General Overview of Rheumatoid Arthritis for Rehabilitation Professionals: Difference between revisions

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Introduction
== Introduction ==
<blockquote>Rheumatoid arthritis (RA) is a “chronic inflammatory autoimmune systemic disease that usually presents with joint inflammation leading to pain, fatigue, and impaired physical functioning and work productivity, all of which negatively impact health-related quality of life.”<ref>Küçükdeveci AA, Turan BK, Arienti C, Negrini S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10170526/ Overview of Cochrane Systematic Reviews of rehabilitation interventions for persons with rheumatoid arthritis: a mapping synthesis]. Eur J Phys Rehabil Med. 2023 Apr;59(2):259-69. </ref></blockquote>RA commonly affects the hands, wrists, shoulders, elbows, knees, ankles and feet.<ref name=":0">Peter WF, Swart NM, Meerhoff GA, Vliet Vlieland TPM. [https://academic.oup.com/ptj/article/101/8/pzab127/6277051?login=false Clinical practice guideline for physical therapist management of people with rheumatoid arthritis]. Phys Ther. 2021 Aug 1;101(8):pzab127. </ref> As it is a systemic condition, it also affects multiple body systems, including the cardiovascular and respiratory systems.<ref name=":0" /><ref name=":1">Radu AF, Bungau SG. [https://www.mdpi.com/2073-4409/10/11/2857 Management of rheumatoid arthritis: an overview]. Cells. 2021 Oct 23;10(11):2857.</ref><ref>Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: Effectiveness, mechanisms and implementation. Best Pract Res Clin Rheumatol. 2018 Oct;32(5):669-82. </ref> Without adequate treatment, RA can cause long-term disability, pain and premature death.<ref name=":2">Turk MA, Liu Y, Pope JE. Non-pharmacological interventions in the treatment of rheumatoid arthritis: A systematic review and meta-analysis. Autoimmun Rev. 2023 Jun;22(6):103323. </ref> <ref name=":3">GBD 2021 Rheumatoid Arthritis Collaborators. [https://www.sciencedirect.com/science/article/pii/S2665991323002114 Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021]. Lancet Rheumatol. 2023 Sep 25;5(10):e594-e610. </ref> While pharmacological management is the mainstay treatment for RA,<ref name=":2" /> rehabilitation professionals can play a role in the non-pharmacological management of this condition.<ref name=":0" />


Rheumatoid arthritis (RA) is a “chronic inflammatory autoimmune systemic disease that usually presents with joint inflammation leading to pain, fatigue, and impaired physical functioning and work productivity, all of which negatively impact health-related quality of life.”
== Epidemiology ==
RA affects around 1% of the global population,<ref name=":1" /> and up to 3% of older persons.<ref name=":2" /> It is 2-3 times more likely to occur in females.<ref name=":3" /> However, with improving medical management, the severity, mortality and associated comorbidities appear to be decreasing.<ref>Finckh A, Gilbert B, Hodkinson B, Bae SC, Thomas R, Deane KD, et al. [https://www.nature.com/articles/s41584-022-00827-y Global epidemiology of rheumatoid arthritis]. Nat Rev Rheumatol. 2022 Oct;18(10):591-602. </ref>
 
The peak age of onset of RA tends to be in younger populations (approx 30-60 years), although the exact age ranges given in the literature vary:<ref name=":4">Yazici Y, Paget SA. Elderly-onset rheumatoid arthritis. Rheum Dis Clin North Am. 2000 Aug;26(3):517-26. </ref><ref>Bullock J, Rizvi SAA, Saleh AM, Ahmed SS, Do DP, Ansari RA, Ahmed J. [https://karger.com/mpp/article/27/6/501/204422 Rheumatoid arthritis: A brief overview of the treatment]. Med Princ Pract. 2018;27(6):501-7. </ref>
 
* younger-onset RA is distinguished from elderly-onset RA (i.e. after 60 years) in the literature<ref name=":4" /><ref>Pavlov-Dolijanovic S, Bogojevic M, Nozica-Radulovic T, Radunovic G, Mujovic N. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10608066/ Elderly-onset rheumatoid arthritis: characteristics and treatment options]. Medicina (Kaunas). 2023 Oct 23;59(10):1878. </ref>
* Slobodin<ref>Slobodin G. Rheumatoid arthritis. In: Slobodin G, Shoenfeld Y, editors. Rheumatic Disease in Geriatrics. Springer, Cham, 2020. </ref> notes that the peak age of onset of RA has increased - in the 1930s, it was typically in the fourth decade of life, whereas by the 2010s, it was the sixth or seventh decade
 
== Risk Factors ==
RA is a multifactorial disease that has been linked to various genetic, environmental and other factors,<ref name=":1" /> including:
 
* '''genetic factors''': the HLA-DRB1 alleles are linked with an increased risk of developing RA<ref>Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/</ref>
* '''certain environmental factors''' in genetically predisposed individuals, such as:
** smoking
** infections (e.g. periodontal disease,<ref name=":1" /> Epstein-Barr virus, baterial superantigens etc.<ref name=":5">Gravallese EM, Firestein GS. Rheumatoid arthritis - common origins, divergent mechanisms. N Engl J Med. 2023 Feb 9;388(6):529-42. </ref>)
** dietary agents<ref name=":1" />
* hormonal factors:<ref name=":5" />
** effects of oestrogen on immune function are believed to play a role in female pre-dominance in RA
** other sex-related factors are probably involved as well
 
