General Overview of Rheumatoid Arthritis for Rehabilitation Professionals

Original Editor - Shala Cunningham Top Contributors - Jess Bell
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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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