International Standards of Care

Rheumatoid arthritis (RA) is a chronic autoimmune disease that requires a multidisciplinary approach. International guidelines (EULAR 2023, ACR 2022, BSR 2023) emphasise early diagnosis and aggressive treatment to control inflammation, protect joints, and reduce disability.

The recommended pillars of care are:

• Disease-modifying medication prescribed and monitored by a rheumatologist

• Specialist physiotherapy and exercise-based rehabilitation

• Joint protection strategies and pacing to support daily life

• Psychological and lifestyle interventions to reduce stress and build resilience

• Somatic and mind–body practices to regulate the nervous system and improve coping

Medical Management

The medical cornerstone of RA is the use of disease-modifying anti-rheumatic drugs (DMARDs). These slow or halt disease progression and reduce joint damage.

• Methotrexate remains the first-line conventional DMARD.

• Biologics (TNF inhibitors, IL-6 blockers, B-cell therapies) are highly effective for patients with persistent activity.

• JAK inhibitors are an emerging oral option where biologics are not suitable.

• Corticosteroids may be used short-term for flares.

Medication controls inflammation, but it cannot maintain strength, mobility, or daily independence on its own. That is where rehabilitation becomes critical.

Exercise and Physiotherapy in RA

Exercise in RA is about more than general fitness. It is about protecting function and independence in the face of fluctuating symptoms and long-term risk of disability.

Research shows that tailored exercise:

• Preserves range of motion in affected joints

• Builds muscle strength to reduce load on inflamed joints

• Improves cardiovascular health, addressing the increased CV risk in RA

• Reduces fatigue and improves energy levels

• Enhances fine motor control and dexterity, especially in the hands

The challenge for patients is knowing how to exercise during flares versus during remission. Many avoid movement out of fear of worsening inflammation, while others push too hard and pay for it with pain and swelling. Both patterns create setbacks.

This is why professional guidance matters. A specialised physiotherapist can:

• Teach joint protection principles (avoiding positions that overstress inflamed joints, using assistive strategies when needed)

• Guide you in low-load strengthening and range of motion exercises that preserve mobility

• Provide hand therapy strategies to protect grip and dexterity

• Adapt exercise intensity according to flare or remission status

• Help you integrate pacing so movement becomes sustainable rather than draining

With the right guidance, exercise becomes a tool not just for the body but for confidence and independence.

Somatic and Mind–Body Approaches

RA is not only about inflamed joints. It is also about living with unpredictable flares, fatigue, and the mental strain of planning life around symptoms. This is where somatic and mind–body practices make a difference.

• Yoga therapy supports flexibility and posture, and improves balance between strength and mobility.

• Mindfulness and meditation change the way the brain processes pain, reducing emotional distress linked to flare cycles.

• Guided relaxation and breathwork reduce sympathetic overactivation, helping with fatigue and sleep recovery.

• Body awareness practices restore confidence in movement, reduce guarding, and allow patients to reconnect with safe and efficient patterns.

These practices complement medical and physical treatments, addressing the nervous system and the psychological burden of RA.

Psychological and Lifestyle Support

• CBT helps patients reframe pain and build healthier behaviour patterns.

• ACT helps people continue living in line with what matters most to them, even when symptoms remain.

• Nutrition: Evidence supports anti-inflammatory dietary approaches, often Mediterranean in style, for both general health and cardiovascular risk reduction.

• Sleep restoration: Essential for fatigue management and immune regulation.

Rehabilitation at Neurokinetica

At Neurokinetica, we understand that rheumatoid arthritis is not just about swollen joints. It is about mornings where your hands feel too stiff to open a jar, days where fatigue keeps you from doing what you planned, and the fear that flares or deformities could take away your independence.

We work with you to protect what matters most: your ability to move, work, and live with confidence. Our programmes combine:

• Targeted physiotherapy and exercise tailored to joint protection and mobility

• Hand-specific strategies and strengthening to maintain dexterity

• Yoga-based movement, breathwork, and guided relaxation to reduce stiffness and support nervous system balance

• Education on pacing and joint protection so you can stay active without worsening flares

• Step-by-step guidance until you feel confident in managing your condition independently

Patients often tell us they leave sessions not only moving better but also feeling clearer, calmer, and more in control of their health.

Our goal is not just short-term relief. It is to help you build the skills, strength, and confidence to live more fully with rheumatoid arthritis.

If you are searching for rheumatoid arthritis treatment in Cork, and want a tailored approach that combines medical knowledge, exercise therapy, and nervous system regulation, book a session to get an assessment and learn about rehabilitation with us.