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Arthritis Care

Arthritis simply refers to inflammation or condition of a joint. There are many different types of arthritis including osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. Certain types of arthritis can affect individual joints, whereas other types can have a more systemic effect on the entire body and the immune system. It is important for physiotherapists to recognise the features of these different types or arthritis as they may require different management and referral onto other specialities such as rheumatologists for medical management. 

Osteoarthritis 

The most common form of arthritis. This is the normal age related wear arthritis that commonly affects many people as they age. It is most common in the hips, knees and hands. Risk factors include previous injury to a joint, age over 45 years old, family history of the condition and being overweight. It can commonly affect just one joint, but may also affect multiple. Your physiotherapist will generally be able to make a diagnosis of this in clinic, although X-rays may also help to confirm this. 

Evidence-based timeframes/expectations for improvement 

International guidelines recommend the use of physiotherapy in the management of knee osteoarthritis. More specifically, this study demonstrated that physiotherapy consisting of strength exercises twice a week for 6 weeks can result in an average pain reduction of 36%, reduced analgesic requirements, reduction in perceived need for surgery, and improvement in joint confidence in patients with hip and knee osteoarthritis (see here). Therefore, this evidence would suggest you should aim to continue with physiotherapy for 6-8 weeks at least to get optimal results. 

Rheumatoid arthritis 

This is a systemic form of arthritis that can affect the whole body including the joints in addition to organs and other body systems such as the cardiovascular or respiratory system. It is the most common autoimmune disorder. It is caused when the immune system (the body’s defense system) is not working properly and begins to attack itself. Risk factors include, but are not limited to, having a known family history of the condition, female gender and smoking.

Evidence-based timeframes/expectations for improvement

As with osteoarthritis, although the disease differs, clinical practice guidelines still promote physiotherapy as a first line treatment to prevent the risk of decline and long-term disability. Exercise and patient education are strongly recommended in addition to offering manual therapy and transcutaneous electrical stimulation in individual cases. Specifically research has demonstrated that 5 sessions of strengthening and stretching exercises administered by a physiotherapist over a 12 week period results in increased hand function at 4 and 12 months for patients with RA of the hand. Further research has demonstrated that 127 patients with generalised rheumatoid arthritis receiving a 6 week exercise program had improved self-efficacy and morning stiffness following the program. Furthermore, these improvements were maintained at 1 year after cessation of the exercise program. Therefore, your physio may recommend treatment for between 6-12 weeks to optimise your results. 

Spondyloarthritis 

This is the name given to a number of inflammatory arthritis conditions. These conditions include Ankylosing Spondylitis, Psoriatic Arthritis, Reactive Arthritis and Enteropathic-associated Arthritis. Although all these conditions have slight differences among themselves, the common feature to all is inflammatory lower back/pelvic pain. The exact cause of the inflammation is not yet known. Ankylosing spondylitis is the most common spondyloarthritis. It is an auto-immune condition where inflammation is prolific within the body. The most common feature is inflammation of the sacroiliac joints that are located at the base of your lower back. The inflammation that occurs in this condition specifically affects sites where tendons or ligaments attach to bone, which essentially means that any joint can be affected. Inflammation can also occur within organs such as the eyes, intestines, heart and lungs. The exact cause of AS is still not yet known.

Why is physiotherapy important for Arthritis?

Physiotherapy is an integral part and is recommended in clinical guidelines for the management of all types of arthritis. Keeping physically active has positive effects on muscle strength, flexibility and general health in addition to reducing pain and mental health benefits.

It is the most effective non-operative management of osteoarthritis, with growing evidence of patients choosing to manage their OA without the need for surgery. Strength exercises mainly targeting the hip and knee muscles are shown to improve patients' outcomes with OA. Your physiotherapist will assess your condition and prescribe an exercise and treatment programme that can help you manage your problem. Other interventions such as joint mobilisation and soft tissue release may also be helpful alongside exercise. For more information on our strength-based rehabilitation programmes for the over 60’s to manage osteoarthritis please click here.

The inflammation related to AS leads to stiffening and immobility of a joint over many years. The input of physiotherapy is vital to help maintain, and in some cases improve, the amount of mobility or movement each joint has. The bigger picture to this is that people with AS can then continue to be involved in the activities important to them without restrictions of immobility, thus improving quality of life.

Rheumatoid arthritis is a chronic disorder that has no cure, therefore treatments should be aimed towards improving patients function and offering a better quality of life. Graded physical activity is recommended in RA and physiotherapy assessment and rehabilitation is recommended in the clinical guidelines. This may include exercise prescription, education, manual therapy and splinting in order to improve flexibility, aerobic condition, strength, bone integrity, coordination, balance and risk of falls. 

For more information on how we can help with arthritis at Auckland physiotherapy please see our blog here