Fast Five Quiz: Do You Know Best Practices for Osteoporosis?

Fast Five Quiz: Do You Know Best Practices for Osteoporosis?

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Herbert S. Diamond, MD

November 12, 2020

Osteoporosis is the most common metabolic bone disease in the United States and can result in devastating physical, psychosocial, and economic consequences. It is often overlooked and undertreated, in large part because it is clinically silent before manifesting as fracture. Lifestyle modifications and pharmacologic therapy as indicated can be beneficial for minimizing fractures and halting disease progression.

Do you know best practices for the diagnosis and management of osteoporosis? Test yourself with this short quiz.

Medscape © 2020  WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Herbert S. Diamond. Fast Five Quiz: Do You Know Best Practices for Osteoporosis? – Medscape – Nov 12, 2020.

Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center, Brooklyn, New York; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital, Pittsburgh, Pennsylvania

Disclosure: Herbert S. Diamond, MD, has disclosed no relevant financial relationships.

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Fast Five Quiz: Do You Know Enough About Rheumatoid Arthritis?

Fast Five Quiz: Do You Know Enough About Rheumatoid Arthritis?

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Herbert S. Diamond, MD

December 05, 2019

Rheumatoid arthritis is a chronic systemic inflammatory autoimmune disease that causes persistent symmetric polyarthritis (synovitis) and can also affect other organ systems. Early treatment, however, can prevent or reduce joint damage and may increase the likelihood of remission. Do you know the signs, workup, and best treatment practices for rheumatoid arthritis? Test your knowledge with this quick quiz.

Medscape © 2019  WebMD, LLC

Cite this: Herbert S. Diamond. Fast Five Quiz: Do You Know Enough About Rheumatoid Arthritis? – Medscape – Dec 05, 2019.

Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital, Pittsburgh, Pennsylvania

Disclosure: Herbert S. Diamond, MD, has disclosed no relevant financial relationships.

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A 59-Year-Old Woman With a Painful Rash and Fingertip Ulcerations

A 59-Year-Old Woman With a Painful Rash and Fingertip Ulcerations

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Victoria M.F. Mank, MD; Jefferson R. Roberts, MD

October 11, 2019

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 59-year-old white woman presented with a pruritic and painful rash on her elbows, overlaying her rheumatoid nodules. Her past medical history was significant for aggressive seropositive rheumatoid arthritis (RA), poorly controlled type 2 diabetes mellitus, hypothyroidism, and fibromyalgia. Her prescribed treatment at that time was etanercept, leflunomide, and prednisone. However, she frequently self-discontinued medications and did not attend scheduled appointments. Multiple other disease-modifying antirheumatic drugs (DMARDs) were attempted prior to the current combination. These medications included methotrexate, hydroxychloroquine, sulfasalazine, adalimumab, and infliximab.

The rash overlaid her rheumatoid nodules on her elbows and forearms and had worsened, increasing in size and severity, involving her lower extremities and including the bases of her feet and shins since she self-discontinued etanercept. She smoked one pack of cigarettes per day for several years and had polysubstance drug abuse.

Medscape © 2019 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Victoria M.F. Mank, Jefferson R. Roberts. A 59-Year-Old Woman With a Painful Rash and Fingertip Ulcerations – Medscape – Oct 11, 2019.

Resident, Tripler Army Medical Center, Honolulu, Hawaii

Disclosure: Victoria M.F. Mank, MD, has disclosed no relevant financial relationships.

Rheumatology Specialist, Tripler Army Medical Center, Honolulu, Hawaii

Disclosure: Jefferson R. Roberts, MD, has disclosed no relevant financial relationships.

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What Is Rheumatoid Arthritis?

What Is Rheumatoid Arthritis?

Rheumatoid arthritis is what doctors call an autoimmune condition. It starts when your immune system, which is supposed to protect you, goes awry and begins to attack your body’s own tissues. It causes inflammation in the lining of your joints (the synovium). As a result, your joints may get red, warm, swollen, and painful.

RA affects joints on both sides of the body, such as both hands, both wrists, or both knees. This symmetry helps to set it apart from other types of arthritis. Over time, RA can affect other body parts and systems, from your eyes to your heart, lungs, skin, blood vessels, and more.

