Rheumatoid arthritis (RA) is a chronic inflammation of the joint, of unknown cause, unpredictable duration and path of progression that affects about 0.5% of the population. It is more common in women than men. It causes pain, swelling, stiffness and gradual loss of joint function. In most patients, RA is a powerful condition that progressively moves forward damaging the joints, reducing work abilities and self-care.
The cosequences are social and financial dependence of the šatient and the shortening of life. RA is a considerable load on the society due to enormous direct expenses of medical therapy and even more side expenses due to the loss of work ability and the ability of self-care.
How and why does RA occur?
The cause of RA is still unknown. There is a genetic predisposition of certain people for this condition, but these genetic reasons are not considered crutial. Outside environment conditions like infections, stress, smoking and other may affect the immune and skeletomuscular system and can cause condition development. It is most probable, that the conditions occurs due to joined effects of both genetic predisposition and outside factors.
Although the symptoms are comaparable, the cause of RA developments and development of osteioarthritis are quite different. RA is in essence an auto-čimmune disease, where increased immune system activity enhances the state of chronic inflammation which leads to joint destruction, but also destruction of other organs and systems.
On the onset of the condition, small blood vessels are damaged and synovial cells multiply, after which immune cells are grouped around the blood vessels. Enhanced production of cytokines, major actors in the inflammation process. Synovial cell multiplication creates panus (synovial tissue). Enymes produced by these cells damage the cartilage, joint sides and other parts. This cascade of events in time leads to deterioration and loss of joint function, tendons and muscles, deteriorating work ability and leading to invalidity.
Why is RA a dangerous condition, and why a prompt reaction is necessary?
Rheumatoid arthritis damages joins, reduces work ability and life. In 50% of patients, MRA shows cartilage deformations even after 4 months, while in 0-90% of patients, these changes are visible even on rentgen inside 2 years of the condition.
During the first 10 years of the condition, 50% of the patients completely losses their work ability, and the average work competence is reduced to a half. In this time, in 10-20% of patients, prosthetics need to be installed for the large joints (knee or hip).
Aside from joint related symptoms, RA affects other systems and life aspects. In around 50% of patients, depression forms and these people have higher divorce rate than others. Also, the relative cardiovascular risk is 2-3 times greater in RA patients than in healthy individuals of the same sex and age.
Statistical results are devastating: death in RA patients is 1.3 times greater than in healthy individuals, even 1.4 times greater in women. RA patients have an average of 3-7 years less in their life spans than those not having RA.
Main therapeutic recommendation for RA
RA is a progressive illness without cure. However, by taking certain therapeutic-preventive measures, quality of life can be greatly improved. Main symptomatic therapy are pain killers and corticosteroids. In the recent time, a biological therapy approach is in use that is able to modify the disease development.
Phisical therapy holds an important place in complex therapy of patients with RA. As the disease is chronic, physical therapy and rehabilitation last for the entire life span of the patient. One of the most important things is the patient’s motivation for a regular physical regime. Trainning courses may have short term effects on the overall abilities and psychological status.
Rest in duration of few days is especially important for the patients with acute arthritis, helping reduce pain and inflammation. Long resting states is not recommended in patients with chronic arthritis for it has a negative effect on the skeletomuscular, cardiovascular and nervous system where muscles can lose up to 3% strength daily. There is some proof that splints significantly reduce pain and that work-splints reduce pain during work but do not enhance hand strength and function.
In RA treatment multiple physical agents are used: climate factors, heliotherapy, thermomineral water treatment, heat therapy, sound or electric therapy, magnetism and mechanical energy is applied as form of kinesiotherapy, massages and and work therapy.
The most accepted physical was of therapy in RA is heat therapy. Cryotherapy is applied in acute phases of the condition, while in the chronic arthritis, all heat based therapies are used. The use of ultrasound in therapy of RA patients, due to vibrations and increase in temperature have shown efficient for enhancing palm strength. Hydrotherapy is one of the oldest physical methids used in treating patients with RA. Recent systematic studies of balneotherapy effects could not provide definite conclusions due to poor methodology of the studies. Further studies are required to determine efficacy of this therapy model.
Dinamic excersises have positive effects on aerobic capacity and muscle strength increase. No adverse effects of practicing were noted in regards to pain and illness activity. In contrast to relaxation, exercise have shown in large randomized clinical trials to give far better results in regards to fist strendth, pain reduction, reduction of swelling, improvement of mobility of the joints and reduction of walk time.
Work therapy enables everyday functions and actions to be performed. Different kinds of tools are made to help movement, eating and hygiene alongside appropriate training courses (canes, crutches or walkers). Work therapist advice and occupational therapy are wery important for patients with limited function of the skeletomuscular system.
Dietitian’ and nutritionist’ advices are very important in the therapy of patients with arthritis. Reduction of body weight in overweight persons is especially important if weight bearing joints are affected (hips, knees). Appropriate therapy is recommended in the guide for prevention and therapy of obesity. In some cases, body mass needs to be increases, because cachexia can appear in patients that have a highly evolutive arthritis. Some studies have shown that people with lower body mass index have a lower functionality of the skeletomascular system.
There are no all excepted recommendations for the diet of people with osteoarthritis. There are some that think meat reduction and fish increase in diet (fish that have high content of fatty acids such as: omega3, – mackerel, herring, sardine and salmon). Meta analysis of diet with added fish oil given to patients with RA was conducted, and reported a significant reduction in the number of sensitive joint regions and in the time of morning stiffness period after 3 months of therapy. Effects on reduction of structural damage to the joint was not seen on radiographs.