Rheumatoid Arthritis and Physical Therapy
Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation, pain, and joint damage. While antirheumatic drugs are the primary treatment for RA, the American College of Rheumatology (ACR) has recently released its first-ever guidelines recommending the integration of exercise, rehabilitation, diet, and additional integrative interventions into Rheumatoid Arthritis Treatment. These guidelines emphasize the crucial role of physical therapists and occupational therapists in a multidisciplinary treatment team. This blog post will explore the key recommendations outlined in the guidelines and the importance of physical therapy in the management of RA.
Development of the Rheumatoid Arthritis and Physical Therapy Guidelines
The development of the guidelines involved a comprehensive process that included a systematic review of the research literature, input from a panel of patients with RA, and collaboration with experts in the field. A team of APTA (American Physical Therapy Association) members actively participated in the development of the guidelines, ensuring that the perspectives of physical therapists were incorporated.
PT Exercise Recommendations for Rheumatoid Arthritis
The guidelines strongly recommend consistent engagement in exercise as a part of Rheumatoid Arthritis Treatment. The specific type, frequency, intensity, and duration of exercise should be tailored to each individual’s needs and goals. While more research is needed to determine the most effective exercise approaches, physical therapists play a vital role in guiding patients in identifying the exercises and treatments that best suit their unique circumstances.
The guidelines also provide conditional recommendations for aerobic, aquatic, resistance, and mind-body exercises, such as Tai Chi or yoga, over no exercise. These recommendations are supported by varying levels of evidence certainty, ranging from low to very low certainty.
Participation in comprehensive physical therapy and occupational therapy is strongly recommended throughout the course of RA. Early referral to these therapies is encouraged to ensure that interventions can be tailored to each patient’s specific needs. The guidelines also provide additional recommendations for hand therapy, splinting, orthoses, compression, bracing, joint protection techniques, activity pacing, assistive devices, and vocational rehabilitation.
Based on available evidence, the guidelines conditionally recommend a Mediterranean-style diet for individuals with RA. However, they acknowledge that patient preferences, accessibility, and associated burdens may affect the ability to adhere to this diet. The guidelines also recommend following established dietary recommendations without relying on dietary supplements.
The guidelines include recommendations for and against various interventions. Some of these recommendations include the use of standardized self-management programs, cognitive behavioral therapy, acupuncture, massage therapy, and thermal modalities. They also advise against the use of electrotherapy and chiropractic therapy for individuals with RA.
The Role of Physical Therapy in RA Management
The guidelines highlight the significant role of physical therapy in the management of Rheumatoid Arthritis Treatment. Physical therapists are crucial in guiding patients through exercise programs, rehabilitation interventions, and providing education on joint protection techniques. By integrating physical therapy into routine care, patients with RA can experience improved outcomes and a better quality of life.
Barriers to Implementation
While the guidelines represent an important step in incorporating physical therapy into RA care, several barriers to full implementation exist. These barriers include a lack of knowledge about the importance of exercise among rheumatology providers, limited awareness of the role of physical therapy among individuals with RA, varying levels of expertise among physical therapists in treating RA, payment policy challenges, and a need for further research in this area. Addressing these barriers is essential to ensure the successful implementation of the guidelines and to enhance the role of physical therapy in meeting the healthcare needs of adults with RA.
The release of the first-ever guidelines for exercise, rehabilitation, diet, and additional integrative interventions in the treatment of RA marks a significant milestone in RA management. These guidelines highlight the importance of physical therapy and occupational therapy as essential components of a multidisciplinary treatment team. By following the recommendations outlined in the guidelines, healthcare providers can optimize the care provided to individuals with RA, leading to improved outcomes and a better quality of life.