What Causes Rheumatoid Arthritis
The exact cause of rheumatoid arthritis is unknown. However, it is believed to be caused by a combination the following factors:
- The environment
Normally, the immune system protects the body from disease. In people who have rheumatoid arthritis, somethingpossibly infections, cigarette smoking, and physical or emotional stress, among other causestriggers the immune system to attack the joints .
Gender, heredity, and genes largely determine a person’s risk of developing rheumatoid arthritis. For example, women are about three times more likely than men to develop rheumatoid arthritis.
Recommendation : Behaviour Change Techniques
BCTs should be an integral component of PA-interventions. Several behaviour change theories were used in PA promotion interventions in the field of RA and HOA/KOA, but the reporting was poor. Future research based on theories in design, evaluation and interpretation of findings is needed.
A meta-analysis of six RCTs investigating the effects of a PA promotion intervention according to general PA recommendations and based on counselling interventions that apply BCTs showed a small beneficial effect on PA level. Counselling interventions show a small beneficial effect if BCTs are applied.
Pharmaceutical And Behavioural Interventions For Treating Rheumatoid Cachexia
Although cachexia in RA was first noted almost 150 years ago , rheumatoid cachexia has only received research attention in the last two decades. Although the lack of established diagnostic criteria for rheumatoid cachexia impairs establishing its prevalence, studies agree that even when disease activity is well-controlled, the majority of patients with RA present with adverse changes to their body composition . Given the combined detrimental effects of muscle mass loss and increased adiposity , successful interventions that reverse rheumatoid cachexia are necessary and could potentially reduce the economic and social impact of RA .
Similarly, preliminary unpublished data from an on-going trial investigating the effects of the current treat-to-target strategy indicates that while this treatment is very successful in lowering disease activity , it is having no effect on rectifying body composition with no beneficial effect on objective functional tests when compared to data collected in laboratories pre-T2T . Although more research is required in this area, it is apparent that even successful control of disease activity by pharmaceutical means does not reverse the adverse changes in body composition that are a common feature of RA.
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Living A Sedentary Lifestyle
As with many forms of arthritis, motion is lotion, meaning that some form of physical activity and exercise is beneficial, says Makol. People with arthritis who exercise regularly have better daily functioning, more energy, and less pain, according to the ACR.
A sedentary lifestyle can harm your health in many ways, from increasing your risk for heart disease to further damaging your joints. A lack of muscle strength can mean a lack of joint protection, Deane says. Exercise and physical activity also seem to have some anti-inflammatory effects that may have benefits for people with RA.
You dont need to run a marathon to reap the benefits of exercise. Low-impact aerobic exercises incorporating some strength training, joint protection principles, and stretching for flexibility are most optimal for people with RA, says Makol. Talk to your doctor or physical therapist about creating a personalized exercise plan that works for you.
Recommendation : Evaluation Of Pa
The PA level and the exercise domains should be routinely assessed. Of 11 trials investigating the effect of PA promotion interventions, three RCTs described baseline screening to distinguish between active and non-active persons before starting the tailored PA-intervention. Specific tools are needed to assess each domain.15,p. 68
Activities That May Be Too Much For Your Joints
Be careful about activities that put a lot of stress on a joint or are “high-impact,” such as lifting heavy weights or jogging, especially on paved roads.
Most experts agree that if exercise causes pain that lasts for more than 1 hour, itâs too much. Check with your doctor or physical therapist if you notice:
- Unusual or long-lasting fatigue
Ra And Exercise: Does Exercise Help With Pain And Inflammation
As part of a well-rounded treatment strategy, it is important to include exercise for rheumatoid arthritis . Though it may seem difficult or challenging to exercise, especially when dealing with chronic pain, physical activity is necessary to increase joint function, strengthen muscles, and improve overall health and energy levels.
While exercise is very important in RA treatment regimens, there are a few risks. Be sure to practice safe exercises and combine them with stretching and strength building activities for better physical health.
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Adjust Exercises According To Symptoms
People the intensity of an exercise on days when symptoms are more severe. For example, they could place a resistance band around the forearms instead of holding it in the hands.
Alternatively, they can try a different type of exercise or exercise for a shorter time.
On days when cycling or swimming seems too much, switching this type of activity to a leisurely stroll or some stretching will still be beneficial.
Whats Ok For Me To Do
If you donât already exercise, check with your doctor first. Tell them what you want to do, and ask what types of things will be best for you and what you should avoid.
Your exercise plan will probably include low-impact activities such as:
- Using an elliptical machine
Any of these will get your heart pumping. Youâll hear this called cardio or aerobic exercise. Picking something you enjoy will help you succeed.
Strength training uses resistance to work your muscles. You can use machines at a gym, hand-held weights, resistance bands, or even your own body weight. This makes muscles stronger and increases the amount of activity you can do.
Itâll take time to get stronger. Make your strength training workouts harder over time. Do them every other day if you can. If you’re new to weightlifting, book a few sessions with a physical therapist or a trainer for pointers.
