Physiotherapy Management in Rheumatoid Arthritis
This review provides manifestations that are associated with RA that helps in further investigation of medical practitioner, their management pathways and relvant practive in physiotherapy. Rheumatoid arthritis (RA) is a inflammatory chronic, autoimmune systemic condiotion which affect multiple Joints of the body. It associated with inflammation, severe pain, disfigurement of Joints, loss in Joints range of motion and movement. Sometimes it may associated with eye inflammation, nodules, vasculitis, neurological disorders, splenomegaly and cardio pulmonary diseases.
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Physiotherapy is concerned with mproving the quality of life, prevention intervention and rehabilitation which includes psychological, physical and social status of well being. Physiotherapy management generally includes assistance with manipulations, excerscie, education, manual therapy. And also works with people for active life styles, maintain and improving the movemhough tens and functional abilities. Even though there is no proper cure for rheumatoid arthritis, early diagnosis and appropriate treatments helps to avoid the symptoms to become worse and improve long-term results.
Physiotherapist must be able to diagnose symptoms and risk factors, identification o ny other disease or condition associated with this condition which may cause serious damage and early death. Symptoms of Rheumatoid arthritis: The symptoms may depends on the degree of inflammation to the tissue, symptoms may include . loss of energy . fatigue Loss of appetite Fever Pain in muscles and Joints Stiffness The Joint stiffness mostly noticeable in the morning and after some period of inaactivity.
It may affect both the sides of body and inflammations on multiple Joint. Causes: The exact cause of RA is unknown as both environment and heredity plays a role. Researcners says tnat nere01ty may make people to get RA ut tney are not sure. In the body immune system fights against foreign invaders accidentally attacks the Joint linings which causes inflammation and makes synovium thicker and destroys Joints. Usually occurs at fingers, wrist, knee, elbow Which are mostly affected. Riskfactors: RA can occur usually at the age between 25 to 55.
Women are mostly affected than men Smoking increases the risk of RA TREATMENT: DRUGS: NSAIDS nonsteroidal anti inflammatory drugs for pain Celecoxib- it is a drug that blocks enzyme cox2 which blocks inflammation Leflunomide Sulfasalazine Hydroxychloroquine Minocycline can slow down the Joint damage Surgery Physiotherapy treatment: There is no complete treatment for RA in physiotherapy but there are some kind of treatments which will help to attain pain relief and makes the aactivity of RA slow. It also helps in preventing disabilities and increases the quality of life.
Physiotherapy Modalities Electric therapy: TENS transcutaneous electrical nerve stimulation for pain relief Hydrotherapy: helps to exercise with small load on Joints Massage therapy: increases flexibility Rom exercise and iscotonic exercises helps to increase range of motion Stretching exercises strengthening and aeroboics helps to prevention of traumatic injuries Uhlig et al. (1998) found that after only 5 years of disease duration major changes had appeared that had a clinicallysignificant effect on people’s health condition.
The functional limitation increased with disease duration(Uhlig et al. , 1998). Well-known instruments (AIMS2and MHAQ) were used and also retrospective register data, hindering causal conclusions. Wolfe et al. (1991) reported ssimilar results in that functional limitation developed early and continued to worsen with disease duration. In this study, ssimilar instruments (AIMS andHAQ) were used and thus confirmed the results from the previous study. Wolfe et al. (1991) also found that anxietyseemed to increase with the duration of the RA.
Wolfe’sstudy was longitudinal (accelerated cohort) and thusallowed causal inferences. The studies located had different aims and methods toinvestigate Quality of life, pain and other variables under study. Pain was found to be common and one of the mosttroublesome problems among those with RA, and ittended to increase with disease duration (Lambert, 1985;Wolfe et al. , 1991; Van Lankveld et al. , 1993; Uhliget al. , 1998). Van Lankveld et al. (1993) initially identified,through interviews, the most roublesome variables for people with RA.
The study was replicated with alarger sample and the same variables (pain, functional limitation and dependence on otners) were agaln Touna to De tne most trouDlesome. some stu01es polntea outtnat other variables (e. g. age and depression) couldincrease pain. Lambert (1985) found that age waspositively correlated with pain, indicating that increasing age made the situation worse, while Waltz et al. (1998)found that depression was moderately correlated with pain and that negative spouse behavior, such asavoidance and critical remarks, increased pain amongthose with RA.
