By: Amelia Clark

Definition Epidemiology Symptoms Diagnosis Treatment Effects of Exercise Exercise Testing Exercise Rx Summary/References

“Arthon”= joint “itis”= inflammation Inflammation of one or more joints resulting in pain, swelling, stiffness and limited movement. No cure YouTube - osteoarthritis

Over 100 types Osteoarthritis (OA): Deterioration or loss of cartilage in synovial joints, particularly in weight-bearing joints followed by formation of bone spurs and subchondral cysts. Also known as Degenerative Joint Disease (DJD) OsteoarthritisPrimarySecondary Normal wear & tear of aging Heredity, obesity, injury Commonly affects: hands, spine, hips, knees

Rheumatoid (RA): inflammation of synovial membrane, formation of pannus tissue, & eventual deterioration of bone and cartilage. Autoimmune disease Other: Juvenile arthritis Ankylosing Spondylitis Lupus fibromyalgia Psoriatic arthritis Gout Pseudogout Commonly affects: Wrists, hands, knees, feet, cervical spine

UNITED STATES 1 in 5 adults=46 million More common among women 1 in 250,000 children has arthritis (294,000) Most common cause of disability More than back problems UTAH Adults with arthritis: 399,000 Have arthritis & are overweight/obese: 71% Have arthritis & are physically inactive: 14%

Being overweight or obese increases your risk for arthritis. Arthritis is often coupled with diabetes and obesity. Physical activity can help prevent risk of arthritis.

Symptoms Swelling Pain Stiffness Limited movement Fatigue Redness around joint Age Genetics Overweight/obesity Females Smokers Previous injury Occupation w/ repetitive movements Risk Factors

Medical History Physical Exam Lab Tests

Information about your health background Heredity Description of symptoms you’ve been having Details about how and when symptoms began Where? How is it affecting you? Other medical problems?

Looks at joints Touches those described Looks for areas that are tender, painful, or swollen, or indications that the joint is damaged. May be asked to stand up and move joints ROM Goniometer Examine position & alignment of neck and spine. Watch you walk to see how you are able to move hips and knees.

Osteoarthritis Joint aspiration extracts fluid for evidence of crystals or joint deterioration X-ray see damage to bone MRI see soft tissue and cartilage NEW! MRI measures GAGs & early detection Sed rate Rate at which blood cells sink C-reactive protein Measure inflammation Rheumatoid factor Antibody found in blood Antinuclear antibodies Antibody combined with nuclei Anti-CCP Antibody X-rays Swelling of soft tissue, loss of bone density Bone scans Detect inflammation MRI Synovitis, inflammation in other organs Rheumatoid Arthritis

Medications Nonpharmacologic Therapies Surgery

NSAIDs Target pain and inflammation Can be hard on the stomach and GI tract Acetaminophen Pain only Topical pain relievers Pain only Corticosteroids Relieve inflammation quickly Good for RA Don’t use frequently Disease-modifying antirheumatic drugs (DMARDs)

Hypnosis Aromatherapy Supplements Fish oil Physical Therapy Electrical Stimulation Exercise Weight loss Patient Education Splints/assistive aids Essential Oils Rub on hands and put rubber gloves on and soak on warm water 5-10 minutes Meditation Reduced pain in 56% of participants Hot & Cold treatments

Joint replacement Improved movement Pain relief Improved joint alignment Arthroscopic surgery Not very beneficial for arthritis Youtube-Fight arthritis pain

RA can affect cardiac and pulmonary function. Could cause vasculitis. Fear of joint pain or harming joint Joint ROM restriction Inability to perform rapid repetitive movements Deconditioned joints-swelling decreases performance “out of shape” Increased resting energy expenditure (REE) as much as 50%

Other diseases (i.e. diabetes, obesity, heart disease) Improve cardiovascular status, balance, flexibility and general health Decreased joint swelling Improve: Function Mood QOL Mobility Increased social and physical activity Reduced depression and anxiety Every 1 lb lost is 4lbs off your knees! Associated with…

Submaximal tests Treadmill (<3mph) Cycle ergometer Suspected cardiopulmonary disease-do a different test 1 rep max Low intensity intially ROM (goniometery) Gait analysis- for those with severe disease Avoid morning exercise (especially with RA) Spinal involvement may cause nerve disfunction Avoid vigorous and high repetitive exercises with unstable joints Submaximal tests Treadmill (<3mph) Cycle ergometer Suspected cardiopulmonary disease-do a different test 1 rep max Low intensity intially ROM (goniometery) Gait analysis- for those with severe disease Avoid morning exercise (especially with RA) Spinal involvement may cause nerve disfunction Avoid vigorous and high repetitive exercises with unstable joints

MethodsSuggested Tests StrengthRepetition Max (1, 8, or 12) Endurance6 min walk Aerobic capacity (REP 6-20) Flexibility (helpful in preventing injury)Goniometry (ROM, symmetry) FunctionalBalance tests, gait analysis

Tests Range of Motion (ROM) Progression of disease Lack of progression of therapy Tests Range of Motion (ROM) Progression of disease Lack of progression of therapy

JointFlexionExtension Hip °10-30° Knee ° ° Ankle0-10° (dorsiflexion) 20-30° (plantarflexion) Shoulder °40-60°

Stretching and warm-up always (even on days when there is a flare up) Use weight-bearing, partial weight-bearing and non- weight-bearing exercises Recommend learning a strength routine Avoid activities that increase joint pain Post-exercise soft tissue discomfort is expected

Do’s Low-impact Muscle are strengthened before increase in intensity flexibility/ROM Proper shoes Several short sessions if necessary Alternate exercise modes Time goals (not distant) Stop and go movements Prolonged one –legged stance Stair climbing Contact sports Overstretching & hypermobility If pain or swelling-reduce load on joint Don’t encourage client to exceeding guidelines Don’ts

ModesIntensityFrequencyDuration Aerobic40-60% VO 2max 3-5 days/week5-10 min build to 30 min sessions Strength1 or more sets of 2- 3 reps, building to 10 reps 2-3 days/week FlexibilityBefore aerobic or strength activities

Arthritis is characterized by swelling in the joint(s). Osteoarthritis, rheumatoid arthritis are most common. It is often common in people with other conditions such as heart disease, obesity, and diabetes. Exercise helps decrease symptoms and is affective for and increase in QOL. Exercise Rx should include a variety of modes of exercise and flexibility. Low-impact exercises are best

Brittain, D.R., Gyurcsik, N.C., McElroy, M., Hillard, S.A. (2011). Woman’s Health Issues. (issue 1, vol. 21) Janssen, I. I., & Mark, A. E. (2006). Separate and combined influence of body mass index and waist circumference on arthritis and knee osteoarthritis. International Journal of Obesity, 30(8), doi: /sj.ijo