The Effects of Rheumatoid Arthritis on Functional Ability and Cardiovascular and Pulmonary Systems

Rheumatoid arthritis (RA) can affect strength, joint mobility, and functional status and increase the risk for cardiovascular (CV) and pulmonary system complications due to chronic systemic inflammation, inactivity, and increased traditional cardiovascular risk factors. Systemic inflammation influences the formation of carotid atherosclerosis, arterial stiffness, and endothelial dysfunction resulting in people with RA having a high prevalence of cardiovascular disease (CVD), with a higher than normal risk for myocardial infarction and stroke. Moreover, there is a 50% greater rate of CVD-associated death in people with RA.

The Role of the Physical Therapist

Along with the pharmacological treatment of RA, management with exercises has been shown to improve joint mobility, muscle production, aerobic capacity, functional status, immune system regulation, insulin resistance, lipid profile, and quality of life, and decrease inflammation and CV risk without the detrimental effects of the disease Research shows improvement in aerobic fitness measured by increased VO₂max was associated with lower CVD morbidity and mortality. Further, endurance, balance, strength, and perception of positive change were improved with aerobic and progressive resistive exercises.

Physical therapy (PT) plays a role in the treatment of patients with RA as a primary or secondary diagnosis. Goals for PT would include decreased pain and CV effects and increased strength, joint mobility, functional ability, and balance. Treatment may consist of aerobic, resistance, flexibility, and balance exercises, and functional training. Working with the patient toward self-efficacy is vital in a continued benefit following the discontinuation of PT. Moreover, identifying and assisting the patient in attenuating barriers improve compliance with a home exercise program.

References:

Bearne, L.M., Manning, V.L., Choy, E., Scott, D.L., & Hurley, M.V. (2017). Participants’ experiences of an Education, self-management and upper extremity eXercise Training for people with Rheumatoid Arthritis programme (EXTRA). Physiotherapy, 103(4), 430–438. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=s3h&AN=126897729&site=eds-live

Chang, C.-L., Chiu, C.-M., Hung, S.-Y., Lee, S.-H., Lee, C.-S., Huang, C.-M., & Chou, C.-L. (2009). The relationship between quality of life and aerobic fitness in patients with rheumatoid arthritis. Clinical Rheumatology, 28(6), 685–691. https://doi.org/10.1007/s10067-009-1132-0

Cooney, J. K., Law, R.-J., Matschke, V., Lemmey, A. B., Moor, J. P., Ahmad, Y., … Thom, J.M. (2011). Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research, 1–14. https://doi.org/10.4061/2011/681640