Before I will discuss the treatment and the management of Rheumatoid Arthritis in Knee, we must know first the background of Rheumatoid Arthritis.
What is Rheumatoid Arthritis?
According to other sources, it is defined as an Autoimmune Inflammatory Disease, which causes inflammation in the synovial tissue of the joint. The causes of Rheumatoid Arthritis are usually unknown, because the sources of this problem are not due to the bones or organ related, but rather it has something to do with your immune system. It is sad to say that out of all kinds of arthritis, Rheumatoid Arthritis is the worst of it all. In addition to that, it is also mostly common in Female and the manifestation started as early as 30 years old.
What are the Signs and Symptoms of Rheumatoid Arthritis?
Unlike Osteoarthritis where it affects only one side, Rheumatoid Arthritis produces symmetrical symptoms, which in other words it affects on both sides equally. Usually, the most common area of the joints that are involved is in the neck known as the cervical spine, shoulder, wrist, elbow, hands, feet’s and knees.
The patient usually experiences such as painful, swelling and tenderness in the joint, which will eventually, causes the destruction of the structures of the joints, leading to abnormal deformities. In addition to that, there is also a presence of nodules and stiffness which got worse on the early stiffness.
Because the problem is due to autoimmune disease, it causes the systemic problem. When we say systemic problem, it involves multiple organ systems such as in the Heart, Lung or in the Kidney.
Treatment for Rheumatoid Arthritis in HANDS
First of all, we remember that there is no cure for Rheumatoid Arthritis, however, pain and other symptoms can be controlled through effective intervention which research have shown, that it will improve the quality of life of the person/ patients.
When treating Rheumatoid Arthritis, the goals are to:
A. Relieve the symptoms and pain
B. Stop or slow down the inflammation
C. Maximize the patient’s function
D. Prevent or reduce Complications of the joints and other involvement
There are four treatments that will be discussed in this article: “Exercises“, “Medication“, “Foods & Nutritional Supplement” and “Modalities”
Exercises are taught by Physical Therapist which they can later be learned to perform in the house. They do not cure the disease, but it is also not the end of the world because they can relieve the pain and improve the quality of life of the patient, which will help maximize their functional capacity. It is important that you as a patient must learn how to perform those exercises while in the house so that you would not need to rely a lot on the others.
DURING REHABILITATION IN THE PHYSICAL THERAPY CLINIC AND IN THE HOUSE
During rehabilitation in the clinic, the Physical Therapist will be given you those exercises which will later be used as a Home Exercise Program when your discharged from Physical Therapy and learn this by yourself.
1. Range of Motion (ROM) Exercise:
This is a kind of exercise where you will be moving your body part either by yourself actively or by the therapist passively if there severe pain. Usually it is done actively, and in this exercise it is simply done by moving your individual joints. For example:
A. Opening and closing your hand slowly and gently for 10 times
B. Bending and Straightening your fingers, thumbs, and wrist for 10 times
C. Spread your fingers and thumb apart for 10 times
Progression: If you manage to perform those exercises, you can progress them by holding each of those hand position for 6 seconds for 10 times. Like for example while spreading your finger apart, maintain this position for 6 seconds and repeat it for 10 times.
2. Stretching Exercise
This exercise involves stretching your muscle to improve flexibility, which will help reduce pain and slow down deformities. When you’re still in the acute phase, do not perform stretching yet because it will get worse. This can be performed if you’re already in the chronic phase such as after 3-4 weeks.
The Physical Therapist will initially stretch your joint structures in your hand gently and slowly, which you will expect to feel the stretch. It might be a bit painful, but gradually you will feel much better. It is practically the same like ROM, except the movement will be pushed or pulled beyond the range until you feel the stret
3. Strengthening Exercise
It is important to strengthen your muscle, as this will provide support on the structures of the joints, relieving pain. This is only performed in the chronic phase and not in the acute phase. There are 3 kinds of exercises you can perform
- If you have a squeeze-ball or any ball made of gel or clay, put it in your hand and squeeze it as hard as you can in a form of FIST. While squeezing it, hold it for 6 seconds and repeat this for 5 times
- If you have a rubber band, weave it through your fingers. Then spread your finger apart and hold it for 6 seconds for 5 times. The rubber band serve as a resistance exercise against your fingers.
