Arthritis
PATRIC DELQUADRO
Overview
 Definitions
 Epidemiology
 Clinical Aspects
 Treatment
 Effects of Exercise
 Testing
 Prescription
 Conclusion
 References
Definitions
 Osteoarthritis (OA) – Chronic deteriorative disease
of cartilage in joints allowing bones to contact/rub
causing inflammation. Result of aging, genetics,
previous injuries, and overuse.
 Rheumatoid Arthritis (RA) - Chronic autoimmune
disease were the body’s immune system, for reasons
unknown, attacks the synovial lining surrounding
joints causing inflammation and destruction of joint
cartilage.
OA Video
 http://www.youtube.com/watch?v=0dUSmaev5b0
RA Video
 http://www.youtube.com/watch?v=AYTutNDWPKg
Epidemiology
 Arthritis
 More than 100 different forms of arthritis
 1 in 7 Americans have at least 1 type of arthritis
 Osteoarthritis
 1 in 12 Americans affected
 Signs start showing after age 45
 More common in men >55, women <55
 Rheumatoid Arthritis
 Close to 1% of Americans affected
 Affects women 3 X to men
Symptoms
 Osteoarthritis (OA)
 Symptoms include:
Stiffness and deep underlying ache or pain in joints
 Warmth, swelling, and/or redness around joint (inflammation)
 Reduced ROM
 Usually felt in early morning, during/post activity, & inactivity
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Late Stages
Bony spurs called Heberden’s nodes develop
 Audible grinding or crackling noise from joint (crepitation)
 Joint deformation
 Spurring or crystallization of bone and/or cartilage
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Osteoarthritis Images
Symptoms Continued
 Rheumatoid Arthritis (RA)
 Many of the same symptoms as OA with the exception of:
Joint pain is generally equal on both sides of body
 Prolonged early morning stiffness
 Greater joint deformation and rheumatoid nodules
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RA is Systemic
Rheumatoid factor affects the whole body
 Numbness or tingling of the hands and feet
 Eye burning, chest pain, and/or dry-mouth
 Damage to cardiorespiratory tissue
 Fever and fatigue

Rheumatoid Arthritis Images
Test and Evaluation
 Physical Exam
 A traditional physical exam is performed on patients with any
type of arthritis
 Special attention is given to:
 Joint movement and function
 Visual appearance noting inflammation, redness, nodes etc.
 History of symptoms and discomfort
 Listening for crepitation
 Blood testing does little to determine if the patient
has arthritis.
Laboratory Diagnosis
 Osteoarthritis
 Joint aspiration
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Synovial fluid drawn from the joint is examined for deterioration
X-ray
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Less invasive and helpful for observing cartilage and bone health
 Rheumatoid arthritis
 Rheumatoid factor (RF) test
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Blood sample is taken and RF levels are evaluated
MRI or Ultrasound
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Same purpose as x-ray, more detailed and convenient
Complications
 Physically
 Large joints like knees, shoulders, hips and back/neck are
usually most affected by arthritis. This limits physical activity
and daily tasks.
 Joints in hands and feet also become problematic causing
issues with balance, gait, and tasks requiring grip strength.
 Emotionally
 Physical appearance can be detrimental to the persons
confidence and emotion wellbeing.
 Being limited and in pain can cause a person to give up on
exercise leading to a sedentary lifestyle.
Treatment
 The best medicine for any type arthritis is….
STAYING ACTIVE!!!
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By staying active, joints, bones and muscles are worked
encouraging repair and growth.
Patients are asked to work through the initial morning pain
and discomfort and participate in moderate exercise.
Over the counter pain relievers: Acetaminophen (Tylenol)
NSAID’s: ibuprofen, aspirin, and naproxen
Treatment Continued
 RA preventative treatments
 Disease modifying antirheumatic drugs (DMARDs):
 Rheumatrex, Arava, Gold sodium thiomalate
 DMARDs target immune processes that cause inflammation
and are administered via IV, injection, pill
 Corticosteroids: Prednisolone
 These treatments are also used in severe cases of OA
Treatment Continued
 Physical therapy
 Strengthens muscle and improves ROM
 Educates patient with usable exercise routines
 Surgery
 Arthroscopic surgery
 Partial and full joint replacements for knees, shoulders, hip,
ankle, and elbow.
 Alignment surgery (knee, elbow, tarsals)
 Fusion (spine, ankle)
Effects of Exercise
 Capable of improving all system functions
 Improves joint ROM, stability, and function
 Decreases inflammation and pain in joints
 Creates positive social wellbeing and outlook on life
 Increases activity and productivity
Ability to Exercise
 Special Considerations
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Joint stability must be planned for and monitored
Only low impact exercises should be used
Allow ample time for warm-up/cool down, especially early day
Progression in exercise intensity should be gradual
Progression in duration before intensity
Good shock absorbing shoes should be worn during exercise
Risk and issues increase with overweight/obese clients
Medications and Exercise
 No exercise specific side-affects with DMARDs
 Methotrexate
 Increased bruising, nausea, decrease in energy
 Arava
 Increased bruising, chest pain, numbness and weight loss
 Gold sodium thiomalate
 Abdominal pain, shortness of breath, and bruising
Exercise Testing
Methods
Strength
Repetition Max (1, 8, or 12 reps)
Isometric knee extension
Standardized functional
measures
Endurance
6 min walk
Cycle Ergometer
Flexibility
Goniometry
Measures
Timed chair rise
Timed up and go
HR
Functional ROM
Assess Symmetry
Exercise Prescription
 Frequency, Intensity, Time an Type (FITT)
 FITT principles apply same as a healthy individual
Resistance
Aerobic
Flexibility
Frequency
2-3 day/week
3-5 day/week
Daily
Intensity
Start @ 10% Max
Increase 10% (Max)
weekly
60-80% HR peak
Pain Dependent
Tension (not pain)
Time
10-15 rep warm-up
3-5 exercises
5-10 reps (tolerable)
5-10 min warm-up
20-30 min (tolerable)
5-10 min
Beginning of day
Pre/Post Exercise
Type
Circuit training
Free/Machine Weights
Elastic bands
Isometric
Low resistance
Walking
Cycling
Water aerobics
ROM joint
stretching
All major muscles
Importance of Flexibility at 80
 http://www.youtube.com/watch?v=UQASHZMeMn
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Summary and Conclusion
 OA is the most common type of arthritis
 Deteriorative disease of joint cartilage
 Most times age dependent
 No cure, only temporary relief or invasive surgery
 RA is less common but with more complications
 Autoimmune disease attacks the synovial lining around joints
 Not age dependent
 Detrimental to other systems of the body
 Medications can be used to slow disease progression
References
 Byk, C. (2008). Osteoporosis: An Exercise Guide. El
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Paso: Workfit Consultants.
M.D., G. C. (2008). The Arthritis Handbook. New York,
NY : DiaMedica.
M.D., T. L. (2003). Living with Rheumatiod Arthritis.
Baltimore, MD: Johns Hopkins Press.
Medicine, A. C. (2010). ACSM's Guidelines for Exercise
Testing and Perscription (8th ed.). Baltimore, MD:
Wolters Kluwer.
Medicine, U. N. (2012, March 21). Medline Plus.
Retrieved March 21, 2012, from
http://www.nlm.nih.gov/medlineplus/arthritis.html