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    Move Forward Guide

    Physical Therapist's Guide to Rheumatoid Arthritis

    Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects approximately 1% of the United States population. RA often results in pain and inflammation in joints on both sides of the body, and can become disabling due to its effect on the immune system. A physical therapist can help manage the symptoms of RA, enhancing an individual's quality of life.

    Other Arthritis Resources:


     

    What is Rheumatoid Arthritis?

    RA is classified as an autoimmune disease—a condition where the body’s immune system attacks its own tissues. Although the exact cause of RA is not known, multiple theories have been proposed to identify who is most likely to develop it. The cause may be related to a combination of genetics and environmental or hormonal factors. Women are more likely to develop the disease; women are diagnosed with RA 3 times more than men. Although RA may begin at any age, most research suggests it often begins in midlife.

     

    How Does it Feel?

    RA symptoms can flare up and then quiet down (go into remission). Research shows that early diagnosis and treatment is important for easing symptoms and flare-ups.

    People with RA may experience:

    • Stiff joints that feel worse in the morning.
    • Painful and swollen joints on both sides of the body.
    • Bouts of fatigue and general discomfort.
    • Fever.
    • Loss of joint function.
    • Redness, warmth, and tenderness in the joint areas.
     

    How Is It Diagnosed?

    RA is generally diagnosed by a rheumatologist. Diagnosis is based upon factors, such as inflammation of the tissues that line the joints, the number of joints involved, and blood-test results. A physical therapist may be the first practitioner to recognize the onset of RA; the physical therapist will refer an individual with suspected symptoms to an appropriate clinician for further tests.

     

    How Can a Physical Therapist Help?

    Physical therapists play a vital role in improving and maintaining function that may be limited by RA. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.

    Because the signs and symptoms of RA can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:

    Aerobic Activities. Studies have shown that group-based exercise and educational programs for people with RA have beneficial effects on individual strength and function.

    Goal-Oriented Exercise. Studies also show that achievement of personal physical activity goals helps reduce pain and increase the general quality of life in people diagnosed with RA.

    Modalities. Your physical therapist may use modalities, such as gentle heat and electrical stimulation to help manage your RA symptoms.

     

    Can this Injury or Condition be Prevented?

    Unfortunately, the actual mechanisms that cause RA are not completely understood. There currently is no sure way to predict or prevent the onset of RA. However, the early detection of the signs and symptoms will help you and your medical providers begin early management of RA, which may enhance your long-term well-being.

    Upon diagnosis, your physical therapist will work with you to develop strategies to better understand and manage your symptoms.

    As with many conditions, education is key. Understanding the underlying mechanisms of RA, so you can recognize early signs and symptoms (eg, morning stiffness, painful and swollen joints), may help you better manage the condition.

    Above all, it is important to keep moving. Maintaining or increasing your activity levels will help improve your function and maintain a better quality of life.

     

    Real Life Experiences

    Regina is a 40-year-old teacher whose primary exercise is walking her dog. One morning 3 weeks ago, Regina noticed that both of her knees looked swollen and red, and felt achy and stiff. She took some ibuprofen, but the pain got worse after school. She tried icing her knees at home, but got little relief. She called her physical therapist.

    Regina's physical therapist asked her several questions about her current condition. She reported that she first noted her symptoms the morning after she had spent the day cleaning out her attic. She said she had climbed up and down the ladder to the attic, and moved a lot of heavy objects all day long. She mentioned how she had tried to manage her symptoms with ibuprofen and ice, but had gotten little relief.

    Her physical therapist asked about her family's medical history, and learned that Regina’s mom was diagnosed with RA 20 years ago.

    Upon examination, Regina's physical therapist noted joint swelling, redness, and tenderness within both knees. Using further tests, he was able to rule out other possible conditions. Based on Regina's symptoms and her family history of RA, he referred her to a local rheumatologist for a final diagnosis.

    Regina reported back to her physical therapist 2 weeks later that she had been diagnosed with RA. She said she was determined that RA wasn’t going to "take over her life."

    Her physical therapist helped her learn all she could about RA and her particular condition. He designed a comprehensive exercise program just for her, focusing on aerobic conditioning and joint mobility to get her moving—and keep her moving well.

    Today, Regina attends a local aerobics class 3 times a week, performs exercises at home, and has joined a dog-walking club, making a new set of friends in the process. Due to her increased level of fitness, she feels "in charge" of her RA—and actually feels more upbeat than she has in years.

    This story highlights an individualized experience of RA. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat conditions, such as RA. However, when seeking a provider, you may want to consider:

    • A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
    • A physical therapist who is well-versed in the treatment of RA or other systemic inflammatory disorders.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist (or any other health care provider):

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with painful conditions
    • During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and keeping a journal highlighting when you experience pain will help the physical therapist identify the best way of approaching care.
     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence for the treatment of RA. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

    Breedland I, Scheppingen C, Leijsma M, Verheij-Jansen NP, van Weert E. Effects of a group-based exercise and educational program on physical performance and disease self-management in rheumatoid arthritis: a randomized controlled study. Phys Ther. 2011;91(6):879–893. Free Article.

    Knittle KP, Gucht V, Hurkmans EJ, et al. Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2011;63(11):1613–1619. Free Article.

    Hurkmans EJ, Jones A, Li LC, Vliet Vlieland TP. Quality appraisal of clinical practice guidelines on the use of physiotherapy in rheumatoid arthritis: a systematic review. Rheumatology (Oxford). 2011;50(10):1879–188

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

    Authored by Joeseph Brence, PT, DPT, FAAOMPT, COMT, DAC.  Reviewed by the MoveForwardPT.com editorial board.