Rheumatoid Arthritis (RA)

Question 1

How much of the general population is affected by RA?

Lee and Weinblatt. 2001

Answer 1

1% of general population

Question 2

Is there a cure for rheumatoid arthritis?

Lee and Weinblatt. 2001

Answer 2

No cure

Question 3

What are the symptoms of RA?

Answer 3

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”

Question 4

What are other symptoms (secondary) of RA?

Treharne et al 2008 (1)
Gettings 2010 (2)

Answer 4

High levels of fatigue (1)

High levels of depression (1)

Wellbeing is affected (2)

Question 5

What is the relationship between CVD and RA?

Kitas and Gabriel. 2011

Answer 5

Increased prevalence

Common cause of mortality

Question 6

What are the causes of RA?

Kitas and Gabriel. 2011

Answer 6

Hypertension

Obesity

Inflammation

Endothelial Dysfunction/ Hypercholesterolaemia

Insulin Resistance

Physical Inactivity

Question 7

How do you assess disease activity of RA?

Answer 7

DAS28

Inflammation
- CRP
- ESR

Joint health
- Radiographic damage

Question 8

What is the medication for RA?

Answer 8

Focuses on reducing inflammation and relieving pain/discomfort

• Steroids
• NSAIDs
• DMARDS
• Biologics
  – anti-TNF
  – anti- IL-6

Question 9

How does exercise influence RA?

Stavropoulos- Kalinoglou et al. 2013

Answer 9

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

Question 10

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)

Answer 10

1. An integral part of standard clinical care of people with RMDs
2. Offered as an adjunct treatment in newly diagnosed patients
3. Offered in the management of specific symptoms (Pain) and co-morbidities (Cardiovascular Disease)
4. A key self-management strategy in RMDs

Question 11

How does exercise influence RA compared to medication?

Veldhuijzen van Zanten et al. 2019

Answer 11

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

Question 12

What is the effect of anti-TNF treatment on CVD risk?

Veldhuijzen van Zanten et al. 2019

Answer 12

Improves mitigating the risk by reducing disease activity

Question 13

What is the effect of exercise treatment on CVD risk?

Veldhuijzen van Zanten et al. 2019

Answer 13

Improves mitigating the risk by enhancing the function of the vasculature

Question 14

What is the activity levels like of patients with RA compared to the general population?

Sokka et al. 2008
Tierney et al. 2012

Answer 14

They are less active

70% no regular activity

13.8% exercised 3x a week

Question 15

What are the perceived barriers to physical activity and exercise?

Veldhuijzen van Zanten et al. 2015

Answer 15

Pain

Fatigue

Mobility

Stiffness

Lack of RA exercise programmes

Question 16

What are the perceived benefits of physical activity and exercise?

Veldhuijzen van Zanten et al. 2015

Answer 16

Symptom management

Pain relief and distraction

Joint function

Independence

Question 17

What are the perceived facilitators of physical activity and exercise?

Veldhuijzen van Zanten et al. 2015

Answer 17

Support

Exercise instructors

Health care provider

Family/friends

Strength and aerobic capacity

Question 18

Are biological interventions positive at treating fatigue in individuals with RA?

Fasigogullari et al. 2023
Pope et al 2020

Answer 18

Yes

(apart from Adalimumab 40mg in PsA)

Question 19

What are the 2 main biological interventions for treating fatigue in individuals with RA?

Fasigogullari et al. 2023
Pope et al 2020

Answer 19

DMARDs
Corticosteroids

Question 20

In Pope et al (2020) study, what did it find about physical activity effects on fatigue in RA individuals?

Answer 20

The intensity of exercise uncertain

Whether supervision is required

Question 21

In general, how does physical activity and fatigue relate in RA?

Rongen-Van Dartel et al 2014
Rongen-Van Dartel et al 2015

Answer 21

Linear association between physical activity and fatigue

When PA increases, fatigue decreases

Question 22

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

Answer 22

Fatigue is often not a primary outcome measure

Question 23

How does physical activity influence fatigue in RA?

Santos et al. 2023

Answer 23

Positively

Significant findings (-0.5%)

Question 24

What are European fatigue management recommendations for individuals with RA?

Dures et al. 2023

Answer 24

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

Question 25

What is RA?

Kucharski et al. 2019

Answer 25

A chronic inflammatory disease characterised by joint pain, stiffness and inflammation of joint synovial tissue

Question 26

What is fatigue?

Kucharski et al. 2019

Answer 26

Fatigue is an “overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work”