You can also do stretching exercises, but they should be gentle. Never stretch a muscle thatâs not warmed up. Ask your physical therapist how and when you should stretch.
After your doctor gives the OK, try to do 20 to 30 minutes of low-impact conditioning exercise on as many days as you feel up to it. Remember, some exercise is better than none!
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Recommendation : Personalised Aims And Evaluation
The PA-interventions should be based on individual aims, which should be regularly evaluated. This can be done by PA assessments and any other assessments related to the individual aims. As PA assessments, performancebased tests, patient-reported outcome measures and self-monitoring tools were identified. However, we did not evaluate the validity and reliability of the assessments applied.
My Second Arthritic Step Forward
I joined the Arthritis Research Canada patient advisory board in September 2018. If I were to experience benefits from exercise to treat my RA, I wanted those results to be recorded in research so health care providers could use this information to help their patients and other people with RA could learn from my experience to improve their health.
When I joined a research study being led by Jasmin Ma, MSc, PhD, a post-doctoral fellow in Knowledge Translation at Arthritis Research Canada and the University of British Columbia, I discovered I wasnt alone in my barriers to strength training.
Many others living with RA were experiencing the same setbacks as I was. Her research is focused on supporting people with rheumatoid arthritis to start and stick to strength training, and developing methods for tailored physical activity interventions.
I met a lot of other patients with similar interests and struggles when I participated in this research. Fellow patients speak a certain language that only we understand its from our lived experiences with our diseases. This is also why patient engagement in research is so important.
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What Are The Symptoms Of Rheumatoid Arthritis
The symptoms of rheumatoid arthritis include the following:
- Stiffness, especially in the morning or after sitting for long periods
Rheumatoid arthritis affects each person differently. In most people, joint symptoms may develop gradually over several years. In other people, rheumatoid arthritis may proceed rapidly. A few people may have rheumatoid arthritis for a limited period of time and then go into remission .
Cartilage normally acts as a shock absorber between the joints. Uncontrolled inflammation causes the destruction and wearing down of the cartilage, which leads to joint deformities. Eventually, the bone itself erodes, potentially leading to fusion of the joint . This process is aided by specific cells and substances of the immune system, which are produced in the joints but also circulate and cause symptoms throughout the body.
Exercise And Cardiovascular Disease Risk
It is well established that RA is associated with an increased risk for CVD, with cardiovascular events typically occurring approximately a decade earlier in patients with RA compared to the general population . This increased risk may be partly due to the increased prevalence of hypertension , hypercholesterolemia , vascular dysfunction and insulin resistance seen in patients with RA. In addition, the significant inflammation-induced alterations in body composition have been implicated in this increased CVD risk . However, all these factors collectively can only partly explain the increased CVD risk in RA. This suggests that an interplay of these factors with other parameters may exist which contribute to the 50 to 100% increased prevalence of CVD in RA .
The reasons why high-intensity exercise has such profound effects on the cardiovascular profile in RA warrants further investigation in appropriately designed trials. However, in patients with RA, exercise-induced reductions in fat mass were independently associated with the beneficial changes in blood pressure and inflammatory biomarkers . So again, the significant exercise-induced changes in body composition may account for this and, hence, exercise holds significant promise in improving the cardiovascular profile of patients with RA.
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Considerations And Contraindications For Rheumatoid Arthritis Massage:
- when inflamed: no hot hydro and No Testing except Active ROM
- treatment with any fever is contraindicated
- local or distal massage on acutely inflamed joints is contraindicated
- aggressive joint play is contraindicated
- avoid giving active or passive ROM of the joint as homecare if joint acutely inflamed
- between flare ups, deep vigorous techniques may provoke inflammation
- no stretching if joint is hypermobile
- do not fatigue muscle with strengthening
- in severe cases, C1 and C2 may become unstable. In this case, NO tractioning and Passive ROM of the cervical spine
Cold Therapy For Rheumatoid Arthritis
If your joints are inflamed, it makes sense that something cold could ease the inflammation and thus the pain. The main benefits of cold therapy are reducing inflammation, swelling, and soreness, as well as temporarily relieving joint pain caused by an arthritis flare.
Like heat therapy, cold therapy comes in several forms. Cold packs that you place directly on an aching joint include everything from common items bags of frozen peas or gel packs found at the drugstore to complete systems of coolers, cooling pads, and devices shaped to certain parts of the body, like the knees and back.
Another simple method of cooling the joints is a cool-water soak in a tub just don’t let the water get so cold that you become chilled. There also are widely available over-the-counter cold sprays and ointments, such as Biofreeze and CryoDerm, that relieve inflammation by numbing the nerves.
One word of caution: If you have Raynaud’s syndrome, a condition in which small blood vessels in the fingers or toes constrict when exposed to cold, you probably should not use cold therapy on the affected part of your body. Of course, you should always consult your doctor or physical therapist before trying heat or cold therapy for rheumatoid arthritis.
