Arthritis: What is it?

ARTHRITIS        
       There are over 100 rheumatic diseases, which cause pain due to inflammation, swelling, and pain in the joints or muscles. Arthritis is a rheumatic disease and one of the leading causes of pain and disability.  Prevalence of arthritis is said to increase drastically by the year 2030 due to the aging population and the continuous rise in obesity.  In the United States 22% of adults (18 years of age or older) are diagnosed with arthritis, while another 9.4% have reported to having arthritis-related activity limitations.

Two Most Common Rheumatic Diseases:  

1. Osteoarthritis: Local degenerative joint disease that can affect one or multiple joints
• Most common in hands, hips, spine, and knees
2. Rheumatoid Arthritis: chronic, systemic inflammatory disease in which there is a pathological activity of the immune system against joint tissues.  

*Other common rheumatic diseases:  fibromylagia, systemic lupus erythematosus, gout, and bursitis.

Treatment:

1. Medications: core components of arthritis treatmen 
• Ex: Analgesics, nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs
2. Patient education in self-management
3. Physical Therapy
4. Occupational Therapy
5. Surgeries: For later stages of disease when pain is refractory to conservative management
• Total joint replacement and other surgeries can provide substantial relief
6. *Exercise: Although pain and functional limitations can present challenges to physical activity among individuals with arthritis, regular exercise is important for managing these painful conditions. 
• Reduces pain
• Maintains muscle strength around affected joints
• Reduces joint stiffness
• Prevents functional decline
• Improves mental health
• Improves quality of life

Exercise Testing:

• High intensity exercise is contraindicated when there is acute inflammation (i.e., hot, swollen, and painful joints). If individual experiences acute inflammation, exercise testing should be postponed until the flare has subsided.
• Although some individuals with arthritis tolerate treadmill walking, use of cycle leg ergometry alone or combined with arm ergometry may be less painful for some and allow better assessment of cardiorespiratory function. The mode of exercise chosen should be a level that is least painful for the individual being tested.
• Ample time should be allowed for the individual to warm up at a light intensity before beginning the graded exercise test.
• Pain levels should be monitored during the test.  
• There are many validated scales available including the Borg CR10 Scale and visual numeric scale.
• Testing should be stopped if the patient indicates pain is too severe to continue
• Muscle strength and endurance can be measured using typical protocols.  Note that maximal muscle contraction in affected joins may be limited due to pain. 

 

  

 

Exercise Prescription:
Pain can be a major barrier when beginning and maintaining a regular exercise program.  In order to prescribe an ideal exercise program for individuals with arthritis, the program should provide minimal pain while gradually progressing in levels that provide greater health benefits.  Overall, recommendations for exercise prescriptions are consistent with those for healthy adults, but FITT recommendations should take into account an individual's pain, stability, and functional limitations.




(Lippincott, Williams, Wilkins. ACSM's Guidelines for Exercise Testing and Prescription, Ninth Edition. Baltimore. 2014)