Rheumatoid Arthritis

rheumatoid arthritis





Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as other organs in the body. Autoimmune diseases are illnesses that occur when the body tissues are mistakenly attacked by its own immune system.

While rheumatoid arthritis is a chronic illness, meaning it can last for years, patients may experience long periods without symptoms.

  • The cause of rheumatoid arthritis is unknown.
  • Even though infectious agents such as viruses, bacteria, and fungi have long been suspected, none has been proven as the cause.
  • Some scientists believe that the tendency to develop rheumatoid arthritis may be genetically inherited.
  • It is suspected that certain infections or factors in the environment might trigger the immune system to attack the body’s own tissues, resulting in inflammation in various organs of the body such as the lungs or eyes.
  • Regardless of the exact trigger, the result is an immune system that is geared up to promote inflammation in the joints and occasionally other tissues of the body.
  • Immune cells, called lymphocytes, are activated and chemical messengers (cytokines, such as tumor necrosis factor/TNF and interleukin-1/IL-1) are expressed in the inflamed areas.
  • Environmental factors also seem to play some role in causing rheumatoid arthritis.
  • Recently, scientists have reported that smoking tobacco increases the risk of developing rheumatoid arthritis.


  • The symptoms of rheumatoid arthritis come and go, depending on the degree of tissue inflammation.
  • When body tissues are inflamed, the disease is active. When tissue inflammation subsides, the disease is inactive (in remission). Remissions can occur spontaneously or with treatment, and can last weeks, months, or years.
  • During remissions, symptoms of the disease disappear, and patients generally feel well.
  • When the disease becomes active again (relapse), symptoms return. The return of disease activity and symptoms is called a flare.
  • The course of rheumatoid arthritis varies from patient to patient, and periods of flares and remissions are typical.
  • When the disease is active, symptoms can include fatigue, lack of appetite, low grade fever, muscle and joint aches, and stiffness.
  • Muscle and joint stiffness are usually most notable in the morning and after periods of inactivity.
  • Arthritis is common during disease flares. Also during flares, joints frequently become red, swollen, painful, and tender. This occurs because the lining tissue of the joint (synovium) becomes inflamed, resulting in the production of excessive joint fluid (synovial fluid). The synovium also thickens with inflammation (synovitis).
  • In rheumatoid arthritis, multiple joints are usually inflamed in a symmetrical pattern (both sides of the body affected).
  • The small joints of both the hands and wrists are often involved. Simple tasks of daily living, such as turning door knobs and opening jars can become difficult during flares.
  • The small joints of the feet are also commonly involved.
  • Occasionally, only one joint is inflamed. When only one joint is involved, the arthritis can mimic the joint inflammation caused by other forms of arthritis, such as gout or joint infection.
  • Chronic inflammation can cause damage to body tissues, cartilage and bone. This leads to a loss of cartilage and erosion and weakness of the bones as well as the muscles, resulting in joint deformity, destruction, and loss of function.
  • Rarely, rheumatoid arthritis can even affect the joint that is responsible for the tightening our vocal cords to change the tone of our voice, the cricoarytenoid joint. When this joint is inflamed, it can cause hoarseness of voice.

Since rheumatoid arthritis is a systemic disease, its inflammation can affect organs and areas of the body other than the joints.

  • Inflammation of the glands of the eyes and mouth can cause dryness of these areas and is referred to as Sjogren’s syndrome.
  • Rheumatoid inflammation of the lung lining (pleuritis) causes chest pain with deep breathing or coughing. The lung tissue itself can also become inflamed and sometimes nodules of inflammation (rheumatoid nodules) develop within the lungs.
  • Rheumatoid inflammation of the lung lining (pleuritis) causes chest pain with deep breathing or coughing. The lung tissue itself can also become inflamed and sometimes nodules of inflammation (rheumatoid nodules) develop within the lungs.
  • Inflammation of the pericardium surrounding the heart, called pericarditis, can cause a chest pain that typically changes in intensity when lying down or leaning forward.
  • The rheumatoid disease can reduce the number of red blood cells (anemia) and white blood cells. Decreased white cells can be associated with an enlarged spleen (referred to as Felty’s syndrome) and can increase the risk of infections.
  • Firm lumps under the skin (rheumatoid nodules) can occur around the elbows and fingers where there is frequent pressure. Even though these nodules usually do not cause symptoms, occasionally they can become infected.
  • A rare, serious complication, usually with long-standing rheumatoid disease, is blood vessel inflammation (vasculitis).
  • Vasculitis can impair blood supply to tissues and lead to tissue death. This is most often initially visible as tiny black areas around the nail beds or as leg ulcers.


  • History of symptoms
  • Examination of the joints for inflammation and deformity
  • Blood and x-ray tests
  • The diagnosis is also based on the pattern of symptoms, the distribution of the inflamed joints.
  • Bone scanning, a radioactive test procedure, can demonstrate the inflamed joints.
  • Arthrocentesis can also be helpful in relieving joint swelling and pain.


  • The goal of treatment in rheumatoid arthritis is to reduce joint inflammation and pain, maximize joint function, and prevent joint destruction and deformity.
  • Early medical intervention has been shown to be important in improving outcomes. Aggressive management can improve function, stop damage to joints as seen on x-rays, and prevent work disability.
  • Optimal treatment for the disease involves a combination of medications, rest, joint strengthening exercises, joint protection, and patient (and family) education.
  • Treatment is customized according to many factors such as disease activity, types of joints involved, general health, age, and patient occupation.
  • Treatment is most successful when there is close cooperation between the doctor, patient, and family members.
  • Two classes of medications are used in treating rheumatoid arthritis: fast-acting “first-line drugs” and slow-acting “second-line drugs” (also referred to as Disease-Modifying Antirheumatic Drugs or DMARDs).


At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  •  Pain relief
  • Reduce swelling
  • Strengthening of muscle
  • Prescription of orthoses

Kindly contact PHYSIOLINE for further consultation and rehabilitation