Managing Rheumatoid Arthritis: Exercise and Medication Strategies

Skeeter Buck has been dealing with joint pain for the past 4 years, having occasional severe episodes. He experiences stiffness in his wrists, hands, knees, and feet every morning for 30 minutes to 2 hours, causing feelings of imbalance and instability. The irregularity of his joint pain also affects his appetite. Currently, he is using a Cortisone shot every 3 months along with Aleve and Tylenol to manage the pain. With a medical history of joint pain dating back 4 years and recent worsening symptoms, he comes from a family background where both his grandmother and mother have undergone surgery related to rheumatoid arthritis.

Both Grandma and his mother had joint replacement surgeries, and most of their family is overweight but has no history of diabetes or heart disease. They are married with 2 children and expecting their third, living in North Bay where he manages a bank and uses a cane during 'flare ups.' He enjoys active play with his kids and helps coach his son's hockey team.

Get quality help now

RhizMan

Verified writer

Proficient in: Case Study

4.9 (247)

“ Rhizman is absolutely amazing at what he does . I highly recommend him if you need an assignment done ”

+84 relevant experts are online

Hire writer

His wife, a dietician, ensures they regularly consume healthy meals.

Risk Factors: Non-smoker, normal cholesterol and blood glucose levels. Physical Examination General Appearance: Healthy, comfortable with good facial color. Vital Signs: Blood Pressure = 123/82 mmHg in both arms, Pulse = 72 beats per minute, Respiration = 17 breaths per minute, Weight = 82 kg, Height = 70 in. (175 cm), BMI = 27, Waist Circumference = 34in. Cardiovascular: Absence of carotid bruits and jugular venous distension, clear lungs, regular heart rate and rhythm, absence of extra heart sounds or edema, normal peripheral vascular exam.

Skin: Mild redness, swelling, and warmth around knuckles on hands and feet.

Musculoskeletal: Slow walking due to pain, slight joint swelling in hands and feet, limited range of motion. Neurologic: Cranial nerves normal, reduced fine motor skills in hand but normal sensory exam. Resting Electrocardiogram before Exercise Test: Sinus rhythm at 72 beats per minute, no abnormalities in Q waves, ST segments or T waves. Computer interpretation indicates a normal electrocardiogram. Diagnosis:

Rheumatoid arthritis impacts the wrists, hands, knees, and feet causing morning stiffness and continuous pain, especially after using the joints excessively. This results in tiredness and inability to engage in physical activity. The goal is to conduct a standard cycle ergometer test and start a training regimen focused on enhancing exercise tolerance, muscle strength, and flexibility. ** Please refer to subsequent pages for pre-screening and informed consent forms! ** PATHOPHYSIOLOGY Rheumatoid Arthritis Rheumatoid arthritis is an autoimmune condition categorized as inflammatory arthritis.

In autoimmune diseases such as rheumatoid arthritis, the immune system mistakenly attacks the body's own tissues, including the synovial lining of joints and other organs. This results in swelling, pain, inflammation, and joint damage as inflammatory cells release enzymes that break down bone and cartilage, limiting movement. Joint inflammation typically occurs symmetrically and bilaterally, impacting both sides of the body equally.

Rheumatoid arthritis is characterized by alternating periods of exacerbated symptoms and alleviation. The condition usually begins slowly in a small number of joints before rapidly progressing to additional joints over a matter of weeks or months. People with rheumatoid arthritis frequently face challenges with physical activities, impacting their flexibility, biomechanical efficiency, muscle strength, endurance, and speed, resulting in functional limitations.

There are three stages of rheumatoid arthritis disease:
1. Acute, with reversible signs and symptoms related to synovitis in the joint
2. Chronic, with stable but irreversible structural damage caused by the disease process
3. Chronic with acute exacerbation of joint symptoms, such as increased pain and decreased range of motion often due to overuse or injury.
(3) Figure:(12) Signs and Symptoms of Concern
(13) If you experience unusual pain and stiffness in your joints for more than two weeks, you should consult your doctor.

Individuals with rheumatoid arthritis frequently experience morning pain and stiffness lasting over 30-60 minutes. This can result in fatigue, reduced appetite, and weight loss. Despite joint discomfort, it is crucial for those with rheumatoid arthritis to engage in regular exercise. Studies indicate that a considerable portion of disability linked to the condition stems from poor physical fitness levels. Failure to maintain consistent exercise may lead to a decline in muscle strength and endurance.

