The Role of the Physiotherapist in

Rheumatoid Arthritis

Chris Washbrook, Superintendent Physiotherapist in Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath
(Peer reviewed by Allison Dean, Clinical Specialist in Rheumatology, Burton Hospitals NHS Foundation Trust, April 2011)
Original article: 04/10/2004
Reviewed: 16/04/2011
Next review due: 16/04/2014

Physiotherapists are members of the multi-disciplinary team involved in the treatment and management of people with rheumatoid arthritis. They work closely with you and other members of the team to make sure that you feel supported, and that your short and long-term needs are addressed.

Physiotherapists have a key role throughout the course of the disease. The extent of their involvement with you will vary throughout that time, dependent upon your needs.

You will often be referred to a physiotherapist soon after you are diagnosed with rheumatoid arthritis. At this stage their input may be to give you information and advice about your condition, teaching you what symptoms to expect and how to manage them. This may help to reassure you, and is likely to include information regarding how to recognise and manage a flare, when to rest and when to exercise, and advice on how to modify activities in order to protect the joints.

Fatigue and pain relief will also be discussed and advice given regarding physical techniques which may help, such as use of ice or heat.

The physiotherapist may continue to be involved until there is a degree of disease control and you feel confident enough to ‘self manage’, using the techniques you have been taught. Whenever you are seen by a physiotherapist you will be assessed. This will involve the physiotherapist asking questions about your symptoms and any difficulties you are having with movement or activities of daily living. You will usually need to undress so that the physiotherapist can examine your joints and muscles and see how you perform functional activities. This enables the physiotherapist to identify any problems you may have and decide with you the most appropriate course of action.

People with rheumatoid arthritis often find that their joints become very stiff, and muscles become weak. You may experience a loss of movement in the joints and as a result have difficulty with carrying out normal daily activities, such as getting up and down the stairs or in and out of a chair. Physiotherapists can help by teaching and encouraging safe stretching and strengthening exercises, to increase movement and strength, allowing better function. Physiotherapists will also analyse the way you stand and walk, looking for whether it may be necessary to suggest, for example balance exercises, insoles to reduce pain and restore good foot posture, or even a walking stick. Some physiotherapists will also have access to a hydrotherapy pool, where patients can do strengthening exercises while the water supports their joints.

The physiotherapist always works in conjunction with the multidisciplinary team colleagues, such as occupational therapists, podiatrists and orthotists, and will refer to them when necessary.

You will continue to have regular reviews with your consultant and specialist nurse. In some places physiotherapists are routinely part of this review, and in other places, patients will be re-referred to physiotherapy if necessary.

The recent advances in medication have led to some people’s symptoms being so well controlled that they feel they can undertake more varied and advanced types of exercise, even such as joining a gym. It is important that before undertaking this, specialist advice and instruction is gained from a physiotherapist, who will be able to suggest safe and effective ways of using the equipment.

It is important to try to find ways to continue with normal activities such as staying in work. The physiotherapist will work with occupational therapy colleagues to discuss your individual problems and help you to find ways to continue with this.

Try to develop a good relationship with and easy access to your physiotherapy team, as along with their multi-disciplinary colleagues, they can help to reassure you, providing advice, education and support which will help to improve your confidence and overall outcome.

The Role of the Physiotherapist in

Rheumatoid Arthritis

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