Rheumatoid arthritis is a chronic syndrome that is characterized by inflammation of the peripheral joints, but it may also involve the lungs, heart, blood vessels, and eyes. The prevalence of this autoimmune disease is between 0.3% to 1.5% of the population in the United States (Feinberg, pp 815). It affects women two to three times more often than men, and the onset of RA is usually between 25 and 50 years of age, but it can occur at any age (Reed, pp 584). RA can be diagnosed by establishing the presence of persistent joint pain, swelling in a symmetric distribution, and prolonged morning stiffness. RA usually affects multiple joints, such as the hands, wrists, knees, elbows, feet, shoulders, hips, and small hand joints. RA is usually characterized by the inflammation of the synovium, which lines the joints and tendon sheaths of the body.
The etiology of this disease is unknown. There are multiple factors involved in this disease, including autoimmune reactions and environmental factors. There is also a genetic predisposition that has been identified that can be related to the cause of RA. Rheumatoid arthritis develops as a result of an interaction of many factors. Much research is going on now to understand these factors and how they work together. Rheumatoid arthritis is one of several "autoimmune" diseases because a person's immune system attacks his or her own body tissues (Gordon, pp 16). A feature of rheumatoid arthritis is that it varies a lot from person to person. For some people, it lasts only a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have severe disease that is active most of the time, lasts for many years, and leads to serious joint damage and disability. Rheumatoid arthritis occurs in all races and ethnic groups. Although the disease often begins in middle age and occurs with increased frequency in older people, children and young adults also develop it.
In 1987, the American Rheumatism Association developed seven criteria to define RA. First, morning stiffness in and around joints lasting at least one hour before improvement. Second, there is arthritis of three or more joint areas. Third, there is swelling of at least one wrist, MCP, or PIP joint. Fourth, there is simultaneous symmetrical swelling in joints. Fifth and sixth, there are subcutaneous rheumatoid nodules and presence of rheumatoid factor. Lastly, there are radiographic erosions and/or Perarticular osteopenia in hand and/or wrist joints (Ryan, pp 57).
Diagnosing and treating rheumatoid arthritis is a team effort between the patient and several types of health care professionals. When assessing a patient with RA, the professional should be looking at their activities of daily living, productivity skills and interests, leisure skills and interests, active and passive range of motion, muscle strength, hand functions, endurance, and cognitive features. Some psychosocial areas to be aware of are self-concept, coping skills, interpersonal and social skills, communication skills, and support systems.
Occupational therapy for an individual with RA will help the patient understand his or her disease and its effects on his or her life. The Occupational therapist will help the patient to improve his or her ability to perform daily activities, prevent loss of function, and direct successful adaptation with the disease. The Occupational therapist will also help the patient to develop problem-solving skills needed to make adaptations throughout one's life. The Occupational therapist will also treat the physical and psychosocial difficulties that may limit the patient's occupational performance (Fienberg, pp 816). The Occupational Therapist will review, observe and interview the patient, as well...
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