Rheumatoid Arthritis

Question 1

Who commonly has RA? (Demographics)

Answer 1

Female:Male 3:1
Between 35yoa and 50yoa
Associated with Raynauds syndrome

Question 2

What causes RA? (Aetiology)

Answer 2

Unknown

Question 3

What is RA?

Answer 3

A chronic systemic inflammatory autoimmune disease
The immune system targets the lining of the joints, causing inflammation and joint damage
Presence of autoantibodies
Genetic link

Question 4

What happens to the joints in patients with RA?

Pathophysiology

Answer 4

Inflammation, thickens synovial membrane,

degrades cartilage and bone.

Question 5

What problems do patients with RA suffer?

Signs and Symptoms

Answer 5

Joint pain, swelling and tenderness to touch.
Morning stiffness lasting longer than 1 hour
Nocturnal pain – wakes pt.
Pain worse with rest and improves with activity. Generalized afternoon fatigue and malaise, anorexia, generalized weakness. Occasionally low-grade fever. Often also dry eyes and mouth. Systemic upset.

Question 6

What is the prognosis of RA?

Answer 6

No cure, hard to reverse damage but early intervention does help to prevent extent of damage

Question 7

Describe conventional therapies for RA

Answer 7

Palliative
Anti rheumatic Drugs
Methotexate (Suppresses nucleic acid and therefore DNA synthesis)

Question 8

Role of aerobic exercise rehab in RA

Neuberger Study

Answer 8

• Exercise had positive effects on walk time and grip strength
• Fatigue and perceived benefits and barriers to exercise affected Exercise Px
• Overall symptoms of fatigue, pain and depression were positively influenced.

Question 9

Aerobic Exercise Recommendations for RA:

Answer 9

AEROBIC
• Frequency
– 3-5 days/week
• Intensity
– 40-60% HRR or VO2R (or 30-40% if deconditioned)
• Time
– ≥ 150 minutes per week
– Initial bouts of 10 minutes may be appropriate
• Type
– Modalities associated with low joint stress (i.e., walking, cycling)
– High impact activities not recommended (i.e., running, stair climbing, stop and go actions)

Question 10

Resistance Exercise Recommendations for RA:

Answer 10

RESISTANCE
• Frequency
– 2-­‐3 days/week
• Intensity
– 10-­‐15
reps at 40-­‐60%
1RM
• Time – 1 or more sets of ~8-­‐10 exercises
• Type – All major muscle groups should be covered

Question 11

Flexibility Exercise Recommendations for RA:

Answer 11

FLEXIBILITY
All major muscle groups
• Should be performed daily – morning better than afternoon

Question 12

Contraindications and Adverse Effects of Exercise in RA:

Answer 12

• Encourage individuals to exercise at time of peak activity of pain medications
• Avoid strenuous exercises during acute flare ups and periods of inflammation
Joint pain
• Inform that it is normal to have a small amount of pain or discomfort immediately after exercise – this does not necessarily mean that
joints are being further damaged.
• However, if pain is higher 2 hours after exercise than it was prior to exercise, intensity and/or duration may need to be reduced in future sessions