UPLAND — There was a time not so long ago when the only treatment available for those affected by rheumatoid arthritis was marginally effective anti-inflammatory pain medication. How times have changed. Now, treatments exist that significantly slow – even halt – the progression of the disease, and therapies are available to help those who live with it to live more fulfilling lives, according to
Many of us – especially those of us middle-aged or older – consider our daily aches and pains to be “arthritis.” Yet rheumatoid arthritis, or RA, is a disease that, although it can cause debilitating aches, is an immune response in the body that aggressively attacks the joints.
Notes Susan Hoch, M.D., chief of the Division of Rheumatology at Crozer-Chester Medical Center in Upland, “There are over 100 different kinds of arthritis. RA is an inflammatory arthritis that can affect children as well. It is not a disease of aging per se since the mean age of onset is in the group 30 to 50. Onset over age 70 is relatively rare.”
“RA is the classic inflammatory arthritis,” says Martin Bergman, M.D., chief of the Section of Rheumatic Diseases at Taylor Hospital in Ridley Park. “What that means is that it is more than just wear and tear; it is a disease. It is a reaction of the body against certain parts of the joint. That reaction wants to destroy the joints. So this is more than just what most people call ‘arthritis’. It is a serious condition that has a lot of potential to do damage, not only to the joints, but to the entire body.”
Bergman says, “People with RA are not only at increased risk of having progressive, destructive joint problems, but they are also at risk of having other conditions such as heart attack, stroke, and certain cancers.” Untreated, RA can also lead to deformity and loss of function. It is also associated with osteoporosis.
RA is usually a “symmetrical disease,” says Frank Passero, M.D., chief of the Section of Rheumatology at Delaware County Memorial Hospital in Drexel Hill. “Thus, it affects both sides of the body more or less equally. It usually involves the smaller joints of the body, but it can involve the larger joints as well.”
RA typically affects the knuckles and the wrists, but it can also hit the knees, ankles, and feet. It generally does not affect the lower back.
Says Hoch, “The cardinal feature of rheumatoid arthritis or any other inflammatory arthritis that distinguishes it from osteoarthritis is the presence of morning stiffness. In RA the joints are painful, swollen, and stiff for an hour or more in the morning and gradually improve with motion as the day goes on. In contrast, people with osteoarthritis have a much shorter period of stiffness and their joint pain worsens with activity.”
Pharmaceutical Approaches to RA Treatment
Rheumatologists aim for “clinical remission” when treating RA, which effectively means little to no evidence of disease at all and that there is no progression of joint deterioration.
“It is no longer acceptable to just give patients only non-steroidal anti-inflammatory drugs (NSAIDs) and leave them alone,” says Bergman. “Because rheumatoid arthritis is an aggressive, progressive disease, it has to be stopped, preferably in the first years.”
The first plan of action may include NSAIDs, but in most cases, rheumatologists move quickly to prescribing a group of drugs called disease-modifying anti-rheumatic drugs (known as DMARDs). If not effective, some patients require “biologics,” including the anti-tumor necrosis factor drugs adalimumab, etanercept, and infliximab. There are two biologics (abatecept and rituximab) that are not tumor necrosis factor inhibitors.
“The newer biologic agents are associated with lack of progression of joint space narrowing and cartilage loss,” says Hoch. “Patients who are properly treated will be much less likely to destroy their joints. In addition, control of inflammation lowers the damage to the rest of the body from continued inflammation.”
Today’s drugs offer possibilities that previous therapies could not promise–and now, many RA patients lead improved, more productive lives.
Physical and Occupational Therapy in RA Treatment
Pharmaceutical therapies are only part of the approach to RA treatment, assert rheumatologists and other medical professionals. Physical and occupational therapy can help patients with RA learn to avoid stress on their joints and also re-learn ways to perform daily tasks. Therapists can also help patients with RA learn to use assistive devices and use non-pharmaceutical modalities to help with pain control. Therapists can help educate patients about their symptoms and when it is fine to exercise versus time to rest. Gentle exercise when the joints are not in an acute inflammatory state helps “oil” the joints.
These services are available through the Crozer-Keystone Human Motion Institute (HMI). HMI is a comprehensive program of musculoskeletal services provided across the Crozer-Keystone Health System, including orthopedic/joint care, sports medicine, hand care, outpatient rehabilitation, foot/ankle care, and spine care. Services include surgery, therapy, education, medical management, and more.
Crozer-Keystone Health System offers four Outpatient Centers for Therapy and Sports Medicine. These programs provide continuing therapy for patients who no longer need inpatient care as well as outpatients with serious injuries or chronic conditions with active flare-ups.
“Physical therapy is an essential part of treatment for RA patients,” says Bergman. “Once we get RA somewhat under control, physical therapy can help people learn how to manage. They may need splints, crutches, canes, or other implements. They may have to re-learn how to do certain things.”
Rehabilitation can decrease pain, and increase mobility, adds Passero. One can learn how to be careful and protect his or her joints. With HMI services, patients can learn to use assistive devices so that they can participate more fully in their normal lives.
According to Carol Seiverd, administrative director of Physical Medicine and Rehabilitation at Delaware County Memorial Hospital in Drexel Hill, patients can be taught new techniques to improve their quality of daily life. “A simple example of this is learning to close a drawer with a forearm instead of the palm of your hand, so as to avoid joint stress,” says Seiverd.
“Additionally, if patients are required to use splints, they can learn to function despite the challenge. In severe cases, when joint replacement is required, HMI specialists can offer rehabilitation and therapy services to aid in recovery.”
Physical and occupational therapy play key roles in maintaining normal joint function and strength at various points in the course of rheumatoid arthritis. Early on in the disease process, when inflammation strikes, physical therapy can help with pain relief by the use of heat or cold modalities, maintenance of range of motion, and conditioning of muscles and ligaments which are not directly affected by the inflammation.
According to Hoch, “With inflamed and painful joints, the patient tends not to move them and this can result in loss of motion due to tightening of the ligaments and muscles around joints. A physical therapist can aid in maintaining range of motion during the inflammation phase and then in building strength and reconditioning when the disease is less active.”
“Occupational therapists are helpful in controlling hand pain with various modalities including the use of paraffin wax, maintaining hand function and preventing deformity with the use of appropriate splinting,” says Hoch.
Physical therapists and occupational therapists also play a vital role in helping those patients who require joint replacement or other orthopedic surgery rehabilitate as well.
To find a Crozer-Keystone rheumatologist who’s right for you, call 1-877-CK-MOTION (1-877-256-6846).
To learn more about Crozer-Keystone Human Motion Institute outpatient rehabilitation services, or to schedule an appointment for Human Motion Institute rehabilitation, call 1-877-CK-MOTION (1-877-256-6846). Services are conveniently offered at four Outpatient Centers for Therapy and Sports Medicine: Crozer-Chester Medical Center, One Medical Center Boulevard in Upland; near DCMH, 1500 Garrett Road in Upper Darby; Springfield Hospital, 190 West Sproul Rd. in Springfield; and near Taylor Hospital, Rt. 420 and Second Avenue in Folsom.
You can also call the 1-877-CK-MOTION number to schedule a prompt appointment with an orthopaedic, sports medicine or neurosurgery specialist. Visit http://ckhshmi.crozer.org to submit an appointment request online.