Rheumatoid Arthritis

By Jon Stiffler, PTA, Spine Center Coordinator

Rheumatoid Arthritis – Overview

Overview: Unlike osteoarthritis, which is caused by mechanical wear and tear on joints, Rheumatoid Arthritis (RA) is considered an autoimmune disorder which 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. If you would like to read more about how the knee is affected by arthritis. Additionally, Rheumatoid Arthritis typically affects the joints in a symmetrical pattern. If one knee is affected, the other one usually is too.

Rheumatoid Arthritis of hands

RA of the hands

RA Symptoms

Early signs of rheumatoid arthritis can be subtle and may include 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, or swollen joints, fatigue, weight loss, and firm bumps of tissue under the skin on your arms. Flare-ups and remissions are common, so make an appointment with your physician if any of these signs are persistent as early intervention results in a better prognosis.

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.

Risk Factors of Rheumatoid Arthritis 

  • Genetics (sex, family history)
  • Age: Although it may occur at any age, RA mostly occurs in those ages between 40 and 60 years.
  • Smoking
  • Environmental exposure
  • Obesity
RA Treatment

Joint Pain from Rheumatoid Arthritis

Test and 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 which can damage the knee ligaments and the knee joints. Knee Pain: Knee pain may be caused by rheumatoid arthritis because of the joint being broken down. Running while suffering from RA can also cause pain because of poor form and biomechanics. Click here to read some tips if you experience pain while running.

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. In extreme cases, surgery may be necessary.

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.
  • Acupuncture: Although not typically covered by insurance, acupuncture is a treatment alternative offered at our San Marco and South offices 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.
  • Shoulder Replacement: A shoulder replacement may be a treatment option when the arthritis progresses. Limits in range of motion and pain prevents a patient from performing daily activities.

Lifestyle Changes and Home Remedies for RA

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.

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.

To schedule an appointment for physical therapy at one of the 12 JOI Rehab Centers, please call 904-858-7045.

To schedule an appointment with a JOI Orthopedic Surgeon for treatment of RA, please Call 904-JOI-2000, schedule online or click below.

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