Treatments Home > Treatments > Arthritis > Rheumatoid-arthritis

Symptoms

The key symptom of Arthritis-Rheumatoid Arthritis (RA) is pain in symmetrical joints for example both the elbow joints, both the knee joints and so on. You would rarely get to see such cases, where pain is developed in single joint. The pain development process in the case of RA generally takes more than a few weeks but the pain might hit you suddenly.

As the pain grows further, it becomes more symmetrical and spreads to other joints as well. Amount of swelling in your synovial membranes is directly related to the joint pain. Hence, the pain fluctuates with swelling, for example when swelling is more, joints tend to feel swollen.

Another symptom that RA patients suffer through includes morning stiffness amongst the joints. This stiffness can linger for two hours. Highest degree of stiffness makes it impossible for the patient to get out of bed or perform daily routine tasks.  This stiffness behaves parallel to to the synovitis aka when synovitis is gone, stiffness also vanishes automatically.

50% of the RA patients have rheumatoid nodules i.e. hard knots under the cover of ligaments or under the skin. Size of these hard knots varies from a size equivalent to a pea to a size equivalent to a golf ball. These nodules generally don’t cause any pain to the patient and tend to disappear or reduce in size with time. The main areas of RA patient’s body, where these knots can be found include finger undersides, outside of elbows, the Achilles tendon on heels, the lower abdomen, and certain toe joints.

Since RA is a systematic ailment, most of the patients feel weak within their bodies and really tired during outbreaks. It is noticed that half of the RA patients suffer systemic inflammation during joint outbreaks of RA.

RA patients witness conjunctivitis or inflammation of the eye as most common symptom during their illness. This includes dryness in eyes and it is connected to the eye disease named Sjogren’s syndrome, which often occurs along with RA.

RA patients might also suffer through the inflammation of the membrane that surrounds the lungs (the pleura.) This happens when the disease had affected lungs already. This leads to breathing problems, coughing and severe pain.

However RA generally hurts the nervous system in human body. But, it is hard to diagnose the symptoms of nervous system damage. This mainly includes damage to the cervical spine joints, weakness & reduced stability between cervical vertebrae. This causes spinal cord issues.

The body parts that are affected by RA often showcase following symptoms:

Cervical spine (the neck): Symptoms include neck stiffness, weakness, and loss of motion. Ligaments are often inflamed, and there may be problems with the spinal cord or nervous system as explained above. Neck pain alone tends to get better, even when the joints are damaged. Damage to the nervous system, however, does not usually improve.

Shoulders: The main symptom is loss of motion. Your body’s unconscious reaction to shoulder pain is simply to not use your shoulders. Since daily life doesn’t require large shoulder ranges of motion, frozen shoulder syndrome, in which the shoulder joint’s range or motion becomes severely limited, can set in quickly.

Hands and wrists: Almost everyone with RA has affected wrists and the joints in the middle of your hand and the middle joints of your fingers. The knuckles at the ends of your fingers usually are not. RA can cause joint deformities that freeze your fingers in unusual positions. Rheumatoid nodules and tendon inflammation can make it hard to bend the fingers. Nodules can cause a locking and catching action as your fingers bend.

Knees: Swelling in the knees is common and can be easily seen. A fluid-filled lump called a Baker’s cyst often appears behind the knee. It can burst and leak fluid into the calf.

Feet and ankles: RA commonly affects the joints in the middle of the toes and the ankle joints. The deformities and pain in the toes can cause problems with walking. The sole of the foot can feel tingly or numb.

This ailment is hard to predict and in its milder form, often RA goes unnoticed.

Diagnosis

Diagnosis of RA involves complete physical examination and inspection of the patient. Your physiotherapists will ask you various questions at Joint Efforts Physiotherapy Clinic to know the history of pain. How the pain began, which particular joints are affected and which activities enhance or relieve your pain. You are suggested to explain all the answers in detailed and appropriate manner. This only will help the physiotherapists to get clear idea about the diagnosis of RA in your joints. Along with ailment specific questions, the physiotherapists will also raise queries about your general health history and performance of your body in various conditions.

Next step in diagnosis process is physical examination of joints. This process includes looking and feeling your joints to find out if there are any troublesome signs of swelling, redness, enhancement in size, warmth or some specific kind of abnormalities (like nodules) and pain. At Joint Efforts, our physicians closely examine the body parts to compare similarities or differences in joints of both sides.

The next important step includes making the patient actively move to notice if they face any trouble with their joints during this process. Finding more about problem of motion deficit is required to diagnose RA properly. Diagnosis experts assess crepitus (high-pitched screech or grinding) that is either felt of heard during the movement. This screech is experienced when bone directly rubs with another bone.

This screeching sound leads to the conclusion that inflammation in the joint weakened the tissues and hence joints rub against each other. We understand importance of checking if this damage and looseness in joints is not stressing the ligaments.

 

Physiotherapy Treatment

Physiotherapists and medical experts have been working to find perfect cure for RA for years. However, they have succeeded in multiple ways, but still, there’s no permanent cure for this disease.

But, there are various medical strategies and treatments available which offer long term relief from painful symptoms of RA. This treatment comprises of Medication and Physical rehabilitation. Experts suggest that patients, who get this ailment diagnoses in its early state and start treatment immediately witness more positive results.  It also prevents worst scale joint damage. Sudden reduction in joints due to this ailment may occur within 2 years of time, but it’s not clear how often it happens.

