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01.07.2014
Rheumatoid arthritis (RA) is defined as a chronic, autoimmune, inflammatory disease that affects multiple joints in the body that are lined with synovial fluid. Physical therapy interventions can benefit rheumatoid arthritis patients who suffer from the major problems of the condition.
With rheumatoid arthritis described as a chronic autoimmune disorder, the consequences to joint surfaces and increased morbidity make patients susceptible to loss of muscle mass, range of motion and diminished aerobic endurance. Since the marker of this disease is joint destruction, the most important benefit to note is the impact exercise has on improving joint health.
Transcutaneous electrical nerve stimulation (TENS) is a therapeutic intervention indicated for pain control and muscle stimulation. The ambiguity of the effectiveness of TENS can be related to the type of intensity and frequency administered. A Cochrane Review in 2010 evaluated the effectiveness of continuous ultrasound in the treatment of RA. Patients with rheumatoid arthritis often have joint deformity and severe pain manifesting in the great toe, heel, and lesser toe. The use of splints may be able to provide relief for a rheumatoid patient in acute stage of the disease.
Physical therapists can employ the use of assistive devices for patients with RA to improve functional ability and independence in daily activities. Sources such as the Mayo Clinic and the Cleveland Clinic discuss that there are other ways to promote joint health in RA patients.
Combating rheumatoid arthritis normally consists of medicinal interventions, lifestyle changes, and conservative treatments to manage symptoms and provide pain relief for patients.
An exercise program is essential to prevent joint destruction and combat the symptoms associated with the disease, but comes with a multitude of challenges.


During the course of the disease, tendon sheaths, ligaments and cartilage can be affected and exercise can maintain their integrity. The most commonly used physical agents in combating rheumatoid arthritis are thermotherapy and cryotherapy. While the literature on the use of TENS in patients with rheumatoid arthritis is rather conflicting, it can be supported using the modality for this patient population as TENS does not cause any adverse side effects.
Research suggests that TENS for patients with this condition, mainly in treating RA of the hand, provides pain relief when the method is administered, but upon its completion, shows little to no residual benefit. This review showed that ultrasound applied to the dorsal and palmar surfaces of hand increased grip strength and to a lesser extent improve wrist flexion and reduce swelling in joints. Appropriate assistive devices that benefit patients range from work chairs, rolling walkers, canes, and reachers.
Those who are diagnosed with RA may be unsure of beginning an exercise regimen due a lack of confidence in abilities and the pain it may cause. Range of motion and flexibility deficits that hinder a patients productivity can be improved with regular exercise, and combat RA-related fatigue. Thermotherapy modalities can increase blood flow and elasticity of tissues and can be applied as hot packs, paraffin wax, or hydrotherapy. It is safe to say at this time TENS is a short-acting therapy and the beneficial frequency to deliver is 70Hz. Patients with RA can be prescribed foot orthoses or specialist footwear to combat these issues, and receive education for care of skin and nails.
Splinting can provide pain relief, reduce inflammation, increase range of motion, and prevent deformities. Research suggests reasons for using assistive devices also reduce amount of load placed on the joint, reduce pain, fatigue and inflammation.


Tai Chi, Yoga, and Pilates are also effective disciplines that can increase range of motion, flexibility, strength, and cardiovascular endurance without putting a large amount of force on joint surfaces.
Transcutaneous electrical nerve stimulation (TENS) for the treatment of rheumatoid arthritis in the hand. Continuous ultrasound to the hand benefits grip strength in people with rheumatoid arthritis. This section will focus on the physical therapy management of rheumatoid arthritis without surgical intervention.
In a review article on the benefits of exercise in this patient population, it is shown that assistance from instructors and social interaction boost motivation for involvement in regular exercise routines. During a flare up of rheumatoid arthritis, a patient may prefer cryotherapy over thermotherapy to cool the joint down, attempt to numb the pain and control inflammation.
A cold-pack, ice chips, ice massage or nitrogen spray can be applied to areas where calming inflammation and pain are desired. According to a Cochrane Review of these physical agents, in treating rheumatoid arthritis, there was no significance for hot and cold packs in objective measures of disease activity (pain, ROM, grip strength, etc) but paraffin wax paths showed positive results in reducing pain and objective measures of range of motion in the arthritic hand. It is recommended that these methods be used in conjunction with medical management and exercise programs for patients with rheumatoid arthritis.



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