Comprehensive care of the patient with rheumatoid arthritis always requires medical measures to control impairment, and may require rehabilitative measures to control disability. The control of inflammation to minimize impairment through the use of anti-inflammatory drugs is understood and in wide usage. The protection of involved joints during both rest and activity has received little more than lip service. Teaching the patient the art of self-defense and the value of pain so that all unnecessary damaging stress can be avoided requires careful and repeated training by the physician and his paramedical associates. Haphazard attempts to mobilize impaired joints and strengthen surrounding muscles frequently cause unnecessary damage and may cause, as well as accelerate, musculoskeletal deformity. Properly designed and fitted orthetic devices may be necessary during both rest and activity to remind the patient when avoidable stress is acting on the involved joint and to protect these joints against the development of avoidable deformity. Early changes in pattern of activity, even to the extent of changing occupation, may be absolutely essential to control functional deformities.
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