Typically affecting the wrist and small joints in the hands, knuckles and finger joints, rheumatoid arthritis (RA) is the most common type of autoimmune arthritis. Affecting 1.5 million Americans, two thirds of which are women, RA causes pain and swelling in the joints, limiting movement and function.
In RA, the synovium, the tissue that lines the joint, mistakenly becomes a target for the immune system. The immune system cells release inflammation-causing chemicals which cause inflammation in the synovium. The synovium creates a fluid called synovial fluid, which lubricates the joint allowing for smooth movement. When the synovium becomes inflamed and damaged, it fails to produce this lubricant and the joint does not move as freely. If the inflammation of the synovium continues over time, the cartilage and eventually the bone become damaged. The joints can then become deformed and misshapen, and movement becomes limited.
RA affects more than just the hands and other smaller joints; it can affect the entire body making it a systemic condition.
- pain in multiple small joints for six weeks or longer,
- morning joint stiffness lasting longer than 30 minutes,
- bilateral pain,
- loss of energy and appetite,
- low grade fever,
- dry eyes and mouth (Siogren’s syndrome),
- and rheumatoid nodules, or lumps, which can grow beneath the skin.
Trouble breathing, anemia and inflammation of the blood vessels can also be symptoms of RA.
Joints affected by RA may be tender, warm and swollen, typically in a symmetrical pattern – meaning if one side is affected the other side usually is affected as well. RA shows up in the smaller joints first, so wrist and finger joints are affected most often, but other joints such as the neck, shoulders, elbows, hips, knees and ankles along with the feet can be affected. While there is a great deal of variation in symptoms, once someone shows signs of RA, those symptoms usually last for years.
Drug treatment for RA involves drugs called disease modifying antirheumatic drugs (DMARDs) that relieve symptoms and slow the progression of the disease. Analgesics like non-steroid anti-inflammatory drugs and NSAIDs may also be used to reduce swelling, pain and fever.
Massage and Rheumatoid Arthritis
While massage can aid in increasing mobility and alleviating muscle tightness resulting from chronic pain, it cannot do much to alleviate pain from deformed or degenerating joints. Moderate pressure Swedish massage and myofascial release are the two types of massage that research has proven offer benefits for those with RA, but working with your clients you may find other techniques that reduce pain and increase mobility as well.
Massage therapy has been shown to reduce pain and increase joint mobility as well as decrease depression and anxiety in clients with RA. In one study, those with RA who received moderate pressure massages enjoyed less pain and greater mobility and grip strength than those who received lighter pressure massage therapy (Field, et.al., 2013). Another study showed that the stress hormone cortisol decreased immediately when RA patients received massage therapy (Field, et.al., 1997).
A 2011 study showed that myofascial massage, applied three times per week for two weeks, provided significant pain relief from RA symptoms. Myofascial release works through the application of sustained moderate to deep pressure, which allows the muscle to lengthen, reducing strain on the joints from muscle tension (Cubick, et.al., 2011).
Be careful using deep tissue massage techniques or trigger point therapy on clients with RA, as these techniques might trigger a flare up of inflammation, especially near joints affected by the disease. When employing these techniques, it is important to work slowly, giving the client time to react, and to not overdo it. Let the client “live with” the work after a short, limited amount of deep work to see how their body reacts. If they are okay and do not have an increase in inflammation in RA-affected joints after the session, you can do a little more deep work at the next appointment. If they have a flare up of symptoms, avoid deep tissue techniques.
Basic contraindications for massage therapy apply to those clients with RA as well; avoid massage when there are open wounds, fever, skin rashes or irritation, or deep vein thrombosis. Clients with any significant health concerns should be cleared by their physician before getting massage therapy.
When working on clients with RA, avoid working on joints that are in an acute stage of inflammation and are warm, red, or extremely painful. Check in with the client regularly to ensure that the pressure is not too deep, as it is important to ensure the massage does not trigger muscle contraction and cause more tension and pain. If a client is having a significant flare up of symptoms, do not perform the massage until symptoms calm down. Be careful in performing joint mobilization and stretching, as joints may be damaged and compromised.
Massage therapy has been shown to significantly reduce pain, increase mobility and reduce stress and anxiety for clients with Rheumatoid Arthritis. Massage therapy should be light to moderate, and care should be taken with inflamed and potentially damaged joints. Clients with RA live with pain as a constant companion and truly appreciate any intervention which offers relief from that pain.