eMedicine Specialties > Physical Medicine and Rehabilitation > Arthritis & Connective Tissue Disorders

Rheumatoid Arthritis: Follow-up

Author: Kavita Gupta, DO, MEng, Department of Orthopedics, Center of Physical Medicine and Rehabilitation, University of Dentistry and Medicine of New Jersey
Coauthor(s): Sarjoo M Bhagia, MD, Honorary Teaching Faculty, Charlotte Institute of Rehabilitation, Consulting Staff, Physical Medicine and Rehabilitation, OrthoCarolina
Contributor Information and Disclosures

Updated: Apr 5, 2009

Follow-up

Transfer

  • Once a deformity associated with rheumatoid arthritis has been detected, a cooperative multidisciplinary approach between the physician, therapist, and patient must be formed to eliminate the deformity or to at least prevent it from getting worse. Initially, outpatient management involves application of moist heat to the joints, followed by ROM active stretching exercises. This procedure helps to reduce the contracture if the inflammation is relieved or is not too severe. If severe, protective splints should be applied. Most patients complain of fatigue, feel chronically tired, and usually do not want to exercise secondary to pain. When strength and endurance are compromised, a course of inpatient rehabilitative therapies may be warranted.

Deterrence

  • Rheumatoid arthritis (RA) can lead to a significant functional decline in patients. RA is the second leading cause of chronic disability in the United States. The physiatrist plays an active role in the management of the disease and has a variety of nonpharmacologic options available to help patients maintain their functional status.

Complications

  • Skin manifestations
    • Rheumatoid nodules develop at some time in up to 50% of patients with rheumatoid arthritis (RA).
    • Vasculitis lesions are also frequently seen in patients with RA, particularly various forms of dermal vasculitis. The most common are leukocytoclastic vasculitis and palpable purpura.
  • Cardiac manifestations
    • Echocardiographic evidence of a pericardial effusion or another pericardial abnormality is seen in almost 50% of patients who have no clinical symptoms of heart involvement.
  • Neurologic manifestations
    • As the peripheral nerve passes through a compartment that is also occupied by synovium or tendon sheaths, the possibility of nerve compression by synovitis or tenosynovitis exists.
    • Possible neuropathies that may exist include median nerve compression at the carpal tunnel, ulnar nerve compression at the Guyon canal, posterior interosseous nerve compression at the antecubital fossa, compression of the femoral nerve anterior to the hip joint, compression of the peroneal nerve adjacent to the fibular head, and compression of the interdigital nerve at the MTP joint.
    • The syndrome of mononeuritis multiplex is marked by an abrupt onset of a persistent peripheral neuropathy that is unaltered by either a change in joint position or a reduction in synovial inflammation.

Prognosis

  • Disease factors that correlate with a poorer prognosis for rheumatoid arthritis and a greater likelihood of joint destruction include the following:
    • Positive RF in serum IgA RF
    • Rheumatoid nodules
    • Being a young woman
    • Synovial fluid abnormalities (ie, WBC >50,000/mm3)

Patient Education

 


More on Rheumatoid Arthritis

Overview: Rheumatoid Arthritis
Differential Diagnoses & Workup: Rheumatoid Arthritis
Treatment & Medication: Rheumatoid Arthritis
Follow-up: Rheumatoid Arthritis
Multimedia: Rheumatoid Arthritis
References
Further Reading
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References

  1. Allaire S, Wolfe F, Niu J, et al. Current risk factors for work disability associated with rheumatoid arthritis: recent data from a US national cohort. Arthritis Rheum. Mar 15 2009;61(3):321-8. [Medline].

  2. Areskoug-Josefsson K, Oberg U. A literature review of the sexual health of women with rheumatoid arthritis. Musculoskeletal Care. Feb 25 2009;[Medline].

  3. Ahlmen M, Svensson B, Albertsson K, et al. Influence of gender on assessments of disease activity and function in early rheumatoid arthritis in relation to radiographic joint damage. Ann Rheum Dis. Jan 21 2009;[Medline].

  4. Jorgensen KT, Pedersen BV, Jacobsen S, et al. National cohort study of reproductive risk factors for rheumatoid arthritis in Denmark - a role for hyperemesis, gestational hypertension, and pre-eclampsia?. Ann Rheum Dis. Mar 15 2009;[Medline].

