Rheumatoid Arthritis (RA) Flashcards
How much of the general population is affected by RA?
Lee and Weinblatt. 2001
1% of general population
Is there a cure for rheumatoid arthritis?
Lee and Weinblatt. 2001
No cure
What are the symptoms of RA?
Pain, stiffness and swelling in joints
- Structural damage if not treated adequately
Heart, lung and blood vessels are also influenced
High grade systemic inflammation
RA is characterised by “flares”
What are other symptoms (secondary) of RA?
Treharne et al 2008 (1)
Gettings 2010 (2)
High levels of fatigue (1)
High levels of depression (1)
Wellbeing is affected (2)
What is the relationship between CVD and RA?
Kitas and Gabriel. 2011
Increased prevalence
Common cause of mortality
What are the causes of RA?
Kitas and Gabriel. 2011
Hypertension
Obesity
Inflammation
Endothelial Dysfunction/ Hypercholesterolaemia
Insulin Resistance
Physical Inactivity
How do you assess disease activity of RA?
DAS28
Inflammation
- CRP
- ESR
Joint health
- Radiographic damage
What is the medication for RA?
Focuses on reducing inflammation and relieving pain/discomfort
- Steroids
- NSAIDs
- DMARDS
- Biologics
– anti-TNF
– anti- IL-6
How does exercise influence RA?
Stavropoulos- Kalinoglou et al. 2013
Combined aerobic and resistance most commonly used
- Increase cardiorespiratory fitness
- Improve function ability
- Reduces CVD risk factors
- Do not aggravate RA
- Reduce the risk for CVD
What are the physical activity guidelines for RA?
Rausch Osthoff et al. 2018, Gwinnutt et al. 2022 (1)
Combe et al. 2017 (2)
Geenen et al. 2018, Agca et al. 2017 (3)
Nikiphorou et al. 2021 (4)
- An integral part of standard clinical care of people with RMDs
- Offered as an adjunct treatment in newly diagnosed patients
- Offered in the management of specific symptoms (Pain) and co-morbidities (Cardiovascular Disease)
- A key self-management strategy in RMDs
How does exercise influence RA compared to medication?
Veldhuijzen van Zanten et al. 2019
Disease activity was higher and functional ability lower in patients in the anti-TNF group at baseline
Both exercise and anti-TNF treatment improved DAS28 and HAQ, with a greater improvement following anti-TNF treatment
Both exercise and anti-TNF treatment induced a decrease in CRP
Endothelial-dependent and endothelial independent vascular function improved in the exercise group, but not in the anti-TNF group
What is the effect of anti-TNF treatment on CVD risk?
Veldhuijzen van Zanten et al. 2019
Improves mitigating the risk by reducing disease activity
What is the effect of exercise treatment on CVD risk?
Veldhuijzen van Zanten et al. 2019
Improves mitigating the risk by enhancing the function of the vasculature
What is the activity levels like of patients with RA compared to the general population?
Sokka et al. 2008
Tierney et al. 2012
They are less active
70% no regular activity
13.8% exercised 3x a week
What are the perceived barriers to physical activity and exercise?
Veldhuijzen van Zanten et al. 2015
Pain
Fatigue
Mobility
Stiffness
Lack of RA exercise programmes
What are the perceived benefits of physical activity and exercise?
Veldhuijzen van Zanten et al. 2015
Symptom management
Pain relief and distraction
Joint function
Independence
What are the perceived facilitators of physical activity and exercise?
Veldhuijzen van Zanten et al. 2015
Support
Exercise instructors
Health care provider
Family/friends
Strength and aerobic capacity
Are biological interventions positive at treating fatigue in individuals with RA?
Fasigogullari et al. 2023
Pope et al 2020
Yes
(apart from Adalimumab 40mg in PsA)
What are the 2 main biological interventions for treating fatigue in individuals with RA?
Fasigogullari et al. 2023
Pope et al 2020
DMARDs
Corticosteroids
In Pope et al (2020) study, what did it find about physical activity effects on fatigue in RA individuals?
The intensity of exercise uncertain
Whether supervision is required
In general, how does physical activity and fatigue relate in RA?
Rongen-Van Dartel et al 2014
Rongen-Van Dartel et al 2015
Linear association between physical activity and fatigue
When PA increases, fatigue decreases
What is often an issue when looking at the relationship between exercise and fatigue in RA individuals?
Rongen-Van Dartel et al 2014
Rongen-Van Dartel et al 2015
Fatigue is often not a primary outcome measure
How does physical activity influence fatigue in RA?
Santos et al. 2023
Positively
Significant findings (-0.5%)
What are European fatigue management recommendations for individuals with RA?
Dures et al. 2023
Regular assessment of fatigue severity, impact and coping strategies into clinical consultations
Offer access to tailored PA interventions and encourage engagement in long-term PA
Offer structured and tailored psychoeducational interventions
Presence/worsening of fatigue should trigger evaluation of inflammatory disease activity status and consideration of treatment
What is RA?
Kucharski et al. 2019
A chronic inflammatory disease characterised by joint pain, stiffness and inflammation of joint synovial tissue
What is fatigue?
Kucharski et al. 2019
Fatigue is an “overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work”
