Rheumatoid arthritis is a chronic and severe inflammatory condition that leads to progressive joint damage, disability, deteriorated quality of life, and shortened life expectancy, affecting up to 1% of the worldwide population 1. Globally, the age-standardized annual incidence rates of rheumatoid arthritis have been found to have increased by nearly 10% between 1990 and 2017 2, and the economic burden of rheumatoid arthritis remains significant due to both direct and indirect costs, including modern drug development. In most patients however, the clinical course is progressive, and major progress has been made in treating rheumatoid arthritis through early disease identification and treatment. In particular, close monitoring of the disease alongside a thorough adjustment of medications, lifestyle factors, and exercise may reduce or even prevent co-morbidities associated with the progression of rheumatoid arthritis. Such rheumatoid arthritis management strategies specifically target pain relief and the prevention of joint damage and functional decline – to this end, carefully patient-tailored physical therapy and rehabilitation significantly enhance medical interventions 3.
Physical and exercise therapy in patients with rheumatoid arthritis are used to improve patients’ daily functioning and social engagement by enhancing muscle strength, endurance, joint mobility, and coordination.
First, hot and cold applications can be used, during acute or chronic stages, respectively, to achieve analgesia, facilitate muscle spasm relief, and promote joint elasticity. Electrical stimulation can also be used for pain relief, most frequently in the form of transcutaneous electrical nerve stimulation therapy. Hydrotherapy has long been recognized in parallel for its ability to increase range of motion, strengthen muscles, relieve muscle spasms and improve overall well-being by facilitating exercise with reduced load on the joints. Finally, additional joint protection strategies may include rest, the use of compression gloves and other assistive devices, and massage therapy. Low-level laser therapy and medical taping may also play a complementary role depending on a patient’s predisposition 4.
Alongside these treatments, more active physical therapy exercises may also be carried out to improve muscle strength. However, a number of parameters should be taken into consideration in the establishment of a patient-tailored exercise program. In so doing, it is important to probe whether the impact of rheumatoid arthritis on joints is localized or systemic, the stage of the disease, the patient’s age, and the expected degree of patient compliance to a physical therapy program. Exercise duration and severity should be adjusted to match the patient’s background, characteristics, expectations, and attitude 3. Furthermore, in general, exercises are developed based on specific recommendations on behalf of the patient and supporting health care personnel as regards the desired intensity, type, characteristics, and frequency of the exercises.
In practice, however, research into clinical practice guidelines has revealed that physical therapy treatments for patients with rheumatoid arthritis must include active exercise therapy alongside lucid patient education 4. Educational initiatives should include the detailed dissemination of rheumatoid arthritis-related information, advice, and self-management tools for better patient engagement and empowerment.
Evidence-based guidelines can guide physical therapists in the treatment of patients with rheumatoid arthritis. In so doing, guidelines must match an individual patient’s situation, as well as public health recommendations for health-enhancing physical activity. Furthermore, in the future, research initiatives must continue to thoroughly monitor and understand disease burden while optimizing patient-tailored physical therapy protocols.
References
1. Uhlig, T., Moe, R. H. & Kvien, T. K. The Burden of Disease in Rheumatoid Arthritis. PharmacoEconomics (2014). doi:10.1007/s40273-014-0174-6
2. Safiri, S. et al. Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017. Ann. Rheum. Dis. (2019). doi:10.1136/annrheumdis-2019-215920
3. Kavuncu, V. & Evcik, D. Physiotherapy in rheumatoid arthritis. MedGenMed Medscape General Medicine (2004).
4. Peter, W. F., Swart, N. M., Meerhoff, G. A. & Vliet Vlieland, T. P. M. Clinical Practice Guideline for Physical Therapist Management of People With Rheumatoid Arthritis. Phys. Ther. (2021). doi:10.1093/ptj/pzab127