The warning signs of RA are:

Rheumatoid arthritis affects everyone differently. For some, joint symptoms happen gradually over several years. In others, it may come on quickly.

Some people may have rheumatoid arthritis for a short time and then go into remission, which means they don’t have symptoms.

Anyone can get RA. It affects about 1% of Americans.

The disease is 2 to 3 times more common in women than in men, but men tend to have more severe symptoms.

It usually starts in middle age. But young children and the elderly also can get it.

Doctors don’t know the exact cause. Something seems to trigger the immune system to attack your joints and, sometimes, other organs. Some experts think a virus or bacteria may change your immune system, causing it to attack your joints. Other theories suggest that in some people, smoking may lead to rheumatoid arthritis.

Certain genetic patterns may make some people more likely to get RA than others.

Immune system cells move from the blood into your joints and the tissue that lines them. This is called the synovium. Once the cells arrive, they create inflammation. This makes your joint swell as fluid builds up inside it. Your joints become painful, swollen, and warm to the touch.

Over time, the inflammation wears down the cartilage, a cushy layer of tissue that covers the ends of your bones. As you lose cartilage, the space between your bones narrows. As time goes on, they could rub against each other or move out of place. The cells that cause inflammation also make substances that damage your bones.

The inflammation in RA can spread and affect organs and systems throughout your body, from your eyes to your heart, lungs, kidneys, blood vessels, and even your skin.

There is no single test that shows whether you have RA. Your doctor will give you a checkup, ask you about your symptoms, and possibly perform X-rays and blood tests.

Rheumatoid arthritis is diagnosed from a combination of things, including:

In addition to checking for joint problems, your doctor will also do blood tests to diagnose RA. She’ll be looking for:


Anemia:
People with rheumatoid arthritis may have a low number of red blood cells.

C-reactive protein (CRP): High levels are also signs of inflammation.

Some people with rheumatoid arthritis may also have a positive antinuclear antibody test (ANA), which indicates an autoimmune disease, but the test does not specify which autoimmune disease.

Cyclic citrulline antibody test (anti-CCP): This more specific test checks for anti-CCP antibodies, which suggest you might have a more aggressive form of rheumatoid arthritis.

Erythrocyte sedimentation rate
(ESR): How fast your blood clumps up in the bottom of a test tube shows there may be inflammation in your system.


Rheumatoid factor (RF):
Most, but not all, people with rheumatoid arthritis have this antibody in their blood. But it can show up in people who don’t have RA.

Treatments include medications, rest, exercise, and, in some cases, surgery to correct joint damage.

Your options will depend on several things, including your age, overall health, medical history, and how severe your case is.

Many rheumatoid arthritis medications can ease joint pain, swelling, and inflammation. Some of these drugs prevent or slow down the disease.

Drugs that ease joint pain and stiffness include:

Your doctor may also give you strong medications called disease-modifying antirheumatic drugs (DMARDs). They work by interfering with or suppressing your immune system’s attack on your joints.

Traditional DMARDs are often the first-line treatment for RA:

Biologic response modifiers are manmade versions of proteins in human genes. They’re an option if your RA is more severe, or if DMARDs didn’t help. You might even take a biologic and a DMARD together. The doctor could also give you a biosimilar. These new drugs are near-exact copies of biologics that cost less. Biologics approved for RA include:

 

You need to be active, but you also have to pace yourself. During flare-ups, when inflammation gets worse, it’s best to rest your joints. Using a cane or joint splints can help.

When the inflammation eases, it’s a good idea to exercise. It’ll keep your joints flexible and strengthen the muscles that surround them. Low-impact activities, like brisk walking or swimming, and gentle stretching can help. You may want to work with a physical therapist at first.

When joint damage from the rheumatoid arthritis has become severe, surgery may help.

Although there isn’t a cure for rheumatoid arthritis, early, aggressive treatment will help prevent disability and increase your chances of remission.

SOURCES:

Mayo Clinic: “Rheumatoid Arthritis.”

American Academy of Family Physicians: “Rheumatoid Arthritis.”

