Rheumatoid Arthritis Flashcards
What is RA?
An autoimmune disease
Is are more prevalent in men or women?
women
What % of the population does RA effect?
1%
Why is there no cure?
As the aetiology (cause) is not known
What are the symptoms of RA?
-Pain, stiffness and swelling in joints
-Heart, lung and blood vessels inflamed
-RA is characterised by ‘flares’
As well as the joints, what are additional symptoms of RA?
-High levels of fatigue
-high levels of depression
-wellbeing is effected
What is a common cause of mortality in RA patients?
Cardiovascular disease as there is an increased prevalence
What are the potential causes of RA?
-Hypertension
-Obesity
-Insulin resistance
-Endothelial dysfunction
-Hypercholesterolaemia
-Physical inactivity
How do you assess RA?
-DAS28
-Inflammation
-‘Joint’ health radiographic image
What is medication for RA focused on?
-decrease inflammation
-reliving pain and discomfort
What are the types of medication for RA?
-Steroids
-NSADIs
-DMARDs
-Biologies (Anti-TNF/anti- IL-6)
(patients are often on a mix of medications)
What is improved with exercise in RA?
-disease activity
-functional ability
-improved CV risk factor with exercise
How is the risk of CV reduced in RA with exercise?
-decrease blood pressure
-improvement in endothelial function with exercise
What is the most common form of exercise used for individuals with RA?
Aerobic and resistance
What do appropriate exercise programmes include?
-increase to cardiorespiratory fitness
-does not aggravate RA
-increase functional ability
-decrease risk of CVD
-support for fatigue
What are the physical guidelines for an individual with RA?
70%VO2max
3x per week
How does medication and exercise effect the CVD risk?
medication- reduces CVD risk by decreasing disease activity
exercise- improves CVD risk by increased function of the vascular
When should PA be increased?
When an individual responds to medication (anti-TNF)
What % of RA patients are not regularly active?
70%
What % of RA patients exercise 3x per week?
13.8%
What are some barriers for exercising in RA patients?
-Pain
-Fatigue
-Stiffness
-Mobility
-Lack of RA exercise programmes
What are the benefits of exercising in RA patients?
-Symptom management
-Pain relief and distraction
-Joint function
-Independence
What are the facilitators of exercising in RA patients?
-Support
-Exercise Instructors
-Health care providers
-Family/Friends
-Strength and aerobic capacity
What benefit does improved self-efficacy have in people with RA?
more chance of overcoming the barriers for exercise
Within the intervention, what will increase autonomy of the individual?
-promotes choice and understanding
-provides rationale
-input into the decision making
-promoting motivation
How is autonomous motivation improved?
Via exercise
What help is needed during the exercise programme?
-right intensity to achieve health benefits
-help changing motivation into action
-intense support
What are the European PA guidelines for RA?
-Clear personalised aims, evaluated over time
-Type, intensity, frequency, duration, mode should all be personalised
What should a PA intervention for RA patients include according to the European PA guidelines for RA?
-self-monitoring techniques
-goal setting
-action planning
-feedback
-problem solving
What should PA recommendations aim to improve according to the European PA guidelines for RA?
-Cardiorespiratory fitness
-Muscle strength
-Flexibility
-Neuromotor performance
What does RA contribute too? why?
-fatigue
-inflammation and pain and side effect of medication
RA effects mental health. What does this impact?
-behavioural responses
-cognitive appraisal
-mood
–>this can all impact on fatigue
What is a way of treating fatigue?
-medication (DMARDs)
-adjusting medications
-PA (reference- Pope et al, 2020)
How long should an exercise intervention be to prove effective in helping improve fatigue?
<12weeks rather than 24weeks
(reference- Ronger-Van Dartel et al, 2014)
What are the European fatigue management recommendations?
-health professionals should regularly assess fatigue severity, impact and coping strategies into clinical consultations
-as part of their clinical care, RA and fatigue suffers should be offered tailored PA interventions and encouraged into longer term PA
(reference- Dures et al, 2023)
