With every decade of life, I am increasingly grateful for the advances that research has produced. These advances go much further than microwave ovens and cell phones. We have seen major strides in treatment of patients with rheumatic diseases.
RA Treatment: Historical Perspective
Thirty years ago, the diagnosis of RA was devastating. Patients with RA frequently experienced joint erosions and marked deformities. Although the medication and treatments available then were markedly better that those used in the prior decade, it still felt a bit like putting a finger in the dike against this powerful disease.
Patients with RA often faced a life of painful challenges. Physicians fought to “keep patients going,” health professionals used words like “maintain and modify,” and orthopedic surgeons described some surgeries as ways to “salvage joints and patient function.”
Hampered by limited resources, rheumatologists initially placed patients on aspirin regimes and provided joint injections when the inflammation could not be curtailed. As these interventions failed to halt disease progression, patients were introduced to other drugs such as the hydroxycholoquine or the gold salts. Finding the correct balance and dosages of drugs was a fine art and took time, and this lengthy process allowed this opportunistic disease to cause permanent joint and soft-tissue changes.
Patients were routinely referred to physical and occupational therapists for uncontrolled symptoms and postoperative treatment. Inpatient and outpatient physical and occupational therapy departments saw a significant number of patients with inflammatory arthritis for days or weeks at a time. During these extended stays, patients learned essential skills from knowledgeable health professionals while gaining confidence and receiving support from other patients.
Care included modalities, splinting, soft-tissue mobilization, gentle exercises, and—most importantly—education. Patients received an education in joint anatomy, disease processes, energy conservation, and joint protection. They learned proper posture and body mechanics techniques in order to reduce joint stress. They engaged in daily exercise programs for range of motion, strength, and balance.
Therapists ensured that correct gait was restored, instructed family members on correct transfer techniques, and modified homes and workplaces for safety and symptom reduction. Therapists empowered patients with self-management techniques so that they might manage their disease symptoms independently. This was all part of the core curriculum for anyone with arthritis.
Prior to the government’s involvement in the length of hospital stays, patients were often admitted to hospitals for longer stays to regulate medications, gain control over symptoms, learn disease management, and undergo surgeries. Treatments were arduous, time consuming, and frequent.
RA Today
That was years ago, and the treatment paradigm has since flipped. Patients are now confidently started on stronger medications earlier to combat disease. Most recently, biologic therapies have joined the arsenal of medicines to more effectively treat arthritis and rheumatic diseases. For the majority of patients, symptoms have been greatly lessened—allowing them to enjoy not only the simple pleasures of life but also the extraordinary ones.
Unfortunately, because no treatment has eliminated rheumatic diseases, the rheumatology healthcare team (including physical and occupational therapists) must continue to assist patients in managing their diseases.
Though the years, the frequency and duration of therapy visits have lessened notably, but most content of those visits has changed little. Educating patients about their disease and how to care for themselves in a physically demanding world remains the core mission of all rehabilitation treatments.
Today, as in previous years, therapists help people with rheumatic diseases gain greater levels of functional independence. Together, occupational and physical therapists account for 15% of the ARHP membership, which is the second largest group of members, behind RNs. We proudly make up an important part of the rheumatology healthcare team and will remain in this role for another thirty years, or until cures are found. We will continue to expand our knowledge base and grow our professional association, ensuring additional advances for our patients.
Kim Kimpton is president of the ARHP and a physical therapist at HealthMark in Denver. Contact her via e-mail at arhp@rheumatology.org.