 years.
• Smoking
• Environmental exposure
• Obesity

What are the Tests for a Diagnosis of RA

Rheumatoid arthritis can be diagnosed in a variety of ways, however there is no single test that can give doctors a clear answer. In the early stages, rheumatoid arthritis can resemble diseases like:

• Sjogren’s syndrome
• Osteoarthritis
• Lyme arthritis
• Lupus

Physicians can prescribe a blood test to check for the presence of “Rheumatoid Indicators” in your blood. X-rays can also be used to see bone abnormalities and joint spacing to help differentiate rheumatoid from other arthritis types.

Complications of Rheumatoid Arthritis or RA

Rheumatoid Arthritis may increase your chances of developing joint pain. This is oftentimes the first sign of rheumatoid arthritis, and is most noticeable after periods of inactivity.  This can damage the knee ligaments and the knee joint itself.

Rheumatoid arthritis can certainly affect your knee’s and hips.  The joint pain associated with RA is certainly magnified by high impact sports like running or basketball.  Since RA breaks down the lining of the joints, running may be an extremely painful or poor choice of exercise for those dealing with this condition. Click here to read about some recommended alternatives to running. Click here to read some tips if you experience pain while running.  When your joints are inflamed, it would be better to swim or ride a bike.

Since inflammatory conditions like rheumatoid arthritis cause swelling, bunions may form as a result of poor posture or biomechanics. When you have an autoimmune disease like RA, it may also lead to a condition known as a frozen shoulder or adhesive capsulitis. This condition occurs when the tissue surrounding the shoulder joint becomes inflamed and stiffens, making the shoulder painful and hard to move.

Other common complications stemming from rheumatoid arthritis include:

• Osteoporosis
• Rheumatoid Nodules
• Carpal tunnel Syndrome
• Heart Problems
• Lung Diseases
• Lymphoma

Treatment of RA

At present, there is no known cure for rheumatoid arthritis. Fortunately, treatment options have increased greatly in the past 30 years. Medications aid in reducing inflammation in the joints in order to relieve pain and reduce the damage done to the joint over time. Both physical and occupational therapy can teach patients how to protect their joints and live with their condition. The goal of the treatment plan is to keep the patient in remission. In extreme flare cases, surgery may be necessary to repair the joint which is damaged.

It is highly recommended for you to be under the care of a Rheumatologist.  A rheumatologist is a physician who specializes in the treatment and care of RA.  Our orthopedic physicians will work side by side with your rheumatologist to deliver the highest level of care for you!

Common medications used to fight RA include:

• NSAIDs (Nonsteroidal anti-inflammatory drugs): These can help reduce inflammation as well as relieve pain. Common NSAIDs include ibuprofen and naproxen sodium.
• Steroids: These are typically only prescribed to relieve acute symptoms in patients with a plan to gradually wean them off the medication. A common name for corticosteroid medications is prednisone, which is also designed to reduce inflammation and pain while slowing joint damage. Read more about injections for pain management.
• DMARDs (disease-modifying antirheumatic drugs): These medications can slow the onset of RA in order to save the joints and other tissues from permanent damage. Common names for DMARDs include methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine.
• Biologic Agents: These work by targeting parts of the immune system that trigger inflammation that causes joint and tissue damage due to RA. These are most effective when paired with a DMARD.
• Consult with your physician about other medications which may help you manage your RA.

Other treatment options offered by JOI include:

• Paraffin Bath: Our occupational therapists use a paraffin bath to relieve pain from arthritis.
• Modalities: JOI Rehab clinicians can use Ultrasound, Laser, Electrical Stimulation, Whirlpools and Fluidotherapy.
• Dry Needling: Although not typically covered by insurance,  dry needling is a treatment alternative offered at our Nassau, San Marco and World Golf to reduce pain from rheumatoid arthritis.
• Surgery: As mentioned earlier, your physician many make a recommendation for surgery.  Sometimes medications and therapy fail to slow joint damage. JOI has a team of highly trained orthopedic physicians with state of the art technology to help you no matter what your needs are. Some surgical options include:
• Arthroscopy: Arthroscopy with some cases of mild arthritis can be helpful.  Although the procedure provides some relief from the pain, it will not eliminate arthritis from the joint. If there is any progression, additional surgery recommendations may in the future.
• Joint Replacement: A total joint replacement may be a treatment option when the arthritis progresses. Limits in range of motion and pain prevents a patient from performing daily activities.  JOI has several joint specialists for every joint in your body to help you get back to doing the things you love.

Lifestyle Changes and Home Remedies for RA

Many people with RA feel like moist heat or heating pads make them feel better while other use ice.  Others will use homemade rice bags that they can heat up in their microwave at home as another moist heat alternative.  Always be careful with whatever heat or ice device that you use to make sure they don’t cause heat or ice burns.  You should always have a layer of some sort in-between your skin and the modality.  Topical analgesics and gels like Voltaren can also be helpful for the reductions of pain and inflammation.

We hope that his article helps to explain more about Rheumatoid Arthritis.  It may be helpful to also join support groups to know that you are not alone in your treatment plan.  Our physicians will work closely with your primary care physician and your rheumatologist.  Our goal is to keep you in remission and prevent further damage to your joints and body.

By: Drew Heideman, PT, ATC

Related Articles:

• Exercises for Shoulder Pain,
• Top 4 Exercises for Hand Arthritis
• Stretches for Shoulder Pain.

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