Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder of unknown cause that primarily affects synovial joints. RA the most common autoimmune disease, affects 1-1.5% of the population worldwide, predominately women. An autoimmune disease is a condition in which your immune system mistakenly attacks its own body.
Unlike osteoarthritis, a condition marked by degeneration of joint cartilage and bone, rheumatoid arthritis is characterized by inflammation of synovial tissues. The synovial membrane is connective tissue that lines the inner surface of many joints and is responsible for creating synovial fluid which lubricating the joint. In the early stages of RA, people may experience morning stiffness and painful and tender joints at the same location on both sides of the body. Smaller joints, such as the hands, fingers, feet, and toes are usually affected first and as the disease progresses, larger joints can become involved such as the wrists, knees, ankles, elbows, hips, and shoulders. Additional symptoms include fatigue, fever, weight loss, malaise (feeling unwell), puffy hands, and/or diffuse musculoskeletal pains.
RA is a chronic condition with no current cure. However early diagnosis and intervention can halt the progressive development of joint destruction, deformity, decline in functional status and premature death.
Classification of Rheumatoid Arthritis
A patient must present with four of the following seven criteria:
- Morning stiffness – lasting at least 1 hour in duration
- Arthritis of three or more joint areas (14 possible joints) – identified by soft-tissue swelling, must be observed by a physician
- Arthritis of hand joints – swelling of either the wrist, hand, or fingers
- Symmetric arthritis – involvement of the same joint on the right and left side of the body
- Rheumatoid nodules – subcutaneous nodules over bony prominences or extensor surfaces
- Serum rheumatoid factor – determined by blood test
- Radiographic changes – x-ray displaying erosions or unequivocal bony decalcification localized to or most marked adjacent to the involved joints
The management of patients with rheumatoid arthritis is directed at preserving joint integrity and function as well as preventing other body system involvement, such as lung and/or kidney manifestations. This can be accomplished through medications prescribed by a Rheumatologist (physician specializing in autoimmune disorders), referral to physical therapy, and patient education. The goals of treatment are to resolve the signs and symptoms, restore physical function, and prevent the development of joint damage or if damage already exists to ameliorate or halt progressive disease.
For athletes, it’s even more essential to focus on the preservation of joint integrity, physical function and energy levels as these are key characteristics of their job performance.
A wholistic approach for an athlete should include:
- Oversight from a Rheumatologist and an individualized medication plan
- Evaluation and treatment by a physical therapist focusing on proper joint biomechanics through exercise and manual therapy, pain and inflammation management, and education.
- Cross training to prevent extreme repetitive wear and tear on joints
- Recovery practices such as ice, massage, and stretching
- A nutrition plan and a well-balanced diet with the assistance of a dietitian
- Acceptance and management of the diagnosis with the assistance of a mental health specialist
For more information on rheumatoid arthritis visit the Mayo Clinic’s Website.