Rheumatoid Arthritis and Physiotherapy: Managing Joint Damage
Rheumatoid arthritis (RA) is an autoimmune condition in which the immune system attacks the joints, causing inflammation, pain, swelling, and eventually joint damage and deformity. Unlike osteoarthritis, which is a "wear and tear" condition, RA is an inflammatory disease that requires medical management alongside physiotherapy.
RA affects approximately one per cent of the UK population, with women two to three times more likely to be affected than men. It typically begins between the ages of thirty and fifty, though it can occur at any age. The condition usually affects the small joints of the hands and feet first, often symmetrically (both sides of the body), before potentially involving larger joints.
The symptoms of RA differ from osteoarthritis in important ways. Joint pain and stiffness are typically worse in the morning and after rest (rather than after activity), the stiffness lasts longer (often more than an hour), joints are warm, swollen, and tender, and there may be systemic symptoms such as fatigue, fever, and weight loss. RA also tends to affect multiple joints simultaneously.
Physiotherapy plays a vital role in managing RA, but the approach differs from osteoarthritis management. During disease flare-ups (periods of active inflammation), the focus is on joint protection, gentle range-of-motion exercises to prevent stiffness, and pain management. Vigorous exercise should be avoided during flares.
During periods of remission (when inflammation is controlled, often by medication), more active rehabilitation is appropriate. Strengthening exercises rebuild the muscle weakness that often accompanies RA, aerobic exercise improves overall fitness and reduces fatigue, and flexibility exercises maintain joint range of motion.
Joint protection principles are essential in RA: using larger joints rather than small ones for tasks (e.g., pushing doors with the shoulder rather than the hand), avoiding tight grips, using assistive devices to reduce joint stress, and balancing activity with rest. Splinting may be used to support painful or deformed joints.
Our home visit physiotherapy service provides comprehensive RA management at home. Our neurological physiotherapy service supports patients with neurological complications of RA, while our elderly physiotherapy service addresses the needs of older adults with RA.