Education And Debate


BMJ 1995; 310 doi: (Published 11 March 1995) Cite this as: BMJ 1995;310:652
  1. M Akil,
  2. R S Amos

    Except for the mildest cases, rheumatoid arthritis cannot be adequately managed by one specialist in isolation from others. Most people with rheumatoid arthritis cope better if they understand their condition and have realistic expectations of the benefits and disadvantages of treatment. Therefore, education of patients is an important aspect of treatment. Specialist rheumatology nurses have become well established in many rheumatology departments; their role includes monitoring drugs used to treat rheumatoid arthritis and differentiating minor or unrelated symptoms from those that require action.

    Goals of treatment in rheumatoid arthritis

    • Relief of symptoms

    • Preservation of function

    • Prevention of structural damage and deformity

    • Maintenance of patient's normal lifestyle

    Physical therapy

    In a physiotherapy department local measures such as heat, cold, and electrotherapy may be used to reduce pain and generally form part of a rehabilitation programme of exercises designed to improve muscle strength and encourage mobility in affected joints. The aims of occupational therapy are to educate patients; to protect joints; to analyse function and to improve it by means of exercise and use of aids and appliances; and to provide splints when necessary.

    Role of physiotherapy for rheumatoid arthritis

    • Education of patients

    • Reduction of pain and swelling

    • Mobilisation of joints to minimise deformity

    • Strengthening of muscles and prevention of disuse atrophy

    • Increase range of movements and function

    Few of the individual techniques used in physiotherapy and occupational therapy have been subjected to controlled trials, but there is no doubt that therapists who are skilled in handling atrophied, inflamed, and stiff tissues and familiar with the problems faced by patients with arthritis greatly help in treatment and rehabilitation.

    Role of podiatry for rheumatoid arthritis

    • Local redistribution of loading to prevent formation of calluses

    • Provision of specialised footwear

    • Provision of customised orthoses and insoles to improve foot and toe posture and function

    • Provision of foot care to prevent local infection


    The aims of surgery are to relieve pain and to restore function. Indications …

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