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by Edward Lockwood, DPT

Rheumatoid arthritis is a chronic inflammatory disease that effects .5- 1 % of people in North American and Northern European. RA can have associated symptoms such as muscle weakness, fatigue, and can cause joint pain / inflammation. 1 Rheumatoid arthritis has been shown to cause decreased aerobic capacity, increased prevalence of cardiovascular disease, and can lead to reduced daily function. 3 Rheumatoid arthritis is a clinical diagnosis that is made based off of physical examination, x-ray findings, and lab / blood tests. 2

The joint pain and swelling caused from RA is thought to be from the abnormal immune response to the synovium/ synovial membrane, causing synovitis (inflammation of joint capsule). RA typically occurs with signs of multiple joints being swollen, warm, painful and stiff, particularly early in the morning on waking or following prolonged inactivity. 4

Synovitis induced by RA can lead to erosion of the joint surface, which can then cause joint deformity and loss of function 2 There are several forms of treatment for RA, most commonly usage of anti-inflammatory medication during periods of exacerbation. Research has shown that exercise and physical activity can be an effective treatment for RA. Endurance training appears to decrease the resting levels of many inflammatory markers and exercise intensity, mode, and duration can impact the immune system. 5 It had been previously thought that exercise and physical activity may induce or exacerbate RA symptoms. A 2012 article by Iversen et. Al recently concluded that data on exercise has consistently demonstrated, through systematic reviews and meta-analyses, that exercise promotes health without exacerbating disease activity and pain.3 The article also poses that the information that has been gathered regarding physical activity and RA combined with pharmacological advances in RA may drastically decrease RA- associated disability. 3

If you have RA or suspect you have RA, regular physical activity and/ or supervised physical activity ( i.e.- physical therapy) may be very helpful for improvement of your everyday function.  The best treatment is aquatic therapy.

Dr. Lockwood is a Physical Therapist at Boston Sports Medicine

1 Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun. Rev. 2005; 4(3): 130-136

2 Majithia V, Geraci SA (2007). Rheumatoid arthritis: diagnosis and management.  Am. J. Med. 120 (11): 936–9.

3 Iversen MD , Brawerman M, Iversen CN. Recommendations and the state of the evidence for physical activity interventions for adults with rheumatoid arthritis: 2007 to present. Int J clin Rheumtol. 2012 October 1 ; 7(5): 489-503

4  “An approach to Early Arthritis”. 12 January 2009.

5 Brodin N, Eurenius E, Jensen I, et al. Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study. Arthritis Rheum. 2008: 59( 3): 325 – 331