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Rheumatoid Arthritis and Aerobic Exercise

Patient Presents

Jody has been seeing a rheumatologist; below is a summary of a recent visit.

Chief complaints: pain, swelling, and stiffness.

Other complaints: myalgias, malar rash, photosensitivity, dryness of eyes and throat, cold intolerance, epigastric and gastrointestinal discomfort, difficulty sleeping, and depression.

Appearance: The patient is a 50-year-old woman weighing 188.5 lbs.

Vital signs: pulse: 68 bpm, blood pressure: 122/76.

She exhibited symptoms consistent with arthritis (RA), systemic lupus erythematosus, mixed connective tissue disease, and fibromyalgia. The rheumatologist ordered x-rays which showed mild osteoarthritic changes in several joints and laboratory tests which came back negative for FANA and rheumatoid factor.

It took approximately 5 years for a rheumatologist to make a definitive diagnosis which is not unusual.

At this time the patient’s diagnosis is seronegative rheumatoid arthritis and fibromyalgia.

Physical Exam and History

Some physical findings of particular interest due to the diagnosis include:

* morning stiffness lasting from ten minutes to over an hour
* general strength of 4/5 (80% of normal)
* metatarsalgia
* deformity of toes of both feet
* swan-necking and ulnar deviation of the fingers of both hands
* swelling of various joints

Through the course of her disease, Jody has been on many different medications, including:

* A variety of NSAIDS (non-steroidal anti-inflammatory drugs)
* DMARDs (disease modifying anti-rheumatic disease) e.g. plaquinel, oral gold
* Medications for gastrointestinal problems: Cytotec®, Zantac®
* Pharmaceuticals for fibromyalgia: Elavil®, amitryptyline
* Prednisone for inflammatory flares

Due to muscular weakness, joint stiffness, fatigue, decreased endurance, disturbed sleep, and depression, the doctor also ordered exercise.

Jody consulted a physical therapist and she began to participate in an exercise research project and then in a community-based exercise program.

Think about the special benefits of exercise for people with arthritis:

* Stronger muscles protect joints from injuries, reduce pain, and improve function. (Exercises slideshow.)
* Better flexibility decreases pain and risk of injuries during activity.
* Stronger bones reduce the risks of osteoporosis and fractures.
* Better coordination reduces the risk of falls and increases efficiency.
* Increased endurance improves energy levels and reduces fatigue.
* Regular motion and weight-bearing nourishes and strengthens joints, including cartilage and bone.
* Being physically active improves sleep and mood and lessens depression and anxiety.

In addition, people with arthritis who exercise regularly also report:

* Less joint pain and swelling.
* Less morning stiffness.
* Increased participation in physical activity.
* Involvement in more social activities.
* Improved self-efficacy for managing pain and other symptoms.
* Less fear of pain.
* They regained control over their lives and their arthritis.

Comprehensive Exercise Program

A comprehensive exercise program the three kinds of exercise: strength, flexibility, and cardiovascular fitness/endurance.

* Strengthening can be done using weights, machines, body weight, rubber bands or whatever is available to you that you enjoy using for resistance.
* Flexibility involves stretching that can be done in a class or on your own or however you prefer.
* Cardiovascular fitness/endurance can be achieved by activities such as walking or swimming.

Physical Therapist’s Viewpoint

As a physical therapist for over 30 years, I have seen our treatment of arthritis and expectations of treatment change dramatically. Probably the greatest impact in the last 15 years has come from the positive results from research on exercise and arthritis and the advances in drugs used to treat a number of rheumatic diseases. As we have learned more about the feasibility and benefits of conditioning exercise for people with many different types of arthritis, we also have developed safe and effective drugs to stop inflammation and slow or stop the progression of disease. We can’t cure arthritis, yet, but good medical care combined with exercise and education for self-management go along way toward decreasing the loss of function and disability we used to think was inevitable.

When I started as a PT, we barely knew the pathogenesis of rheumatoid arthritis and didn’t even think that osteoarthritis could be managed. The most we had for treatment were range of motion exercises and thermal modalities. It was disheartening to have so little to offer. Now there is so much that can be done. Our challenge today is to encourage people to seek good professional care early and to start effective disease management without delay.

We now know that people with arthritis can improve flexibility, endurance, strength and cardiovascular fitness with regular exercise. Their arthritis does not get worse with increased activity. In fact, regular exercise appears to have a positive effect on disease-related problems such as joint swelling, morning stiffness, pain, depression and lost function. Appropriate exercise and maintenance of adequate levels of physical activity are important components of improved outcomes and are well within the scope of self-management. All people with arthritis should be told about the importance of exercise, and provided appropriate information and ongoing support to become successful exercise self-managers. We know too much about the safety and benefits of exercise to not make it a part of everyone’s comprehensive care.

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