The American College of Sports Medicine has identified three exercise goals for individuals with arthritis in order to prevent joint weakening and decrease the likelihood of chronic diseases like coronary heart disease, diabetes mellitus, and osteoporosis. These goals involve maintaining or improving range of motion and flexibility in impacted joints, increasing muscle strength and endurance for better joint stability, and enhancing aerobic capacity for improved mental health and reduced risk of heart problems.

Current research indicates that engaging in intense weight-bearing exercises can enhance joint mobility, muscle strength, and aerobic capacity for individuals with rheumatoid arthritis without causing harm to the joints. It is crucial to recognize that experiencing some discomfort after exercising is typical, but activities that result in prolonged joint pain exceeding two hours should be steered clear of, particularly in instances of acute joint inflammation or uncontrolled systemic disease.

Research shows that individuals with rheumatoid arthritis often have limited aerobic capacity due to a lack of physical activity, but engaging in aerobic exercises has been proven to be a safe and effective treatment for those without severe symptoms. The American College of Sports Medicine advises that individuals with rheumatoid arthritis should engage in activities like walking, cycling, rowing, swimming, and dancing at 60-80% of their peak heart rate or 40-60% of their VO2max. This should be done with an RPE rating of 11-16, 3-5 days a week for sessions starting at five minutes and gradually increasing to thirty minutes.

When working with individuals who have rheumatoid arthritis, it is important to focus on duration rather than intensity in order to improve VO2max, peak work, and endurance over a 4-6 month period. It is also crucial to include at least fifteen minutes of warm-up and cool-down in the exercise routine.

MEDICATION Despite the lack of a cure for rheumatoid arthritis, there are various medications available to help manage symptoms and enhance the condition. These medications belong to different categories such as NSAIDs, Corticosteroids, DMARDs, Biological Agents, Salicylates, and Pain Relief Medications.

Your doctor is likely to recommend a mix of NSAIDs (Non-steroidal Anti-inflammatory Drugs) to relieve pain and protect joints from damage. While NSAIDs effectively reduce pain and inflammation by blocking prostaglandin production, they do not shield against further joint damage. However, prolonged use of high doses of NSAIDs can result in serious side effects like stomach bleeding, gastric ulcers, and potential harm to the kidneys and liver.

Corticosteroids help manage inflammation and treat rheumatoid arthritis by suppressing the immune system. However, prolonged use can result in adverse effects such as easy bruising, glaucoma, cataracts, diabetes, excessive weight gain, and bone thinning. On the other hand, DMARDs (Disease Modifying Anti-Rheumatic Drugs) aim to prevent joint damage by stopping the immune system from causing harm to joints.

It is essential to start treatment for rheumatoid arthritis quickly in order to avoid lasting damage to the joints. However, these medications have possible dangers such as bone marrow and liver toxicity, susceptibility to infections, skin reactions, and autoimmunity. Biological agents offer a different way of reducing inflammation by blocking tumor necrosis factors.

Salicylates were once used to decrease the production of prostaglandins in the body, which can help address inflammation by eliminating Beta cells. However, their use has been replaced by NSAIDs due to adverse side effects. While pain relief medications may not prevent joint damage or reduce inflammation, they can enhance comfort and functionality. PHYSICAL ASSESSMENT PROTOCOL

Exercise testing can be utilized to evaluate baseline levels and pinpoint areas for enhancement in exercise. People with rheumatoid arthritis might encounter difficulties with maximal treadmill tests, yet they can usually handle sub-maximal treadmill tests at speeds under 3 miles per hour. Nonetheless, premature muscle fatigue could affect the precision of test outcomes. To prevent excessive strain on joints, it is advisable to opt for sub-maximal bicycle tests as they could offer more precise data for individuals with rheumatoid arthritis.

Before starting any physical testing, it is advised to complete the Arthritis Impact Measurement Scales 2 (AIMS2) questionnaire to determine the appropriate baseline test. For cardiovascular testing, cycle ergometry is recommended for individuals with mild to moderate lower-extremity impairment. It is also suggested to use protocols with small incremental increases (e.g. 10-25 W•min-1) or ramping protocols. It should be noted that the equation provided by the American College of Sport Medicine for estimating peak VO2 may overestimate functional capacity: VO2(mL-1 •min-1•kg)= 0.0698 X speed (m•min-1) + 0.8147 X grade (%) X speed (m•min-1) + 7.533 mL-1•min-1•kg (8)