- Another exercise you can perform is using light weight such 1 Ib dumbell. Grab the dumbell and move your wrist up and down for 10 times. This exercise is used for strengthening your muscles in the wrist. Please be aware that this is usually performed in an advanced phase and it is better to seek permission from a physician or a physical therapist prior to initiating this exercises.
When you were diagnosed with Rheumatoid Arthritis, you were given by the physicians a pain killer medications, and there are 3 drugs you should know:
A. Nonsteroidal anti-inflammatory drugs (NSAID)
This is a nonsteroid drug which can help reduce pain and inflammation which can be bought over the counter. Example of NSAID would be Aspirin, ibuprofen, naproxyn, or Acetaminophen (Paracetamol).
These kinds of drug are not recommended for long term user because it produces horrible side effects such as gastrointestinal bleeding or stomach ulcer. However, there is a new generation of drugs such as COX-2 (Celocoxib or Rofecoxib) produces lesser side effects of stomach ulcer or bleeding which is much preferable to other common NSAID drugs
B. Steroid Drugs
Steroid drugs such as Corticosteroid or Glucocorticoid are effective compare to NSAID drugs and it doesn’t produce stomach irritation. However, its side effect is much worse than NSAID which requires doctor’s prescription. Side effects of Steroid drugs include:
- Weakening your bones and muscles leading to risk of osteoporosis or fracture
- Prone to infections due to weaker immune system
- Increase Blood Pressure
- Increase swelling in your legs
- Increase pressure in the eyes known as Glaucoma
- And many more others
Note: Please be aware that taking Steroid for long term will be detrimental for your health since it causes horrible side effects. It is advisable that the dosage should be taken based on the prescription of the physicians.
C. Disease-modifying anti-rheumatic drugs (DMARDs)
This is the main drug for Rheumatoid Arthritis because not only it produces anti-inflammatory effect but it also suppress the body’s overactive immune system. Drugs such as Methotrexate, Sulfasalazine, Hydroxychloroquine, Azathioprine, Cyclosporine, or Leflunomide are an example of DMARDS. The only problem for DMARD is that it takes weeks or months and are not designed to provide immediate relief of symptoms compare to NSAID. You have to be patience when taking this kind of drugs.
Please be remember that it is still important to seek consultation from the physicians before deciding yourself on what kind of medication do you want, it is still the doctor’s decision to decide which medication you should take.
FOODS AND NUTRITIONAL SUPPLEMENT
It is highly recommended that the best food to eat isfoods that are high in anti-oxidant such as:
- Fish (Salmon, Tuna etc)
- Olive Oil or Virgin Oil
- Fruits and Dark Green Vegetable
- And other foods that fight inflammation in the body
If you’re not able to eat all those kind of foods just to get the minimum nutrient, you can just buy Fish oil or Cod liver oil supplements in the pharmacy or health stores because such research have shown that may help with rheumatoid arthritis pain and morning stiffness and other inflammatory diseases.
Modalities are defined as a therapeutic agent that will produce beneficial effects for relieving pain, reduce tightness, and relax muscles and many more others. It is usually in a form of devices or products such as “TENS”, “Hot Pack”, “Cold Pack” or “Paraffin”
In the clinic which also includes in the house, you can use either hot or cold compress. But the question is WHEN WILL YOU USE THEM? If your arthritis is in the acute phase, for example your arthritis started last week or the same month, then you will use Cold compress. If your Rheumatoid Arthritis is in Chronic like more than a month, then you can use Hot compress.
TENS on the other hand, can be used on both acute and chronic phase. This is in fact one of the best product to use, which is highly recommend for you to have one if you’re always experiencing recurrent pain. It produces electricity which is in a comfortable sensation.