American Autoimmune Related Diseases Association: “Autoimmune Diseases in Women.”

American College of Rheumatology: “Rheumatoid Arthritis.”

News releases, FDA: “FDA approves Inflectra, a biosimilar to Remicade,” “FDA approves Amjevita, a biosimilar to Humira.”

UptoDate for Patients: “Clinical Features of Rheumatoid Arthritis.”
 

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Rheumatoid Arthritis Assessment

Rheumatoid Arthritis Assessment

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Reviewed by
David Zelman, MD on January 19, 2016

2010 ACR-EULAR Classification Criteria for Rheumatoid Arthritis.

2011 ACR/EULAR Definitions of Remission in Rheumatoid Arthritis Clinical Trials.

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Stanford University School of Medicine. “The Health Assessment Questionnaire (HAQ)© and the Improved HAQ©,” June 2009.

Health Assessment Questionnaire (PROMIS HAQ©)

Fries, J.F. Journal of Rheumatology, September 2009.

Bruce, B. Clinical and Experimental Rheumatology, 2005.

Stanford Patient Education Research Center: “Pain Visual Numeric.”

Health Organization of Pudendal Education: “Comparative Pain Scale.”

American College of Rheumatology (ACR): “Antinuclear Antibodies (ANA),””Methotrexate (Rheumatrex, Trexall),” “Biologic Treatments for Rheumatoid Arthritis,” “What is a Rheumatologist?” “Rheumatoid Arthritis,” “Cardiovascular Disease Risk High in RA Patients,” “Pregnancy and Rheumatic Disease.”

Arthritis Foundation: “Who Gets Rheumatoid Arthritis?” “Arthritis Symptoms,” “What is Rheumatoid Arthritis?” “How the Arthritis Foundation is Advancing Research,” “What is Osteoarthritis?” “Cardiovascular Risk and NSAID Use,” “Tips for Managing Pain,” “Types of Exercise,” “Introduction to Exercise.”

MedlinePlus, NIH: “Rheumatoid Arthritis,” “Osteoarthritis vs. rheumatoid arthritis,” “Rheumatoid Factor (RF)”

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS): Questions and Answers about Arthritis and Rheumatic Diseases, “Questions and Answers about Juvenile Arthritis.”

PubMed: “Arthritis,” “Scleritis.”

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U.S. Food and Drug Administration: Guidance for Industry Clinical Development Programs for Drugs, Devices, and Biological Products Intended for the Treatment of Osteoarthritis (OA), July 7, 1999.

Arthritis Today, Arthritis Foundation: “How is Rheumatoid Arthritis Diagnosed,” “Newer Diagnosis of RA May Mean Fewer Surgeries,” “Rheumatoid Arthritis: Remission is Possible,” “Precautions to Take Before Starting Biologics,” “Managing Corticosteroids Side Effects,” “Corticosteroids Can Cause Irregular Heartbeat,” “Rheumatoid Arthritis: Will I Need Surgery?” “Assessing the Impact of Joint Replacements for Rheumatoid Arthritis,” “Traditional Arthritis Meds May Prevent Joint Damage as Effectively as Biologics,” “Benefits of Massage,” “How Will a Rheumatoid Arthritis Diagnosis Affect Your Life?” “When Should I See My Doctor?” “Using Heat and Cold for Pain Relief,” “How to Beat Fatigue,” “Coping With Fatigue,” “Self-Help Arthritis Devices,” “Managing Stress,” “Can Support Groups Help You Cope?” “Fatty Acid Benefits: How Omega-3s Reduce Inflammation,” “More Fiber, Less Inflammation?” “Arthritis Food Myths,” “Rheumatoid Arthritis and Pregnancy.”

National Rheumatoid Arthritis Society (NRAS): “Laboratory tests used in the diagnosis and monitoring of rheumatoid arthritis,” “DMARDs used in the Treatment of RA,” “Steroids in Rheumatoid Arthritis,” “Methotrexate in Rheumatoid Arthritis,” “What is RA?” “Rheumatoid Arthritis & Pregnancy.”

Anemia.org: “Considering Anemia when Treating Rheumatoid Arthritis Patients,” Feb. 4, 2009.

UpToDate: “Rheumatoid Arthritis,” “Patient information: Complementary therapies for rheumatoid arthritis (Beyond the Basics).”

Agency for Healthcare Research and Quality (AHRQ). Rheumatoid Arthritis Medicines: A Guide for Adults, April 2008; Choosing Medications for Rheumatoid Arthritis: Clinician’s Guide, April 2008.

Schipper, L.G. Arthritis Research & Therapy, May 20, 2010.

University of Maryland Medical Center: “Rheumatoid arthritis – Medications.”

Cleveland Clinic: “Rheumatoid Arthritis: How to Treat,” “Stay Fit: Aerobic Exercise.”

van der Heijde, D. Arthritis & Rheumatism, April 2006.

American Pain Foundation. Treatment Options: A Guide for People Living with Pain, 2006.

American Academy of Orthopaedic Surgeons
: “Rheumatoid Arthritis of the Foot and Ankle.”

Arthritis Foundation, Wisconsin Chapter. “Fact Sheet: Role of PT/OT and OA/RA,” Just Joints, vol 1.

American College of Rheumatology (ACR). Position statement: “Complementary and Alternative Medicine for Rheumatic Diseases,” 2008.

U.S. Department of Health and Human Services. Complementary and Alternative Medicine Use Among Adults: United States, 2002.

National Center for Complementary and Alternative Medicine (NCCAM): “What Is Complementary and Alternative Medicine?” “Rheumatoid Arthritis and CAM,” “Meditation.”

Natural Medicines Comprehensive Database: “Borage.”

Efthimious, P. Rheumatology International, March 2010.

University of Michigan Health System, Department of Surgery: “Hand Surgery: Rheumatoid Arthritis.”

Kremer, J.M. American Journal of Clinical Nutrition, January 2000.

Callahan, L.F. Preventing Chronic Disease, April 2009.

Endean, A.L. American College of Rheumatology meeting, Boston, Nov. 7-11, 2007.

Lindhardsen, J. British Medical Journal, Mar. 8, 2012.

Nadasreishvili, Z. Arthritis Care & Research, July 30, 2008.

“Cardiovascular Disease Risk High in RA Patients,” The Rheumatologist, June 2010.

Chung, C.P. Seminars in Arthritis and Rheumatism, Feburay 2012.

U.S. Food and Drug Administration: “The Benefits and Risks of Pain Relievers Q&A on NSAIDs.”

Ornbjerg, L.M. Journal of Clinical Rheumatology, April 2008.

The American Geriatrics Society: 2012 Beers Criteria Update Expert Panel.

Drug Safety and Risk Management Advisory Committee, U.S. FDA: “An Update on NSAID Labeling and Data Review,” Feb. 10, 2006.

Saevarsdottir, S. Arthritis & Rheumatism, January 2011.

Saag, K.G. Annals of Rheumatic Diseases, August 1997.

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Källberg, H. Annals of the Rheumatic Diseases, published online Dec. 13, 2010.

David Pisetsky, MD, chief of rheumatology, Duke University Medical Center, Durham, N.C.

American Dietetic Association. Nutrition Fact Sheet: “Adult Beverage Consumption: Making Responsible Drinking Choices,” 2008.

National Sleep Foundation: “How Much Sleep Do Adults Need?” “Myths and Facts,” “The Sleep Environment.”

Braudal, N. Athritis & Rheumatism, October 2010.

Johns Hopkins Medicine Health Alerts: “Rheumatoid Arthritis.”

Feldman, J.B. American Journal Of Clinical Hypnosis, January 2004.

Murphy, L.B. Arthritis Care & Research, published online May 1, 2012.

Sleath, B. Arthritis Care & Research, February 2008.

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King, D.E. Molecular Nutrition & Food Research, June 2005.

Academy of Nutrition and Dietetics: It’s About Eating Right

Science Daily: “Exercise Program Improves Symptoms In Arthritis Patients,” “Aerobic Exercise Safe and Effective for Rheumatoid Arthritis Patients, Experts Say,” “Tai Chi Relieves Arthritis Pain, Improves Reach, Balance, Well-Being, Study Suggests.”

University of Michigan Health System, Chronic Pain & Fatigue Research Center: “Lifestyle Activity & Exercise.”

Harvard Medical School: “Sleep and Health.”

American Sleep Association: “Sleep Hygiene Tips.”

American Academy of Sleep Medicine: How to Sleep Better, 2012.

Organization of Teratology Information Specialists. “Methotrexate and Pregnancy,” December 2010.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE.
 It is intended for informational
purposes only. It is not a substitute for professional medical advice,
diagnosis or treatment. Never ignore professional medical advice in seeking
treatment because of something you have read on the WebMD Site. If you think
you may have a medical emergency, immediately call your doctor or dial
911.

© 2016 WebMD, LLC. All rights reserved.

©2005-2018 WebMD LLC. All rights reserved.

WebMD does not provide medical advice, diagnosis or treatment. See additional information.

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Foods That Help Rheumatoid Arthritis

Foods That Help Rheumatoid Arthritis

There’s no perfect meal plan to help you feel better if you’ve got RA, but go for a variety of nutritious foods. It’s good for your overall well-being and weight. You might try the Mediterranean diet, which features fish, whole grains, and fruits and veggies that may lower the inflammation caused by your disease.

Everyone is different. You have to see how you feel when you eat certain types of foods.

Omega-3 fatty acids in salmon, tuna, trout, and other cold-water fish can fight inflammation, which can help aching joints and morning stiffness. Eat about two 3-ounce servings of fish each week.

If fish isn’t your thing, omega-3 supplements might be an option for you. They could even help you cut back on anti-inflammatory medication. Borage seed oil may also relieve pain along with your RA meds. Just make sure you always tell your doctor before you take any supplements.

Saturated fats, which are in foods like butter and red meat, are linked with inflammation. Limit those and get your fats from healthier choices, like nuts and avocados. Instead of butter, try olive oil, which may lower pain and inflammation.

Fiber is good for your digestion, and it can also ease your inflammation. Look for breads, crackers, and cereals that list “whole grain” or “whole wheat” as part of the first ingredient.

Most of them are full of antioxidants, which boost your immune system and may fight inflammation. Try fruits like prunes, raisins, and berries. Go for veggies like kale, spinach, and Brussels sprouts. And don’t forget fresh, leafy greens. They’re a great source of fiber and folic acid. If you take methotrexate, folic acid can ease some of the drug’s side effects.

They’re another tasty way for you to get fiber and protein. Fiber can ease inflammation caused by your RA, and protein can help keep the muscles that support your joints strong. Beans are an excellent meat-free source of protein. Enjoy them in chili, as a side dish, or whipped into a healthy dip like hummus.

They may help prevent the bone loss that can come with taking corticosteroids for your RA. 

You can also eat beef liver and egg yolks for vitamin D, leafy greens for calcium, and fatty fish and fortified items like cereal and orange juice for both. Supplements may be an easier way to get the recommended amounts, though.

Some people think that this family of veggies — tomatoes, potatoes, eggplant, and some peppers — makes RA symptoms worse. But there’s no proof that they do.

If you think a specific food causes you problems, don’t eat it for at least 2 weeks. See what happens when you add it back.

More research is need, but turmeric and ginger may ease your inflammation. Try adding them when you’re cooking. If you take blood thinner medication, talk to your doctor first. The spices may make bleeding more likely.

It may lessen inflammation and joint damage from rheumatoid arthritis. And tea — whether it’s green, black, white, or oolong — has antioxidants called polyphenols that boost your immune system.

Talk to your doctor or a dietitian. They can help you fine-tune your diet and tell you if you need supplements.

A dietitian can also create a meal plan that takes into account your medications and your lifestyle, so you’ll be more likely to stick with it.

Sources
|

Medically Reviewed on 10/03/2018

Reviewed by Melinda

Ratini, DO, MS on October 03, 2018

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Arthritis Care: “Eating Well.”

Arthritis Foundation, Arthritis Today: “A Cup of Tea Can Be Good For Your Health,” “Arthritis Food Myths,” “Nutrition Guidelines for People with Rheumatoid Arthritis,” “Fish May Reduce Inflammation.”

Buckley, L. Annals of Internal Medicine, December 15, 1996.

Cleveland Clinic: “The Power of Fish.”

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Federation of American Societies for Experimental Biology, News Release.

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Ma, Y. American Journal of Clinical Nutrition, April 2006.

Martin, R. Proceedings of the Nutrition Society, 1998.

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Ramadan, G. Inflammation, August 2011.

Shapiro, J. Epidemiology, May 1996.

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The Johns Hopkins Arthritis Center: “Nutrition & Rheumatoid Arthritis.”

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U.S. Department of Agriculture: “Top Antioxidant Foods.”

Van Vugt, R. Clinical Rheumatology, June 2008.

Whole Grains Council: “Identifying Whole Grain Products.”

American Heart Association: “Keep saying yes to fish twice a week for heart health.”

Reviewed by Melinda

Ratini, DO, MS on October 03, 2018

This tool does not provide medical advice. See additional information.

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

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How Physical Therapy Helps RA

How Physical Therapy Helps RA

You can make your day-to-day life with rheumatoid arthritis (RA) easier by going to physical therapy. It helps you move better, get stronger, and maybe even have less pain.

To get started, ask your rheumatologist for a referral. She may have a physical therapist that she often works with. You can also check the American Physical Therapy Association’s website (apta.org) for licensed physical therapists in your area.

Think about the things that you most want to improve. Is it your weekend hike, picking up your kids (or grandkids), going up and down stairs, pushing a grocery cart, or reaching up to blow-dry your hair?

Tell your physical therapist about it.

“We can teach you moves and stretches to help improve your strength and range of motion, which will allow you to maintain those important daily functions,” says physical therapist Jan Richardson, PhD, professor emeritus at Duke University School of Medicine.

You might learn in physical therapy that you can do more than you think.

“In the past, it was thought that RA patients should stay away from high-impact types of aerobic exercise, like running, as well as weightlifting, because it would exacerbate [worsen] the disease,” Richardson says.  But now it’s clear that people with RA who do those types of things “actually have healthier joints, even as they grow older.”

Make sure you get aerobic exercise (cardio), because RA can mean you’re more likely to get heart disease, says Maura Iversen, a professor of physical therapy, movement, and rehab sciences at Northeastern University.

What activities sound like fun to you? “It could be tai chi classes, swimming, or yoga,” Richardson says. “One program won’t necessarily fit the bill for every patient, so work with your physical therapist to find something that works for you.”

You need a good balance between rest and exercise. Physical therapy is a great place to tune in to that.

The first step is to learn the difference between a symptom of joint inflammation and muscle soreness from exercise.

“If your hands or wrists feel hot, swollen, and painful, that’s different from an ache that you’d feel after starting a new exercise program,” Richardson says. “Your physical therapist can help you learn to distinguish the two over time and determine when it’s OK to ramp up your activity and when to cut back.”

RA can make your joints achy in the morning.

“Stretch around a bit before you get out of bed, and check which joints feel stiff and which ones you want to focus on that day,” Iversen says.

At your next PT session, tell your physical therapist what you felt. She can show you more moves that will help.

If your RA makes you tired, break up your at-home exercise into short chunks. Take it bit by bit. “You can increase how often and how long you exercise as you gain strength, mobility, and flexibility,” Richardson says.

Once you’re done with physical therapy, stay active! You’ll keep those benefits you worked so hard for.

SOURCES:

Jan Richardson, PhD, physical therapist; professor emeritus, Duke University School of Medicine.

John Castro, physical therapist; clinical supervisor, Hospital for Special Surgery Joint Mobility Center, New York.

Maura Iversen, physical therapist; professor of physical therapy, movement, and rehabilitation science, Northeastern University, Boston.

American College of Rheumatology: “Exercise and Arthritis.”

Johns Hopkins Arthritis Center: “Rehabilitation Management for Rheumatoid Arthritis Patients.”

UW Medicine Orthopaedics and Sports Medicine: “Rheumatoid Arthritis.”

American Physical Therapy Association.

Arthritis Foundation: “Community Programs.”

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