Other symptoms include fatigue, articular stiffness, anorexia and fever. A complaint of pain and limited lifestyle are the characteristic features of the onset of the disease. If left untreated, the inflammation will result in serious life-threatening conditions during its progression. Morbidity, progressive disability and hastened mortality feature the untreated disease conditions. As a result, it entails serious economic implications for both the patients and their families as well as society as the affected people are unable to continue in their employment with the same efficiency as before with the normal functioning of their palms, feet and gait seriously affected and progressively disfigured and disabled (Cush, Weinblatt, Kavanaugh, 2010). According to the National Audit Office, there are around 580,000 people afflicted with RA with additional 26,000 new cases every year. The disease affects people of age between 40 to 60 years with women who are three times more likely to be affected than men. The patient referred herein for treatment also happens to be a woman aged 40. This being an auto-immune disease, affects small joints of the hand and feet. If severe, it reduces life expectancy by 6-10 years as a result of co-morbidity through cardio-vascular diseases or side effects from treatment (Home Carr, n.d.) The disease reduces the affected person’s work-life by five years. Its annual cost to the U.K. economy is estimated to be between £ 3.8 and £ 4.75 billion (NationalAuditOffice, 2009). There are many institutions engaged in the care of RA with their own guidelines for treatment. British Society for Rheumatology (BSR, (n.d)), NHS (NHS, n.d.), National Rheumatoid Arthritis Society (NRAS) (NRAS, n.d.), The Society of Chiropodists and Podiatrists (SCPOD, n.d.), The Musculoskeletal Services Framework (DeptOfHealth, 2006), NSF long-term conditions (DeptOfHealth, Department of Health, 2005), 18-week commissioning pathway (DeptOfHealth, Department of Health, 2006) and Podiatry rheumatic care associations (PodiatryRheumaticCareAssociation, n.d.) are the major sources of standards of care for RA conditions.

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