General Overview of Rheumatoid Arthritis for Rehabilitation Professionals: Difference between revisions
No edit summary |
No edit summary |
||
(2 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
<div class="editorbox"> '''Original Editor '''- [[User:Shala Cunningham|Shala Cunningham]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div> | |||
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.” | <div class="noeditbox">This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! ({{REVISIONDAY}}/{{REVISIONMONTH}}/{{REVISIONYEAR}})</div> | ||
== 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" /> | |||
== 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 | |||
== Clinical Characteristics == | |||
RA is usually symmetrical, with the wrists, fingers (MCP), knees, ankles, feet and upper cervical spine are commonly affected.<ref name=":6">Cunningham S. Rheumatoid Arthritis Course. Physiopedia Plus, 2024.</ref> | |||
Joint symptoms may include:<ref name=":0" /><ref name=":6" /> | |||
* symmetrical joint pain | |||
* morning stiffness that lasts for more than one hour or stiffness after inactivity | |||
* joints may feel warm and tender after more than one hour of inactivity | |||
* loss of / limitations in range of motion | |||
* deformity | |||
== Typical Joint Deformities == | |||
'''Cervical spine''': prevalence of atlantoaxial instability (AAI) in individuals with RA is 40–85%<ref>Cunningham S. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4984819/ Upper cervical instability associated with rheumatoid arthritis: a case report]. J Man Manip Ther. 2016 Jul;24(3):151-7.</ref> | |||
* hypermobility between C1 and C2 | |||
* transverse ligament laxity | |||
* subluxation risk | |||
* possible neurologic involvement | |||
'''Hand''':<ref name=":6" /> | |||
* swan neck deformity | |||
* boutonniere deformity | |||
* ulnar drift | |||
* thumb metacarpophalangeal flexion with interphalangeal hyperextension | |||
'''Knee''':<ref name=":6" /> | |||
* genu valgus | |||
* Baker cyst | |||
'''Ankle / foot''':<ref name=":6" /> | |||
* pronation | |||
* hallux valgus | |||
* claw toes | |||
'''Other symptoms and extra-articular manifestations''':<ref name=":0" /><ref name=":1" /><ref name=":6" /><ref>Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920070/ Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies]. Bone Res. 2018 Apr 27;6:15. </ref> | |||
* pulmonary issues (e.g. pleuritis, pleural effusions, pulmonary fibrosis, interstitial lung disease and arteritis<ref name=":1" /> - can be common but often asymptomatic<ref name=":6" />) | |||
* cardiac issues (e.g. atherosclerosis, arterial stiffness, coronary arteritis, congestive heart failure, valvular disease and fibrinous pericarditis<ref name=":1" />) | |||
* Felty’s syndrome (i.e. low white blood cell count, spleen enlargement and rheumatoid arthritis<ref>Arthritis Society Canada. Felty's syndrome. Available from: https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/felty-s-syndrome (last accessed 22 May 2024).</ref>) | |||
* dry eyes and mouth (Sjögren's syndrome) | |||
* numbness, tingling, or burning sensation in the hands and feet | |||
* sleep difficulties | |||
* rheumatic nodules | |||
** these occur more in individuals with seropositive RA with erosive disease<ref name=":1" /> (see Pathophysiology section for information on seropositive / seronegative RA) | |||
* fatigue | |||
* reduced cognitive function | |||
* sarcopenia | |||
* osteoporosis | |||
* vasculitis (can result in “skin manifestations, gastrointestinal complications, cardiac disease, and pulmonary manifestations”<ref name=":1" />) | |||
== References == | |||
[[Category:Course Pages]] | [[Category:Course Pages]] | ||
[[Category:Plus Content]] | [[Category:Plus Content]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] |
Revision as of 12:24, 22 May 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:
- 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
Clinical Characteristics[edit | edit source]
RA is usually symmetrical, with the wrists, fingers (MCP), knees, ankles, feet and upper cervical spine are commonly affected.[14]
Joint symptoms may include:[2][14]
- symmetrical joint pain
- morning stiffness that lasts for more than one hour or stiffness after inactivity
- joints may feel warm and tender after more than one hour of inactivity
- loss of / limitations in range of motion
- deformity
Typical Joint Deformities[edit | edit source]
Cervical spine: prevalence of atlantoaxial instability (AAI) in individuals with RA is 40–85%[15]
- hypermobility between C1 and C2
- transverse ligament laxity
- subluxation risk
- possible neurologic involvement
Hand:[14]
- swan neck deformity
- boutonniere deformity
- ulnar drift
- thumb metacarpophalangeal flexion with interphalangeal hyperextension
Knee:[14]
- genu valgus
- Baker cyst
Ankle / foot:[14]
- pronation
- hallux valgus
- claw toes
Other symptoms and extra-articular manifestations:[2][3][14][16]
- pulmonary issues (e.g. pleuritis, pleural effusions, pulmonary fibrosis, interstitial lung disease and arteritis[3] - can be common but often asymptomatic[14])
- cardiac issues (e.g. atherosclerosis, arterial stiffness, coronary arteritis, congestive heart failure, valvular disease and fibrinous pericarditis[3])
- Felty’s syndrome (i.e. low white blood cell count, spleen enlargement and rheumatoid arthritis[17])
- dry eyes and mouth (Sjögren's syndrome)
- numbness, tingling, or burning sensation in the hands and feet
- sleep difficulties
- rheumatic nodules
- these occur more in individuals with seropositive RA with erosive disease[3] (see Pathophysiology section for information on seropositive / seronegative RA)
- fatigue
- reduced cognitive function
- sarcopenia
- osteoporosis
- vasculitis (can result in “skin manifestations, gastrointestinal complications, cardiac disease, and pulmonary manifestations”[3])
References[edit | edit source]
- ↑ 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 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.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Radu AF, Bungau SG. Management of rheumatoid arthritis: an overview. Cells. 2021 Oct 23;10(11):2857.
- ↑ 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.
- ↑ 5.0 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.
- ↑ 6.0 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.
- ↑ 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.
- ↑ 8.0 8.1 Yazici Y, Paget SA. Elderly-onset rheumatoid arthritis. Rheum Dis Clin North Am. 2000 Aug;26(3):517-26.
- ↑ 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.
- ↑ 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.
- ↑ Slobodin G. Rheumatoid arthritis. In: Slobodin G, Shoenfeld Y, editors. Rheumatic Disease in Geriatrics. Springer, Cham, 2020.
- ↑ 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/
- ↑ 13.0 13.1 Gravallese EM, Firestein GS. Rheumatoid arthritis - common origins, divergent mechanisms. N Engl J Med. 2023 Feb 9;388(6):529-42.
- ↑ 14.0 14.1 14.2 14.3 14.4 14.5 14.6 Cunningham S. Rheumatoid Arthritis Course. Physiopedia Plus, 2024.
- ↑ Cunningham S. Upper cervical instability associated with rheumatoid arthritis: a case report. J Man Manip Ther. 2016 Jul;24(3):151-7.
- ↑ Guo Q, Wang Y, Xu D, Nossent J, Pavlos NJ, Xu J. Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res. 2018 Apr 27;6:15.
- ↑ Arthritis Society Canada. Felty's syndrome. Available from: https://arthritis.ca/about-arthritis/arthritis-types-(a-z)/types/felty-s-syndrome (last accessed 22 May 2024).