Rheumatoid arthritis

Question 1

Who commonly has RA? (Demographics)

Answer 1

Female:Male 3:1Between 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 damagePresence 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-­‐15reps 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

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 inflammationJoint pain• Inform that it is normal to have a small amount of pain or discomfort immediately after exercise – this does not necessarily mean thatjoints 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