Pathology Report on Rheumatoid Arthritis.



Rheumatoid Arthritis (RA) is a chronic systematic disease believed to be related to an antigen-antibody reaction that effects the joints of the body leaving them crippled and disfigured. The use of massage can be an important part of the prevention strategy of dealing with RA, which is considered the most severe type of joint inflammatory disease. (Donald W. Scheumann).


Etiology:
The Etiology of rheumatoid Arthritis is not fully understood, evidence however points towards a complex interaction between environmental (e.g. viral infections) and genetic factors. Risk factors believed to increase your chance of RA are:
- Female have a 2-3 times greater chance of developing RA than men.
- Positive family history of RA.
- Older age.
- Smoking.


Pathogenesis (Signs and Symptoms):
Early stage Rheumatoid Arthritis patients initially experience symptoms at just one location or a few widely spread sites, surfacing over weeks to months with signs of weakness or fatigue in the joint common. Joints more commonly effected by Rheumatoid Arthritis are those with a high ratio of synovium: articular cartilage. RA usually effects joints both sides equally and common joints are the wrists, metacarpals, interphalangeals, knees, ankles and toes, (Harris ED) but RA can also effect the hips, shoulders, cervical spine, TMJ, and sometimes small bones of the larynx causing hoarseness or narrowing of the airways. Rheumatoid joints are typically tingly, tender to the touch, and warm. Some patients complain of "puffy" hands resulting from increased blood flow to inflamed areas.


Treatment:
Once existence of RA has been confirmed your goals of treatment should be to:
- Reduce pain
- Limit inflammation
- Halt joint damage
- Improve function


RA is characterised by periods of painful, inflammatory flare-ups (acute phase) and remission (sub-acute phase).

ACUTE PHASE

Massage Caution:
- Massage is best avoided in its acute (flare) phase. RA is an inflammatory condition caused by agents in the circulatory system, anything that increases circulation also increases the risk that the disease may spread to other joints in the body. Massage is therefore contradicted during these flare-ups.

SUB-ACUTE PHASE
Massage is significant in the sub-acute remission stages of RA to encourage local circulation to improve mobility and aid the relaxation of muscle tissue to reduce stress that soft tissue surrounding the joints can trigger (Fritz, S.). During remission chronic pain presents both from physiological and psychological causes, the physiological from weight bearing on the effected joints and the psychological due to stress, anxiety and depression experienced after loss of normal function therefore massage is useful to clients for reduction of pain and stress management. (Charles C. Tuchtan…etc).

Massage Caution:
- Clients may be taking analgesic or anti-inflammatory medication that reduces sensitivity and masks pain. (Premkumar, K.).
- Surrounding muscles and tendons become stressed and tight from chronic pain making joints become stiff rather than inflamed.


Prevalence:
World wide Rheumatoid effects about 1% of the world’s population.

Incidence:
- Worldwide the annual incidence of RA is approximately 3 cases per 10,000
- 2-3 times greater chance of having rheumatoid arthritis if you are female with its most pronounced in patients under the age of 50 years old.
- About 1 in 10 RA patients will experience severe joint damage due to cartilage and bone decay, if left untreated permanent disfigurement can result.
- 10-20% of RA patients the disease goes into remission in the early stages or never develops beyond a mild case.
- Onset may be at any age, most often between 35 yr and 50 yrs of age.



References:

1) Charles C. Tuchtan, Vicki M. Tuchtan, David Stelfox. (2003). Foundations of Massage. (2nd Edition). (Pg 153). Australia: Elsevier Australia. 2)Donald W. Scheumann. (2006). The Balanced Body. (3rd Edition). (Pg 105). Philadelphia: Lippincott Williams & Wilkins.
3)Fritz, S. (2005). Sports & exercise massage. Missouri: Mosby.
4)Harris ED (2005). Clinical features of rheumatoid arthritis. Harris ED, Kelley WN. Kelley's Textbook of rheumatology. (7th Edition). Philadelphia: WB Saunders.
5)Premkumar, K. (2000). Pathology A to Z – A handbook for massage therapists (2nd Edition). Philadelphia: Lippincott Williams & Wilkins.
6)Saag KG, Cerhan JR, Kolluri S. (1997) Cigarette smoking and rheumatoid arthritis severity.