Exercise rheumatoid arthritis

The musculoskeletal system consists of the muscles, bones, joints, tendons, and ligaments. Disorders related to the musculoskeletal system often are classified by etiology. Acute soft-tissue injuries include strains and sprains of muscles and ligaments. Repeated movements in sports, exercise, work, or activities of daily living may lead to repetitive strain injury, where cumulative damage occurs to the muscles, ligaments, or tendons.1-3 While tendonitis and bursitis can arise from acute injury, more commonly these conditions occur as a result of chronic stress.3,4 Other forms of chronic musculoskeletal pain, such as pain from rheumatoid arthritis (see Chap. 54) or osteoarthritis (see Chap. 55), are discussed elsewhere in this text. 

Many disorders benefit from exercise (Pederson Saltin, 2005). These include asthma, cancer, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), depression, type 1 diabetes melUtus, type 2 diabetes melUtus, hypertension, intermittent claudication, osteoarthritis, osteoporosis, rheumatoid arthritis and obesity. 

Brief History. R.F., a 63-year-old woman, has been receiving treatment for schizophrenia intermittently for many years. She was last hospitalized for an acute episode 7 months ago and has since been on a maintenance dosage of haloperi-dol (Haldol), 25 mg/d. She is also being seen as an outpatient for treatment of rheumatoid arthritis in both hands. Her current treatment consists of gentle heat and active range-of-motion exercises, three times each week. She is being considered for possible metacarpophalangeal joint replacement. 

Pentoxifylline (oxipentifylline) is a methylxanthine that antagonizes the vasoconstrictor effects of catecholamines and increases cyclic AMP concentrations, causing smooth muscle to relax. It has also been claimed to correct impaired microcirculation, by improving various factors that disturb blood rheology, and to reduce the generation of toxic free radicals from leukocytes during ischemic leg exercise in patients with intermittent claudication. Pentoxifylline has been used to suppress overproduction of tumor necrosis factor alfa in conditions such as falciparum malaria and rheumatoid arthritis and in transplant recipients, with varied success. 

The joints affected most frequently by rheumatoid arthritis are the small joints of the hands, wrists, and feet (Fig. 89-3). In addition, elbows, shoulders, hips, knees, and ankles may be involved. Patients usually experience joint stiffness that typically is worse in the morning. The duration of stiffness tends to be correlated directly with disease activity, usually exceeds 30 minutes, and may persist all day. Chronic inflammation with lack of an adequate exercise program results in loss of range of motion, atrophy of muscles, weakness, and deformity. 

Elevated plasma levels of IL-1 have been detected in a wide range of different conditions that are characterized by inflammation such as rheumatoid arthritis (RA), acute arthritides (D13, E2, M5), Crohns disease (SIO), periodontitis (C16), sunburn (G20), bums (K34), endometriosis (F3), psoriasis (C5), gram-positive meningitis (Sll), and extended exercise in healthy volunteers (C9). In RA there is some correlation with disease activity (E2). In synovial fluid, biologically active... 

Rheumatoid arthritis and osteoarthritis may involve the joints of the wrist and hand. Psoriatic arthritis and gouty arthritis may also affect this area. Many of the findings and specific deformities were mentioned previously. In the arthriti-des, the small accessory motions of the joint are lost first. The osteopathic physician must articulate all joints once the acute inflammation has subsided. Placing traction on the joint as it is articulated decreases the discomfort for the patient. The patient should be encouraged to exercise the joints gently to maintain mobility. 

Symptoms (diagnosis). Osteoarthritis is the most common cause of painful knees, backs, and fingers. But it seldom causes deformity of the joints or crippling. Affected joints may creak and grate on movement. Typically, pain is increased by exercise and relieved by rest. Unlike rheumatoid arthritis, osteoarthirtis does not produce any nodes under the skin and is not accompanied by constitutional symptoms such as fever and weight loss. 

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