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Rheumatoid Arthritis New Research to Guide Clinical Management

Over the past decade, Advanced Physiotherapy has published 15 bulletins outlining the research demonstrating supervised exercise therapy to be a good first-line treatment in osteoarthritis

On the other hand, this is the first bulletin produced by this practice focusing on rheumatoid arthritis. In as much as rheumatoid arthritis is an autoimmune disease,1 the role of exercise therapy is less clear. Most guidelines that evaluate physiological therapeutics recommend exercise therapy and education most frequently, but this often relies heavily on expert consensus.2

Fortunately, two reviews published in the last year have been able to make evidence-based recommendations concerning exercise therapy and rheumatoid arthritis. Disability, Function, Pain, Quality of Life To inform the development of new guidelines, a research team in Japan performed a systematic review and meta-analysis focusing on patient-reported outcomes.3

Their review covers 662 articles including nine randomised, controlled trials. Researchers were able to conclude that patients report significant improvements in disability, function, pain, and quality of life following supervised exercise therapy. Sarcopenia Another research team from Taipei Medical University looked specifically at the sarcopenia often associated with rheumatoid arthritis.4 Their meta-analysis included nine randomised, controlled trials. Similarly, researchers concluded that supervised exercise therapy effectively increases muscle mass for patients with comorbid rheumatoid arthritis and sarcopenia.

Supervised Group Exercise to Optimize Long-term Results Studies find that long-term adherence to a plan of therapeutic exercise promotes long-term outcomes. That being the case, home/independent exercise programmes prove less effective, as adherence with these programmes remains low.5 On the other hand, supervised group classes prove effective in both encouraging adherence and in long-term pain, strength, and function outcomes.

At Advanced, exercise physiology offers both generally supervised exercise at our patient-only gym as well as Get Active Classes, both serving as good options for follow-up after individually supervised therapeutic exercise programs. Cardiovascular Disease Of course, the effects of rheumatoid arthritis extend beyond joint and muscle dysfunction.6 For instance, cardiovascular disease (CVD) is a leading cause of death in patients with rheumatoid arthritis. The risk of CVD in rheumatoid arthritis is comparable to the CVD risk created by diabetes.7

Guidelines repeatedly recommend exercise, diet, and weight management, based on some evidence and expert consensus. These recommendations point back to the exercise therapy and lifestyle changes taught in exercise physiology, as well as to the availability of supervised group exercise. Dementia and Cognitive Impairment Similarly, patients with rheumatoid arthritis experience a 61% higher risk of dementia.8 Thirty percent of patients with rheumatoid arthritis experience cognitive impairment, compared to eight percent in healthy controls.9

Again, exercise therapy has been shown to significantly improve cognition among rheumatoid arthritis patients at three months.10 In conclusion, while guidelines have long called for exercise recommendations in rheumatoid arthritis, we are now also getting enough empirical data so that some of these recommendations can be evidenced-based. We also have a number of indicators that solutions offered in exercise physiology can mitigate more than the joint and muscle disfunction but also the other damages caused by rheumatoid arthritis. linical Rheumatology. 2020 Jun;39(6):



1. Smith MH, Berman JR. What Is Rheumatoid Arthritis?. JAMA. 2022 Mar 22;327(12):1194-.

2. Hurkmans EJ, Jones A, Li LC, Vliet Vlieland TP. Quality appraisal of clinical practice guidelines on the use of physiotherapy in rheumatoid arthritis: a systematic review. Rheumatology. 2011 Oct 1;50(10):1879- 88.

3. Sobue Y, Kojima T, Ito H, Nishida K, Matsushita I, Kaneko Y, Kishimoto M, Kohno M, Sugihara T, Seto Y, Tanaka E. Does exercise therapy improve patient-reported outcomes in rheumatoid arthritis? A systematic review and meta-analysis for the update of the 2020 JCR guidelines for the management of rheumatoid arthritis. Modern Rheumatology. 2022 Jan;32(1):96-104.

4. Liao CD, Chen HC, Huang SW, Liou TH. Exercise therapy for sarcopenia in rheumatoid arthritis: A meta[1]analysis and meta-regression of randomized controlled trials. Clinical Rehabilitation. 2022 Feb;36(2):145 -57.

5. Kettunen JA, Kujala UM. Exercise therapy for people with rheumatoid arthritis and osteoarthritis. Scandi[1]navian Journal of Medicine & Science in Sports. 2004 Jun;14(3):138-42.

6. Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Torp-Pedersen C, Hansen PR. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. An[1]nals of the Rheumatic Diseases. 2011 Jun 1;70(6):929-34.

7. Barber CE, Smith A, Esdaile JM, Barnabe C, Martin LO, Faris P, Hazlewood G, Noormohamed R, Alvarez N, Mancini GJ, Lacaille D. Best practices for cardiovascular disease prevention in rheumatoid arthritis: a systematic review of guideline recommendations and quality indicators. Arthritis Care & Research. 2015 Feb;67(2):169-79.

 8. Ungprasert P, Wijarnpreecha K, Thongprayoon C. Rheumatoid arthritis and the risk of dementia: A sys[1]tematic review and meta-analysis. Neurology India. 2016 Jan 1;64(1):56.

 9. Appenzeller S, Bertolo MB, Costallat LT. Cognitive impairment in rheumatoid arthritis. Methods and Find[1]ings in Experimental and Clinical Pharmacology. 2004 Jun 1;26(5):339-44.

10. Azeez M, Clancy C, O’Dwyer T, Lahiff C, Wilson F, Cunnane G. Benefits of exercise in patients with rheu[1]matoid arthritis: a randomized controlled trial of a patient-specific exercise programme. Clinical Rheuma[1]tology. 2020 Jun;39(6):1783-92.

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