Rheumatoid arthritis (RA) is an autoimmune disease. This means that the immune system, which normally protects the body by attacking any harmful substances, now begins to attack the joints.
This creates inflammation which causes the tissue which lines the inside of the joints to thicken; resulting in the swelling and pain generally associated with rheumatoid arthritis. If inflammation is not managed it can result in both cartilage and subsequent bone damage and causes joint narrowing. Patients may complain of “loose joints”; feeling as though their joints are unstable and painful with a loss of mobility.
So what is the difference between osteoarthritis (OA) and rheumatoid arthritis (RA)? Osteoarthritis is a disease caused by the wear and tear of joints and is prevalent in the later years of life, whereas rheumatoid arthritis is an autoimmune disorder which can start at any age. The risk factors for RA range from genetics, the environment, hormones, and even smoking and obesity. OA develops over a long period of time whereas RA can have a sudden onset and worsen rapidly.
Rheumatoid arthritis is also distinguished by “flaring symptoms” meaning that joints can feel painful one day and normal the next. Flares can be predictable; for instance after spending the day cleaning the house, or spontaneous with no obvious cause.
So how do we treat RA?
The best thing for your body is to stay active and healthy and many people will treat aching joints with a hot pack or something warm to soothe the pain. But what if heat isn’t the only answer? When heat is applied you achieve pain relief, relaxed muscles, and joints which are less stiff. But cartilage destroying enzymes are produced in the joints and these can be affected by the local temperature of the joints. Studies have shown that a normal joint has a temperature of 33°C and a RA joint may rise to 36°C. When the joint is in an inflammatory stage, increasing the temperature further may result in increased enzyme activity and therefore increased cartilage damage.
Heat therapy may dilate, or open the blood vessels thus increasing blood flow to that area, and flush out the enzymes in the joint, and provide some relief. However it may not be a good idea during the inflammatory period, or “flaring” stage, of rheumatoid arthritis as it could lead to further cartilage destruction.
Cryotherapy, or cold therapy, may provide some other benefits. Applying cold to the area over a short period of time causes constriction, or closing, of the vessels. It is also known to relieve pain, increase movement of the joint, improve strength of the joint, and overall increase function.
So which is it? Hot or cold?
Both are equally effective and few studies have found a difference between the two in relation to a person’s pain and overall improvement.
Remember that RA is a disease with periods of flaring and increased inflammation; it does not have the same symptoms all the time. It may be that now we should consider the timing of when to use hot therapy and when to use cold. It appears that during a flaring episode it would be wiser to use cold therapy as opposed to heat. So cold should be used during an acute inflammatory stage and either heat or cold can be used during a chronic phase.
Physiotherapists are skilled in treating RA with various modalities including heat and cryotherapy. You Physiotherapist will not only treat your pain, but will also look at the biomechanics of RA joints and the joints surrounding them to minimise the dysfunction you may experience. They may also do a functional assessment. RA doesn’t need to be a debilitating disease and there are many options for its management.
Some physiotherapy techniques include:
Other management techniques include:
Robinson Private Hospital
Medical Centre Block 4
Tel: 011 693 5041
Lenmed Private Hospital
Ward Street, Greenhills
Tel: 011 693 5041
1679 President Kruger Street
Tel: 011 753 2113
Luke and Barker Physiotherapy is a member of: