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Rheumatoid Arthritis causes inflammation of specific synovial joints in the body causing degeneration of tissues. With RA, patients will experience periods of time know as flares. Flares occur when the inflammation of the joints is active and signs and symptoms of RA are most prevalent. The prevalence of these episodes will vary from person to person, as well as, the duration and severity. RA typically effects the following joints; hands, feet, ankles, knees, elbows, and spine. Again, this varies from patient to patient and the type of RA that the individual has. The type of arthritis that is being referred to is juvenile rheumatoid arthritis. This type of arthritis differs in that the patient develops the disease at birth or shortly after. This type of RA more commonly affects the joints of the knees and hips. Signs and symptoms for Ra include; joint pain, morning stiffness, gelling of the joints (stiffness that returns after periods of immobilization), malaise, and fatigue. Interesting to note, an interview with a patient with juvenile RA showed hip replacement surgery at the age of 27. This shows the affects that this disease has on the joints. The patient had no contact of the femur head and acetabulum prior to the surgery which suggests that the only structures holding the hip together were the musculotendinous units and connective tissues. These implications suggest severity in mobility and quality of daily living.
There are tests and procedures to accurately diagnose and test for RA, but it is important to understand exactly what RA does to the body to completely understand the methods being used. There are two main trains of thought as to why RA occurs in the body. Both of these ideas hold that T-cells in the body, along with macrophages and fibroblasts, function incorrectly and perpetuate the condition of chronic inflammation. Along with the chronic inflammation causing secondary injury to cells in the area; the dysfunctional cells of the immune system attack the body's synovial sheaths and cartilage causing irreversible damage to the joints.
For testing purposes the American College of Rheumatology has developed specific criteria for the diagnosis of RA. Joint imaging is typically used for diagnosis to confirm the disorder. In patients with RA erosion of joint margins and invasion of synovial tissue at the intersection of cartilage and bone can commonly be seen. Along with imaging there are several useful serum and synovial fluid laboratory tests that in combination with other tests can be used to diagnose the issue. There is also a blood test that can be used to diagnose RA and predict future development of RA in healthy individuals and those that have unidentified forms of arthritis. These tests are done by a professional clinician in this field and recommendations are given for treatment of the disorder dependent on the severity of the case. As a clinician in the field of exercise science these recommendations are important to follow but may not be very specific. Since this is the case it is important to understand the principles of treatment including; exercise testing, exercise prescription, and other forms of prevention and care. (John Hopkins Arthritis Center)
Exercise testing, exercise prescription, pharmaceuticals, and diet are all important factors in RA patient care. Exercise testing is critical with patients that have RA; these patients are at an increased risk of cardiovascular disease due to the nature of their disease, and possibly associated with the inflammatory disease process. These individuals also tend to be more deconditioned than other individuals of the same age group due [url=http://www.jeremyparendt.com/Hollister-b5.php]hollister[/url] to the [url=http://www.sandvikfw.net/shopuk.php]hollister sale[/url] mobility and movement issues associated with the disease. This sedentary lifestyle also tends to increase the risk for cardiovascular disease in these individuals. Thus, cardiovascular testing is the most important aspect of exercise testing with these individuals and needs to be known regardless if the patient expects to have surgery for joint reconstruction. It is important to consider the mode for this testing in these individuals as joints and inflammation may limit their ability to perform certain tasks. Cycle ergometry is most [url=http://www.rtnagel.com/louboutin.php]louboutin pas cher[/url] useful for this population and, dependent on the joints involved, can be leg [url=http://www.tagverts.com/barbour.php]barbour deutschland[/url] or arm ergometry. Studies show that VO2 Max equations can over-predict results in this population; while no equation has been validated presently it is important to know that basing exercise on these results could lead to overestimation of ability in exercise prescription. As with most populations range [url=http://www.jeremyparendt.com/jimmy-choo.php]jimmy choo paris[/url] of motion and flexibility should be tested using a goniometer and considered for future progression in the program. However, the clinician should be cautious with this population because of possible deformity and disorders within the joints. Strength is another aspect to be tested; typically these individuals will be relatively weak in relation to their peers but is an important baseline to develop an exercise program. To test this population the use of a dynamometer would be the best choice. It is also beneficial to do functional testing with this population and can be done with a multitude of testing protocols; this is important since the main goal of the clinician is to improve the quality of life for their patient.