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What Is Rheumatoid Arthritis
Arthritis is a general term for inflammation in joints. Rheumatoid arthritis is a type of chronic arthritis that occurs in joints on both sides of the body , which helps distinguish it from other types of arthritis.
In addition to affecting the joints, rheumatoid arthritis may occasionally affect other parts of the body, including the skin, eyes, lungs, heart, blood, nerves, or kidneys.
Rheumatoid arthritis is an autoimmune disease, meaning that patients immune system is overreacting against itself. The result can cause some or all of the symptoms of rheumatoid arthritis.
Education Agenda For Physical Activity In People With Inflammatory Arthritis And Osteoarthritis
Increase knowledge about PA among health professionals , physicians and people with inflammatory arthritis and osteoarthritis.
Increase HPs and physicians skills in communicating the role of PA in managing general health and disease-specific issues.
Include knowledge and skills on PA promotion in all HPs and physicians undergraduate training curricula.
Develop a EULAR training module on PA for HPs and rheumatologists.
Propose a session on PA at every EULAR congress.
Develop education materials for people with inflammatory arthritis and osteoarthritis.
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Exercise And Body Composition
In patients with RA, resistance training alone has been found to significantly increase muscle mass probably due to the increased muscle levels of insulin-like growth factor-I that coincide with the hypertrophic response to resistance training . Combining resistance and aerobic training also results in increases in the muscle cross-sectional area of type I and II muscle fibers in patients with RA by 6 wk , while significant improvements in electromyographic activity and quadriceps femoris cross-sectional area are evident after 21 wk . These findings are in line with the strengthening and hypertrophic responses seen in healthy individuals following appropriate exercise training . In fact, Hakkinen et al. has directly compared women with RA with age-matched healthy women and showed comparable absolute and relative increases in strength as well as similar increases in quadriceps femoris thickness and reductions in quadriceps femoris subcutaneous fat thickness following completion of the same combined strength and aerobic training program . This similarity in training response is consistent with reports that muscle quality is maintained in RA despite reductions in muscle quantity .
Precautions For Avoiding Complications
The first step in minimizing unwanted results is to begin by injecting temporary fillers. This will enable both the patient and the treating physician to evaluate the cosmetic results and decide whether or not a more permanent filler would be desirable.
Swelling and bruising can be minimised by avoiding the use of anticoagulant medication or over-the-counter products and applying ice-packs before and after a treatment along with gentle but firm pressure after a treatment.
A thorough understanding of the different recommended depths for injecting different products is also mandatory to avoid the reactions associated with injections placed too superficially. As a general rule, non-permanent, absorbable fillers can be injected more superficially and the more permanent fillers need to be injected more deeply.
Exaggerated and repeated movements should be minimised during the first 3 days after a treatment to minimise product migration/displacement..
As already stated, bovine-derived collagen products must be skin tested before treatment.
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Research And Education Agendas
Based on the gaps identified in the literature, the TF discussed and proposed a research agenda with the prioritised research topics and an education agenda with topics for education and training in PA promotion for HCPs. Evidence on impact of sedentary behaviour emerged as an important future research topic.
Recommendation : Delivery Of Pa
The delivery of interventions should be performed by HCPs competent in the field of PA principles and rheumatic conditions. The reporting of training on PA guidelines was rare. One study described a 4hours education session on cardiovascular training, others described the instructing person as trained or experienced. Some studies with focus on the promotion of daily PA described training sessions on behaviour change skills like Motivational Interviewing.
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Recommendation : Modes Of Delivery
HCPs should consider the whole range of modes to deliver interventions. No evidence on the superiority of specific delivery modes was found. The delivery modes of PA-interventions vary considerably and are mostly described as land-based and/or water-based and supervised and individualised, the latter usually applied to group settings. As booster strategies phone calls, devices , home visits, log book, web-based instructions, written material, visual instructions were reported.
How Is Rheumatoid Arthritis Treated
The goals of rheumatoid arthritis treatment are to:
- Control a patient’s signs and symptoms.
- Prevent joint damage.
- Maintain the patients quality of life and ability to function.
Joint damage generally occurs within the first two years of diagnosis, so it is important to diagnose and treat rheumatoid arthritis in the window of opportunity to prevent long-term consequences.
Treatments for rheumatoid arthritis include medications, rest, exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.
The type of treatment will depend on several factors, including the person’s age, overall health, medical history, and the severity of the arthritis.
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Pay Attention To Small Things
Most exercises focus on large muscle groups. It is essential to make time for smaller parts of the body, such as the hands and fingers. It is also important to do small exercises with the toes and feet. Exercises that help with balance, such as yoga, are important also.
Creating a daily routine for these exercises can help.
Making Your Exercise Plan
Exercise for RA is critical in the overall treatment plan. However, appropriate types and levels of exercise depend on the disease stage and each patients unique case. Talk to your rheumatologist about the recommend types of exercise that will work best for you.
You may also consider working directly with a physical therapist for additional support. Always be sure to protect your health and not push your body too hard. Light, consistent exercise can go a long way towards improving RA symptoms and enhancing mental and emotional well-being.
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