Rheumatoid arthritis

We’re here today to talk about rheumatoid arthritis, and this is the commonest of the inflammatory polyarthrities. What does that mean? Poly means many, and arthrities means inflammation of joints. And, in fact, rheumatoid arthritis is not just a condition that involves inflamed joints but it’s actually a systemic inflammatory syndrome that involves really, many organ systems potentially, but with its predominant manifestation in the joints. Now rheumatoid is common. It affects about 1/2% of the population to somewhat more roundabout 0.8% of the population as a whole, but its peak incidence is in the middle years. And it’s more common in women than it is in men. It’s about 3-to-1 female to male. Rheumatoid arthritis in the joints involves inflammation in the synovium.

That’s the lining of the joint. And it can be locally destructive. It’s not invariably so, but it can be so. And so the inflammation over the years is cumulative and can lead to progressive loss of function. This impacts on every area of life, of course, including employment. And in the past, many people lost their jobs or had to change their employment because of rheumatoid arthritis. So from a physician’s point of view, one of the goals of treatment is to try and achieve remission or low-disease activity. And we do this with pharmacotherapeutic intervention that suppresses the inflammatory process, both systemically and locally in the joints. But, of course, we need to look at a holistic approach to care.

And one of the ways to preserve joint function and general health is to exercise. Strong muscles that function normally and are regularly exercised will preserve joint integrity. And in many cases, it’s the muscular strength and integrity that actually stabilizes a particular joint. There are a few joints, for example, the hip joints, will have a ball and socket configuration that actually gives some intrinsic stability. But in the case of most joints– and the joint is simply where two bones come together– it’s the musculature, and the tendons, and the integrity of those that are going to maintain function and structure.

So any exercise program that tones up muscles and keeps them strong and maintains the structure and function of the joints has got to be a very good thing. And since the hands are one of the areas for the highest predilection of involvements in rheumatoid arthritis, it’s particularly important that we have good exercises for the hand to maintain function and dexterity and to give the patients an overall sense of well-being. The SARAH exercises have been proven to be of benefit to patients with rheumatoid arthritis. And these particularly apply to hand function.

And we know that they’re safe, and they enable patients to continue to function and maintain dexterity and do what they want to do with their hand function over the course of time. Certainly, my patients have benefited enormously from the SARAH program of exercises, which has been developed by occupational therapists and physiotherapists at the Botnar Research Center here in Oxford. And you’re going to hear more about that today through the course of this program.