| Rheumatoid arthritis (RA) is a chronic, progressive | | | | prevent joint stress, support joints, and decrease joint |
| disease which may lead to considerable disability. While | | | | stiffness. |
| there are no cures for RA, recent developments in | | | | Wrist splints and ring splints are useful for reducing |
| biologic therapy make it possible to place many | | | | inflammation and preventing deformity in the hands. |
| patients into remission. | | | | Joint stress in the feet can be reduced by using a |
| In addition to medications though, it is important to add | | | | supporting pad at the sole of the foot and by using |
| adjunctive treatments such as physical therapy and | | | | metatarsal pads. Visco-elastic soles may help reduce |
| rehabilitation which help to increase functional capacity, | | | | shock loading occurring in the legs with walking. |
| provide pain relief, and also provide patient education. | | | | For RA patients with serious neck involvement, |
| Before starting therapy, physical assessments should | | | | particularly with the first and second vertebrae, a |
| include: functional assessments (what the patient is | | | | Philadelphia collar may be needed. The Philadelphia |
| capable of at the present time), range of motion, | | | | device provides excellent immobilization and may be |
| muscle strength, posture, and level of fitness. | | | | used in the presence of neck instability. |
| Cold and hot modalities are the most commonly used | | | | Patients using compression gloves have reported |
| physical treatments in arthritis therapy. Cold application | | | | reduced joint swelling and pain but there is no hard |
| is mostly used in acute stages whereas hot is used in | | | | evidence that they improve grip strength or hand |
| chronic stages of RA. | | | | function. Improvement may be provided by using |
| Heat works because it induces analgesia, relieves | | | | compression gloves both during the day as well as at |
| muscle spasm, and improves flexibility. Heat can be | | | | night in patients with inflammation in their hands or |
| used before exercise to help loosen muscles and | | | | fingers. |
| joints. Heat treatment may be applied as a hot-pack, | | | | Occupational therapy interventions such as assistive |
| infrared radiation, diathermy, paraffin, or hydrotherapy. | | | | devices and adaptive equipments have beneficial |
| Applications are recommended for 10-20 minutes once | | | | effects on joint protection and energy conservation in |
| or twice a day. Caution should be exercised in patients | | | | arthritic patients. Assistive devices are used in order to |
| with nerve damage, impaired circulation, or diabetes, | | | | improve functioning, reduce pain, and keep patients self |
| since there is a risk of thermal injury. | | | | sufficient. |
| Cold therapy is preferred in active joints where | | | | Loading over the hip joint may be reduced by about |
| inflammation is uncontrolled. Cold packs, ice, nitrogen | | | | 50% by using a cane. Elevated toilet seats, widened |
| spray, and cryotherapy are different ways of applying | | | | gripping handles, bathroom adjustments all help improve |
| cold-therapy. | | | | activities of daily living. |
| Cartilage-destroying enzymes such as collagenase, | | | | Massage is used to improve general well being and |
| elastase, hyaluronidase, and protease are produced in | | | | help diminish swelling of inflamed joints. Massage can |
| the inflamed joints of patients with RA. Levels of these | | | | help with depression, anxiety, mood, and pain. |
| enzymes are affected by the temperature within | | | | Muscle weakness in patients with RA occurs as a |
| joints. Increasing temperature inside the joint leads to | | | | result of immobilization or reduction in activities of daily |
| an increase in collagenase activity and cartilage | | | | living. Maintenance of normal muscle strength is |
| damage. | | | | important not only for physical function but also for |
| Electrostimulation is used in patients with RA to relieve | | | | stabilization of the joints and prophylaxis of traumatic |
| pain. Transcutaneous electrical nerve stimulation | | | | injuries. Exercise therapy has beneficial effects on RA |
| (TENS) therapy is the most commonly used method. | | | | by improving endurance and enhancing fitness. |
| TENS is a short-acting therapy and it also has a high | | | | Things to consider before launching an exercise |
| placebo effect. | | | | program include: whether the involvement of the joints |
| Water therapy, also known as hydrotherapy or | | | | is local or systemic, disease stage, patient age, and |
| "balneotherapy" has been used for arthritis since | | | | patient compliance. |
| ancient times. | | | | Range of motion exercises, stretching, strengthening, |
| Objectives of hydrotherapy are to increase range of | | | | aerobic conditioning exercises, and routine daily |
| motion, strengthen muscles, relieve painful muscle | | | | activities all should be included in a comprehensive |
| spasms, and improve a patient's well-being. | | | | exercise program. |
| There have been studies showing beneficial effects of | | | | Every joint should be moved in full range of motion at |
| hydrotherapy with pain reduction and improvement in | | | | least once per day in order to prevent contracture. In |
| grip strength. Because of buoyancy, water therapy | | | | the case of acutely inflamed joints, isometric exercises |
| allows patients to perform exercise without undue joint | | | | provide muscle tone without worsening disease |
| stress. Some studies have shown that hydrotherapy | | | | activity. |
| leads to muscle, tendon, and ligament relaxation and a | | | | If the disease activity is minor, then isotonic exercises |
| feeling of well-being. Endorphin release may also | | | | should be performed by using very low weights. If pain |
| contribute to improved pain control. | | | | persists more than 2 hours or too much fatigue, loss of |
| Some have suggested that water therapy may have | | | | strength, or increase in joint swelling occurs after an |
| beneficial immune system benefits with reduction in | | | | exercise program, then the program should be made |
| pro-inflammatory cytokines. | | | | less intense. Walking can aggravate knee pain in |
| Physical and occupational therapists educate patients | | | | patients with active inflammation. Therefore, patients |
| in joint protection strategies, use of assistive devices, | | | | with active RA should avoid activities such as climbing |
| and performance of therapeutic exercises. | | | | stairs or weight lifting. Producing excessive stress over |
| Joints should be put at rest during the acute phase of | | | | the tendons during the stretching exercises should be |
| the disease. Bed rest relieves the pain in cases of | | | | avoided. |
| extensive joint involvement. It is critical, at this stage, to | | | | When arthritis is controlled medically, conditioning |
| put the joints into rest at a functional position. | | | | exercises such as swimming, walking, using an elliptical |
| Fortunately, bed rest is not needed as much as it once | | | | trainer, and cycling with adequate resting periods are |
| was. Splints are used to keep involved joints in a | | | | recommended. They increase muscle endurance and |
| functional position. Splints help to mitigate pain and | | | | aerobic capacity and improve function of the patient, |
| inflammation, prevent development of deformities, | | | | and they also make the patient feel better. |