== References ==
[[Category:Course Pages]]
[[Category:Course Pages]]
[[Category:Plus Content]]
[[Category:Plus Content]]
[[Category:Rheumatology]]
[[Category:Rheumatology]]

Revision as of 12:04, 22 May 2024

Original Editor - Shala Cunningham Top Contributors - Jess Bell
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (22/05/2024)

Introduction[edit | edit source]

Rheumatoid arthritis (RA) is a “chronic inflammatory autoimmune systemic disease that usually presents with joint inflammation leading to pain, fatigue, and impaired physical functioning and work productivity, all of which negatively impact health-related quality of life.”[1]

RA commonly affects the hands, wrists, shoulders, elbows, knees, ankles and feet.[2] As it is a systemic condition, it also affects multiple body systems, including the cardiovascular and respiratory systems.[2][3][4] Without adequate treatment, RA can cause long-term disability, pain and premature death.[5] [6] While pharmacological management is the mainstay treatment for RA,[5] rehabilitation professionals can play a role in the non-pharmacological management of this condition.[2]

Epidemiology[edit | edit source]

RA affects around 1% of the global population,[3] and up to 3% of older persons.[5] It is 2-3 times more likely to occur in females.[6] However, with improving medical management, the severity, mortality and associated comorbidities appear to be decreasing.[7]

The peak age of onset of RA tends to be in younger populations (approx 30-60 years), although the exact age ranges given in the literature vary:[8][9]

  • younger-onset RA is distinguished from elderly-onset RA (i.e. after 60 years) in the literature[8][10]
  • Slobodin[11] notes that the peak age of onset of RA has increased - in the 1930s, it was typically in the fourth decade of life, whereas by the 2010s, it was the sixth or seventh decade

Risk Factors[edit | edit source]

RA is a multifactorial disease that has been linked to various genetic, environmental and other factors,[3] including:

  • genetic factors: the HLA-DRB1 alleles are linked with an increased risk of developing RA[12]
  • certain environmental factors in genetically predisposed individuals, such as:
    • smoking
    • infections (e.g. periodontal disease,[3] Epstein-Barr virus, baterial superantigens etc.[13])
    • dietary agents[3]
  • hormonal factors:[13]
    • effects of oestrogen on immune function are believed to play a role in female pre-dominance in RA
    • other sex-related factors are probably involved as well

References[edit | edit source]

  1. ↑ Küçükdeveci AA, Turan BK, Arienti C, Negrini S. Overview of Cochrane Systematic Reviews of rehabilitation interventions for persons with rheumatoid arthritis: a mapping synthesis. Eur J Phys Rehabil Med. 2023 Apr;59(2):259-69.
  2. ↑ 2.0 2.1 2.2 Peter WF, Swart NM, Meerhoff GA, Vliet Vlieland TPM. Clinical practice guideline for physical therapist management of people with rheumatoid arthritis. Phys Ther. 2021 Aug 1;101(8):pzab127.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Radu AF, Bungau SG. Management of rheumatoid arthritis: an overview. Cells. 2021 Oct 23;10(11):2857.
  4. ↑ Metsios GS, Kitas GD. Physical activity, exercise and rheumatoid arthritis: Effectiveness, mechanisms and implementation. Best Pract Res Clin Rheumatol. 2018 Oct;32(5):669-82.
  5. ↑ 5.0 5.1 5.2 Turk MA, Liu Y, Pope JE. Non-pharmacological interventions in the treatment of rheumatoid arthritis: A systematic review and meta-analysis. Autoimmun Rev. 2023 Jun;22(6):103323.
  6. ↑ 6.0 6.1 GBD 2021 Rheumatoid Arthritis Collaborators. Global, regional, and national burden of rheumatoid arthritis, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 Sep 25;5(10):e594-e610.
  7. ↑ Finckh A, Gilbert B, Hodkinson B, Bae SC, Thomas R, Deane KD, et al. Global epidemiology of rheumatoid arthritis. Nat Rev Rheumatol. 2022 Oct;18(10):591-602.
  8. ↑ 8.0 8.1 Yazici Y, Paget SA. Elderly-onset rheumatoid arthritis. Rheum Dis Clin North Am. 2000 Aug;26(3):517-26.
  9. ↑ Bullock J, Rizvi SAA, Saleh AM, Ahmed SS, Do DP, Ansari RA, Ahmed J. Rheumatoid arthritis: A brief overview of the treatment. Med Princ Pract. 2018;27(6):501-7.
  10. ↑ Pavlov-Dolijanovic S, Bogojevic M, Nozica-Radulovic T, Radunovic G, Mujovic N. Elderly-onset rheumatoid arthritis: characteristics and treatment options. Medicina (Kaunas). 2023 Oct 23;59(10):1878.
  11. ↑ Slobodin G. Rheumatoid arthritis. In: Slobodin G, Shoenfeld Y, editors. Rheumatic Disease in Geriatrics. Springer, Cham, 2020.
  12. ↑ Chauhan K, Jandu JS, Brent LH, et al. Rheumatoid Arthritis. [Updated 2023 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441999/
  13. ↑ 13.0 13.1 Gravallese EM, Firestein GS. Rheumatoid arthritis - common origins, divergent mechanisms. N Engl J Med. 2023 Feb 9;388(6):529-42.
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