In patients with RA, studies show significant improvements with exercise programs; most notably due to their severely low functional baseline. With these patients joint mobility, strengthening, and cardiovascular training are equally important and should all be incorporated. Studies are quite inconclusive with patients who have RA. Some studies show a decrease in disease progression with the above activities while others show little decrease in disease but gains functionally. One study pointed out that the only exercise that showed detrimental effects on joint structure using radiographic imagery was high intensity load bearing. With this in mind, the clinician should avoid structural exercises with large loads and rather focus on a lower intensity higher volume approach. With the exception of the latter, the majority of studies involving RA patients show exercise of all types to be beneficial. Studies also point to a wide variety of benefits in RA patients from exercise including; cardiovascular improvements, decreased pain, increased function, improved mood, improved body composition, improved flexibility, and improved dexterity and grip strength. Note that all of these benefits directly relate to quality of life, as this is the main goal of the clinician. (Ehrman, Visich, Keteyian 461)
Exercise prescription for this population is not well defined and is primarily due to the vast differences [url=http://www.mxitcms.com/abercrombie/]abercrombie[/url] in cases. As stated previously joint mobility, strengthening, and cardiovascular training are all important components to this populations' exercise program. Cardiovascular training should start at two to three days [url=http://www.osterblade.com]moncler sito ufficiale[/url] per week and progress as needed. The mode is dependent on the disease's affects on the individual but could range from walking, cycling, and swimming. Intensity should progress as needed but cardiovascular gains are important so a RPE of 12-16 should be used. Duration for cardiovascular training should progress as needed and can even be broken into multiple sessions throughout the day if needed. Strength training should consist of isotonic exercises as this promotes joint mobility. This should start at one day a week, one set per exercise, and consist of 8-12 repetitions. The workout should promote total body strength and progress as needed; it is important to note that joints affected may determine the exercises used for each individual. Joint mobility can be accomplished by the previous exercises mentioned as well as static stretching and aquatics. Water acts as a good medium and can prove extremely beneficial for range of motion and joint mobility exercises in this population. Aquatics should be supplemental to the program and never be the sole mode due to the relatively low structural loading involved.
There are other treatments that prove beneficial to RA patients. Since RA is an autoimmune disease and causes inflammation of the joints leading to degeneration, anti-inflammatory treatments are used. Diets can have an anti-inflammatory component when the correct foods are used to promote the affect. There are also multiple prescription and non-prescription drugs available to combat the inflammation. Commonly used medicines and modalities include NSAIDS and [url=http://www.gotprintsigns.com/abercrombiepascher/‎]abercrombie pas cher[/url] cryotherapy which help to reduce the inflammation and secondary injury to the area affected.
Special considerations for people with RA include; area of the patient that is affected, modalities to use that have shown improvement in the patient, age of the patient, history of [url=http://www.shewyne.com/hoganoutlet.html]hogan sito ufficiale[/url] the patient, medication of the patient, comorbidities of the patient, personal goals, and lifestyle. The most important thing for the clinician to remember is the fact that RA is a degenerative disease and since these treatments do not necessarily reduce the affects degeneration will still occur. What does this mean to the clinician? Over [url=http://www.shewyne.com/moncleroutlet.html]moncler outlet[/url] time there may be a reduction in function with the patient despite a great exercise program with excellent adherence; this is especially true as the patient becomes elderly. The best thing that can be done for these patients is to improve their quality of life through a reduction of pain and an increase in functional ability. (Ehrman, Visich, Keteyian 461)
Scott McKinney is the [url=http://www.teatrodeoro.com/hollisterde.php]hollister deutschland[/url] Vice President at Midwest Institute for Addiction. He holds a Master's degree in sports rehabilitation and a degree in exercise physiology. He is nationally [url=http://www.mnfruit.com/airjordan.php]jordan pas cher[/url] certified in strength and conditioning and corrective exercise. Scott has directed fitness facilities, trained trainers, and taught as a professor in biomechanics.
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