  5. Luqmani R, Hennell S, Estrach C, et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years). Rheumatology (Oxford). Jan 27 2009;[Medline]. [Full Text].

  6. Goldenberg DL. The interface of pain and mood disturbances in the rheumatic diseases. Semin Arthritis Rheum. Feb 12 2009;[Medline].

  7. Barry MA, Purser J, Hazleman R, et al. Effect of energy conservation and joint protection education in rheumatoid arthritis. Br J Rheumatol. Dec 1994;33(12):1171-4. [Medline].

  8. Guccione AA. Physical therapy for musculoskeletal syndromes. Rheum Dis Clin North Am. Aug 1996;22(3):551-62. [Medline].

  9. Jain R, Lipsky PE. Treatment of rheumatoid arthritis. Med Clin North Am. Jan 1997;81(1):57-84. [Medline].

  10. Klippel JH, ed. Primer on the Rheumatic Diseases. 13th ed. New York, NY: Springer; 2008.

  11. Lipsky PE. Rheumatoid arthritis. In: Isselbacher KJ, Braunwald E, Fauci AS, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 1994:1648-55.

  12. Nicholas JJ. Physical modalities in rheumatological rehabilitation. Arch Phys Med Rehabil. Sep 1994;75(9):994-1001. [Medline].

  13. Nicholas JJ. Rehabilitation of patients with rheumatic disorders. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: Saunders; 1996:711-27.

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Further Reading

Clinical guidelines:
 Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercises in the management of rheumatoid arthritis in adults.
Ottawa Panel - Independent Expert Panel.  2004 Oct.  39 pages.  NGC:004019

Ottawa Panel evidence-based clinical practice guidelines for electrotherapy and thermotherapy interventions in the management of rheumatoid arthritis in adults.
Ottawa Panel - Independent Expert Panel.  2004 Nov.  28 pages.  NGC:004020

Rituximab for the treatment of rheumatoid arthritis.
National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.].  2007 Aug.  26 pages.  NGC:005902

Abatacept for the treatment of rheumatoid arthritis.
National Institute for Health and Clinical Excellence (NICE) - National Government Agency [Non-U.S.].  2008 Apr.  29 pages.  NGC:006483

Clinical trials:
RESTART C0168Z05 Rheumatoid Arthritis Study
Evaluation of EULAR-RAID Score in Rheumatoid Arthritis Patients (Rainbow)
PPAR-Gamma Agonists, Rheumatoid Arthritis and Cardiovascular Disease (RA PPAR)

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Juvenile Rheumatoid Arthritis [Radiology]
Rheumatoid Arthritis [Rheumatology]
Rheumatoid Arthritis and Pregnancy
Rheumatoid Arthritis, Hands
Rheumatoid Arthritis, Spine
The Approach to the Painful Joint

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Keywords

rheumatoid arthritis, arthritis, rheumatoid, arthritis pain, arthritis treatment, arthritis symptoms, rheumatology, juvenile arthritis, arthritis knee, arthritis medicine, hip arthritis, juvenile rheumatoid, rheumatoid factor, symptoms of arthritis, swan-neck deformity, rheumatoid arthritis symptoms, juvenile rheumatoid arthritis, rheumatoid arthritis treatment, treatment for rheumatoid arthritis, rheumatoid arthritis drug, inflammatory arthritis, symptoms of rheumatoid arthritis, rheumatoid arthritis rehabilitation

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Contributor Information and Disclosures

Author

Kavita Gupta, DO, MEng, Department of Orthopedics, Center of Physical Medicine and Rehabilitation, University of Dentistry and Medicine of New Jersey
Kavita Gupta, DO, MEng is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, Association of Academic Physiatrists, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Sarjoo M Bhagia, MD, Honorary Teaching Faculty, Charlotte Institute of Rehabilitation, Consulting Staff, Physical Medicine and Rehabilitation, OrthoCarolina
Sarjoo M Bhagia, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Milton J Klein, DO, MBA, Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital, Allegheny General Hospital, and Ohio Valley General Hospital.
Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
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