Get Moving to Slow Down Rheumatoid Arthritis
Vigorous physical exercise does not appear to damage the joints of people with rheumatoid arthritis (RA) and may actually have a protective effect, according to the Annals of the Rheumatic Diseases (2004;63:1399–1405).
RA is an autoimmune inflammatory condition of the joints that causes pain, warmth, swelling, and stiffness, and sometimes fatigue and flu-like symptoms. More common in women than in men, RA affects over two million Americans, with symptoms usually beginning between ages 30 and 50. As the disease progresses, the cartilage and bones of the joints sometimes become irreversibly damaged. RA most frequently affects the joints of the hands and wrists, causing characteristic deformities in these areas; it may also affect the neck, shoulders, hips, knees, ankles, and feet. Other organs including the lungs, heart, skin, and eyes may also be involved. People with RA are at an increased risk of developing thinning of the bones (osteoporosis). The symptoms of RA usually occur periodically, with flare-ups and remissions.
Although there is no cure, early treatment is recommended to slow the process of joint deterioration. Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil™) decrease pain and inflammation of the affected joints. Long-term use of NSAIDS, however, may damage the gastrointestinal tract, causing irritation and bleeding. Corticosteroids such as prednisone are used in more severe cases to decrease inflammation. Unfortunately, corticosteroids may further increase the chance of developing osteoporosis. Disease-modifying anti-rheumatic drugs (DMARDS) are also used to try to slow damage of the affected joints. Commonly prescribed DMARDS are methotrexate (Rheumatrex™) and sulfasalazine (Azaline™). While these drugs can have beneficial effects on the symptoms and progression of RA, they are associated with serious side effects including seizures and kidney failure (Rheumatrex™), and liver damage and anemia
Previous studies have shown that intensive physical exercise does not appear to increase damage to the large joints in people affected by RA. The new study aimed to investigate the effects of a high-intensity exercise program on the
smaller joints of the hands and feet. The participants were enrolled in the Rheumatoid Arthritis Patients in Training study; 281 people completed the two-year trial. The participants were assigned to either a usual-care group or to an exercise group. The usual-care group received physical therapy as deemed appropriate by the physician but did not partake in high-intensity exercise. The exercise group engaged in supervised intensive exercise sessions two times per week, including bicycling, stair walking, step exercises, and sport and game exercises. Over the course of the study, the following parameters were measured to assess the response to the different treatments: change in the amount of joint damage in the hands and feet, amount of disease activity (determined by the degree of swelling, pain, laboratory tests of inflammation, and the participant’s perception of disease activity), use of medications to manage symptoms, and change in the level of aerobic fitness.
Arthritis-related damage to the joints of the hands and feet occurred significantly more slowly in the exercise group than in the usual-care group. This difference was most pronounced in the feet. There were no significant differences between the groups in the use of DMARDS or corticosteroids over the two years and no significant difference in the level of disease activity was found between the groups.
The results of the new study suggest that a regular intensive exercise program has a protective effect on the small joints in people with RA, potentially slowing disease progression.
Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.
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