Those RA patients, who developed this disease at young age or are RF positive or have someone suffering through RA in their family tree or have RA nodules, tend to face more difficulties in the treatment of this disease.

Medication

Here are some of the major medications that your doctor will suggest you to reduce the painful impact of RA.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help decrease the pain and swelling.

Corticosteroids taken by mouth can also help with inflammation but it should not be used for long term as it has side effects.

Disease-modifying antirheumatic drugs (DMARDs) help in treating RA as they stop structural damage. Though, this drug is known for interacting with other drugs. Therefore, it is important to find the best combination of drugs that work for each individual. Following are the Common DMARDs prescribed:

Unfortunately, DMARDs can be very hard on the body and can interact with other drugs. Often more than one DMARD is taken at the same time and it is not always easy to find the frequently prescribed are:

Hydroxychloroquine:  A relatively nontoxic drug that was made to treat malaria. It can be safely used with other DMARDs. It is most useful in early, mild RA. Regular eye check-ups should be conducted while taking this drug.

Sulfasalazine: Much like hydroxychloroquine. This drug requires regular blood monitoring.

Gold salts: Can cause short-term remissions. Over the long-term, however, the RA does progress.

Blood and urine monitoring is required.

Methotrexate: Can help manage RA, but it is unclear how much it actually changes the course of the disease. Methotrexate can be very useful over the long-term, but there are problems with flare-ups when patients stop taking it.

Azathioprine:  Used with moderate and severe RA.

Penicillamine: Only used in patients who have systemic disease that doesn’t respond well to other medications.

Cyclosporine: Expensive and hard on the kidneys, so it is most often used in severe RA.

Cyclophosphamide: Very effective but very toxic, so it is only used in specific cases.

Certain antibiotics are somewhat effective in mild cases.

Biologic response modifiers (BRMs) are among the newest drugs used to treat rheumatoid arthritis.

Biologics medications are used to reduce severe impacts of RA. Though, their performance in dealing with other ailment has not been satisfactory. They are used with other drugs and are dedicated to target strengthening immune system.

Abatacept (Orencia): It is given intravenously (IV) as an infusion over 30 minutes. Firstly, it is given within every 2 weeks and later once in 4 weeks. It is either used alone or with DMARDs.

Etanercept (Enbrel): It is taken once or twice a week mainly with concomitant methotrexate.

Infliximab (Remicade): It is given as a 2-hour intravenous infusion. It is given at doctor’s place only.

 At first, 3 doses are given within a 6-week period; afterward, a single dose is given every 8 weeks. This is done to maintain drug’s effect. It is often used with concomitant methotrexate.

Adalimumab (HUMIRA): This medication is given in the form of injection given weekly often used with concomitant methotrexate.

 Rehabilitation

Joint Efforts Physiotherapy Clinic aims to reduce negative impacts of RA by relieving the symptoms and prevent joint destruction. We provide rehabilitation solutions that preserve your joint functioning and let you live a normal & healthy lifestyle.

At Joint Efforts Physiotherapy Clinic we understand completely that it is challenging to deal with the complex diseases like RA. Therefore, we have updated our knowledge and excellence to offer advanced treatment to our patients and manage the flare-ups.

We first offer you relaxation from pain with medications and then begin with the rehabilitation process.  When you face flare-ups the synovitis occurs actively and this is the main reason of pain. Modalities such as heat or cold may be useful as well as other modalities such as transcutaneous nerve stimulators (TENS.)

TENS machines ease the pain by delivering moderate electrical current to the affected areas. This overrides pain sensations.

Hydrotherapy is next recommended rehabilitation technique in that either your entire body or affected joints are submerged in warm water. Patients are then suggested to gently move their joints, which reduces pain associated with flare-ups.

Along with this, physiotherapy experts at Joint Efforts clinic will advise you on the most effective resting position for any of your RA affected joints and can also advise you on when it is appropriate to begin exercise again after the rest period. We prefer to recommend you home exercise program, so that you can reduce your troubles and get rid of RA troubles.

We have installed advanced technology based physiotherapy equipment and tools to ensure improved and modified treatment to the patients. We offer specifically altered stretching exercises as per your body requirements and aim to heal you better.

Experts suggest that along with physiotherapy treatment, taking medications prescribed by your doctors is equally important. These medications help you to deal with the flare-ups during the physiotherapy treatment and makes sure that synovitis doesn’t causes damage to the joints.

We prescribe a series of joint strengthening exercises, which empower your RA affected joints to move actively and face lesser pain while doing this. With these exercises at your home, you can deal with motion deficits, strength deficits easily.

Joints that are about to face deformity show some signs of the same. Physiotherapists in such situations suggest you to install braces or splinting to prevent further damage to the joints. The common braces are designed by any physiotherapists but for complex structured braces, you need to consult occupational therapist.

Physiotherapists at Joint Efforts Clinic suggest you to do motion and strengthening exercises on routine basis to deal with RA. Along with this, to deal with pain, inflammation, and joint deformity experts also suggest you to practice coordination and proprioception exercises. This will make sure that joints will not lose usual functioning.

Physiotherapy experts at Joint Efforts Clinic suggest you to do gentle aerobics exercises to reduce the negative impacts of RA. This is amongst the highly preferred rehabilitation treatments by RA patients. Swimming, walking and cycling are named amongst such exercises, which improve strength in your muscles and joints. It builds endurance and capacity for your entire body. During flare-ups it’s not possible to practice aerobics but when your body is able to do it, you can attempt the same under the guidance of experts.

 


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