ARTHRITIS What is Arthritis? ‘An inflammatory condition mainly affecting the joints, resulting in pain and loss of movement’
U.S. – The most common chronic condition with 50% of over 65’s suffering with arthritis. 15 % of the total population and expected to increase to 18% by 2020. UK – 2 million related visits to their GP every year. 4.4 million have x-ray evidence of moderate to severe osteoarthritis in the hands/wrist, 550000 in the knees and 210000 in the hip.
Degenerative bone disorder resulting in pain and loss of motion about affected joints.
Osteoarthritis (OA)
Rheumatoid Arthritis
Osteoarthritis Osteoarthritis is the most common joint problem (affecting over 5 million people in the UK) and generally begins asymptomatically in a person’s 30’s. It is extremely common by the age of 70. Almost all people aged 40 have some change in weight bearing joints although relatively few have any symptoms.
It is caused by the degeneration of cartilage in the joints. The lack of cartilage creates wearing on the bone surfaces causing inflammation and pain.
Rheumatoid Arthritis Rheumatoid arthritis is a degenerative joint disease in which the body’s immune system attacks its own tissue. This can cause an inflammatory response in multiple joints leading to pain and loss of movement.
In Summary: Osteoarthritis
Most common Affects over 5 million people in the UK Begins asymptomatically in 30’s Extremely common by age 70
Rheumatoid Arthritis
Genetic disorder
RISK FACTORS
Increasing age (OA is not an inevitable result of aging, but is strongly linked) Sex (severe OA, especially of the hand and knee show a female preponderance) Ethnic groups (Hip OA is uncommon in black and Asian populations compared to white people, and hand OA is rare in black Africans and Malaysians) the link is thought to be genetic rather than cultural Obesity Genetics, hand, knee and hip OA show a strong heritability Occupation and repetitive joint use (farmers show increased propensity to hip and knee OA) Surgery (for example meniscectomy leading to joint instability) Injury (for example shoulder dislocation that damages the cartilage) Joint deformity or previous disease
PHYSICAL EFFECTS OF ARTHRITIS
Pain in and around the joint Initially worsened by exercise Joint stiffness and reduced Range of Movement Joint enlargement/effusion, locking or catching Joint stability, joint deformity and closing of joint space
Initially somebody suffering from arthritis may be reluctant to exercise, believing that exercise will wear the joints out faster. However, exercise will:
Improve weight control
Reduce chance of deconditioning
Improve mood
BENEFITS OF EXERCISE
Regain independance
Reduce pain
Reduce dependance on pharmaceutical treatments
Slow progression of condition
EXERCISE GUIDELINES Light to moderate low-impact exercise can improve the symptoms of OA by increasing the production of synovial fluid, and functionality of the OA sufferer. Strength/Resistance:
Low impact 1-3 sets, 10-12 reps 2-3 days per week Use pain free ROM Consider passively warming affected joints Stretch before and after resistance training
Consider isometric exercises (beware of other possible conditions that may contraindicate this) or isotonic exercises (start with body weight, then build resistance gradually using equipment such as bands or tubing, then lighter weights). Strength training should occur two or three times a week and resistance should build up gradually with an emphasis on lighter weights and higher reps. Emphasis on strengthening the muscles around the affected joints will improve joint stability and reduce impact/trauma on the joint. Flexibility
Aim to improve flexibility and ROM through stretching – follow with stability and functional training Use pain as the limiting factor Be aware of the feel of an end range of a joint Use stretching at the beginning AND end of every training session
CV CV training should be low impact (swimming, cycling and walking are best). Build up gradually; start with a few minutes’ exercise per day if fitness levels are low. Aim for a 20-30 minute session three to five times per week. Make sure you have an extended (8-10 mins) warm up and cool down. Select exercises that minimise the stress placed on the affected joints – pain lasting longer than one hour post-exercise indicates that the exercise was too strenuous.
CAUTIONS
Arthritis can flare up o Period of time when condition is more active o Particularly applies to rheumatoid arthritis o Increased levels of pain o Increased levels of joint destruction o Exercise not advised during these periods o Gentle stretching may be advisable and help relieve the symptoms
In OA and RA the joint can become a different shape o This cannot be altered and can affect the mechanics of movement o Look for compensation and postural changes o Always use pain or a hard, bony end feel to joint ROM as your limiting factor when stretching, performing ROM exercises and exercise generally
Avoid positions of hyperflexion and hyperextension of the joint o These place joint in uncomfortable positions o Likely to lead to increased joint damage
PSYCHOLOGICAL EFFECTS OF ARTHRITIS
Limited enjoyment of life (due to the effects of chronic pain) Reduced active daily living Depression Frustration with the disease