Thus, older people seemed to have an increasing risk of being affected by pain, and if they alsowere depressed and had no supportive social network therisk of pain increased. Some of the studies focused on RA. ln some of these there was a clear distinction between the two patient groups and these were comparedwith each other. In other studies, however, there was no spacification of the diseases, e. g. arthritis in general wasstudied. Hill et al. (1999) found (age 15+, 1 1. % >70 years old)that those with arthritis (RA, OA and unspecified arthritis)were more likely to be female, older and of lower ocioeconomic status, but the result may not be representativeof the age group (75+) because of the low number of these people iincluded . Studies showed that pain influenced thelife situation of both RA and OA patients. Wolfe &Hawley (1997) studied patients with RA, OA andfibromyalgia and found a high prevalence of pain amongthose with RA and OA. Among those with RA/OA,60. 5% had moderate or worse pain measured with HAQ and 96. % had moderate or worse pain measured withEuroQuality of life (Wolfe & Hawley, 1997). The authors (Wolfe &Hawley, 1997) suggested that the EuroQuality of life may not fulfilthe requirement for easuring Quality of life among those withrheumatic diseases because of low internal validity,especially face validity, of the questions iincluded . Hagen et al. (1997) also found a high level of pain (measured with one question with five response categories) among thosewith RA: 97. 1% of the RA patients had moderate orsevere pain and 40. 0% had severe or worse pain.
Mannet al. (1999) studied older people (age: meanh75. 1, SD 7. 3) with arthritis and found that pain increased withdisease duration. As the sample is reported as patients with arthritis, no firm conclusions about people with RA. Inconsistency was found with regard to Quality of life among people with RA and OA. Hill et al. (1999) compared those with arthritis (RA, OA and unspecified arthritis)and the non-arthritic regarding their Quality of life and foundthat those with arthritis had a significantly lower Quality of lifeon all subscales (measured with SF-36).
Hagen et al. (1997) compared RA with other non-inflammatory musculoskeletaldiseases and found that patients with RA hada higher Quality of life (measured with MHAQ) than those withnon-inflammatorymusculoskeletal diseases. Wolfe &Hawley (1997) found hen comparing RA and OApatients that Quality of life was ssimilar in both groups when measured with two different instruments (EuroQuality of life &CLlNHAQ). A major problem that occurred in this review was thatthere was no study focusing only on respondents aged 75and over.
The studies which were iincluded in the analysishad, however, varying representation of this age group, mostly a smaller part of the samples. This mearns that no conclusion about pain and Quality of life can be drawn for the agegroup of people 75 or over. Thus, this is an important areafor Turtner researcn. I ne resul s Trom stu01es Tocuslng onyounger people could not De generalized to the care of old people and therefore they cannot satisfactorily serve as a knowledge base to outline nursing care.
The sparse representation of people from this age group can be explained by the fact that older persons often have several different diseases (co-morbidity) compared with youngerpeople. The impact of these other diseases mearns that no conclusions can be drawn about a specific disease and therefore older people may be less interesting to include in studies focusing on specific diseases (Grimley Evans &Bond, 1997). Another reason for the sparse results of RA/OA studies including older people (75+) could be that this group has a higher mortality than younger people (Pincus et al. , 1994; Wolfe et al. , 1994; Kvalvik et al. 2000) and thus may not have survived that long. However,taking demographic developments into consideration, itseems important to focus on people aged 75 years andover. From a clinical perspective it tends to be morecommon for older people to have several diseases rather than one. Conclusion: Inconsistency was found regarding Quality of life but it was ingeneral low in both roups studied. It is important to focus on these patients to better understand the factors that contribute to lower Quality of life and to distinguish the effects of these factors as well as to identify variables that strengthen Quality of life.
The fact that no study focused only on those over 75, or had a satisfactory large sample,caused a major problem. Another problem was that different methods and instruments were used in the studies. This mearns that no firm conclusions from the different studies can be drawn. Despite this, the review pointed out important variables for further esearch and to be focused on in nursing care, such as age, pain, depression, functional limitation, Quality of life and social network/ support as a moderating factor.
Research as well as nursing care should especially focus on the ‘old’ and the Very elderly because increased age was related to increased pain (RA) and decreased Quality of life (both RA and OA) and there is a lack of research on these groups. Research should also include both men and women because differences were found in gender regarding people with RA/OA. Knowledge about this group of people is still sparse and further research is needed, focusing on older people with RA and/or OA and taking demographic changes into consideration.