Managing Rheumatoid Arthritis

Ryan LaCorte Marian Nashed, Publications

Have you ever noticed the joints in both of your hands to be swollen and painful? Do your joints remain painful and stiff for a long period of time, well into the morning? Has your ability to open jars, cut food, and turn doorknobs become more challenging? You may be one of the 1.3 million Americans suffering from Rheumatoid Arthritis.

Rheumatoid Arthritis (RA) is a systemic, chronic, autoimmune disorder that can cause joint deformities. It can also decrease your ability to perform activities of daily living (ADL’s), cause muscle spasm and shortening, increase ligament laxity, and destroy bone and cartilage. In some cases, the synovial lining of tendons and tissues of internal organs may also be affected.

Research suggests that hand involvement is an early clinical sign of RA, with joint swelling occurring at the small knuckles or your proximal interphalangeal joints (PIP’s) and your larger knuckles or metacarpophalangeal joints (MCP’s), and wrists.

Signs and Symptoms of RA vary as the disease progresses, and symptoms may go into remission or exacerbate.

  • Stage I: Early, Acute, Inflammatory: Increased pain, joint swelling and warmth in the knuckles and wrists of both hands
  • Stage II: Moderate, subacute: Decreased range of motion (ROM), decreased pain symptoms, and weakening of soft tissues and joints
  • Stage III: Severe, chronic active, destructive: Decreased ROM, increased soft tissue involvement, and increased joint deformities
  • Stage IV: Chronic: Severe deformities affecting both hands, with the dominant hand being more severely damaged

Causes and Risk Factors: The exact cause of rheumatoid arthritis is unknown, but those with a family history of rheumatoid arthritis, are more likely to be diagnosed with RA, due to the genes affecting the immune system making people more prone. Both genders may be affected, but women have a greater than 75% chance of getting RA, with onset between 20-50 years of age.

Treatment Options: In accordance with seeing a Rheumatologist to manage RA symptoms. Occupational therapy and physical therapy can help:

  • Decrease Pain in joints
  • Maintain or increase range of motion & strength
  • Provide education on adaptive equipment and compensatory techniques to resume ADL performance
  • Fabricate resting hand splints to prevent further joint deformity & recommend daytime splinting options.
  • Resting hand splints: Allow your fingers and wrists to remain in good alignment, and decrease your pain.
  • Silver ring splints: Allows freedom to perform activities during the day, while keeping the fingers positioned in proper alignment. The Hand Therapists at All-Care Physical Therapy Center, LLC, are equipped with the knowledge and measuring kit required to evaluate the most appropriate splint to improve function.

Joint Protection & Energy Conservation Techniques:

  • Replacing doorknobs and faucets with levers to decrease the amount of strain on the joints.
  • Using a pizza cutter or rocker knife to cut up food instead of a traditional knife to decrease stress to the joints
  • Adding built up, large cushioned handles, for commonly used items like kitchen utensils, gardening tools, and pens.
  • Using spring loaded scissors that are readily available to open up packages, instead of fingers to pinch.
  • Avoid using squeeze bottles or tubes, to decrease stress on the joints. A better alternative would be pump bottles for shampoo, toothpaste, lotions, and soaps.
  • Use lightweight cookware, to avoid excessive load to the joints.
  • Use both arms to carry objects, close to the body, and avoid using hand to lift heavy groceries and handbags.

Rheumatoid Arthritis can have a significant impact on the use of both your hands making your ADL’s more challenging. Recognizing and addressing RA in its early stages will provide the best prognosis for this chronic disorder. At All-Care Physical Therapy, our hand therapists specialize in the treatment of RA and other hand disorders. Contact your physician if you are experiencing these symptoms and ask if an Occupational Therapist at All-Care can help. OT hand therapy is currently practiced in our Toms River (732-569-6556) or Whiting (732-849-0700) locations.

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