# Exercise as it relates to Disease/Exercise's Effect on Inflammatory Arthritis
### Inflammatory Arthritis

Arthritis is a term that encompasses most joint symptoms and dysfunction. Broadly speaking, there are two main forms of arthritis, the degenerative form osteoarthritis, and the inflammatory arthropathies, where inflammation occurs in the affected joints and their surrounding structures. Inflammatory Arthritis is an umbrella term describing a diverse range of conditions where inflammation of the affected joints and their associated structures occurs. This inflammation is the result of an uncontrolled immune response and speaks for conditions like Rheumatoid Arthritis, the seronegative spondylarthropathies, and other less frequent conditions.

#### Causes

Many of the inflammatory arthropathies causes are still relatively unknown, with genetic pre-disposition thought to play a role in the contraction of the more prevalent forms like Rheumatoid Arthritis. As a whole, the cause of such conditions can be due to infection, crystal deposition within joints and their associated structures or autoimmune disease. The joints and their related synovial structures are the most commonly affected by all forms of inflammatory disease, making these areas particularly vulnerable to autoimmune inflammation as well.

#### Risk Factors

Extra-articular manifestations can occur if the autoimmune inflammation involved with many forms of inflammatory arthritis is untreated and creates systemic inflammation, posing serious threats to health. Studies have shown that if left relatively untreated, Rheumatoid Arthritis can shorten life expectancy by around 6–10 years. It has also been found that patients with inflammatory arthritis are at a 50% increased risk of developing cardiovascular disease. Other co-morbidities including malignancy, infection, and gastro-intestinal ulcerationseem to be associated with the prolonged autoimmune inflammation seen in inflammatory arthritis cases.

#### Signs & Symptoms

The key to interpreting inflammatory arthritis is pattern identification. Particularly important is the timing and location of joint stiffness and swelling, and it should be noted that fatigue is a significant factor in inflammatory arthritis. Other signs & symptoms include:
* Morning stiffness in and around joints lasting at least 1 hour before maximal improvement
* Soft tissue swelling of three or more joint areas as observed by a physician
* Symmetric swelling, especially around the wrist joints, and in between the knuckles
* Heat, pain, redness and swelling of one or multiple joints
* The presence of Rheumatoid Factor, an autoantibody found in Rheumatoid Arthritis and;
* Radiographic erosions or osteopenia in the hand or wrist joints,

## The Effect of Exercise
### Exercise and Inflammation

Inflammation is the immune system's response to infection or trauma. This necessary response produces increasing levels of circulating inflammatory mediators, however a prolonged inflammatory state has detrimental effects and predisposes the body to a number of chronic disease and health conditions. The inflammatory pathway is therefore a good target for interventions designed to reduce the risk of disease and disability. Physical activity has been well recognised as an important strategy for improving the inflammatory profile. It is widely acknowledged that it provides multiple health benefits for both the general population and patients with chronic diseases, including Inflammatory Arthritis. Improving insulin sensitivity, reducing adiposity, increasing muscle strength, improving balance, and facilitating psychological well-being are just a few of these numerous benefits.

### Exercise and Inflammatory Arthritis

The majority of patients with chronic Inflammatory Arthritis have their disease controlled by a series of powerful disease-modifying antirheumatic drugs (DMARDs). However, does not help with the functional limitation adopted with the condition. The same population is involved with a significant decrease in physical activity levels due to the functional limitation caused by joint pain, restricted mobility, fatigue, reduced muscle mass, strength and endurance. Patients with Inflammatory Arthritis receive a lack of education about physical activity and their disease, and therefore their perceived exercise threshold is much lower than actually exhibited. The extreme physical inactivity of these patients can become a progressive circle in terms of health and disease progression. Thus it is apparent that encouraging physical activity is an important and essential part of the overall treatment of Inflammatory Arthritis. The benefits of increase physical activity in this population will improve the risk and progression of co-morbidities elevated by their inflammatory disease, but may also aid in mobility, improving functional limitations, and reducing inflammation and pain.

## Recommendations

Being physically active is essential in the maintenance and improvement of Inflammatory Arthritis and it's related co-morbidities. For those who have less chronic and debilitating forms of arthritis, it is recommended that the Australian Physical Activity Guidelines be followed, including:
* Doing any physical activity is better than doing none: if you currently do no physical activity, start by doing some, and gradually build up to the recommended amount
* Be active on most, preferably all, days every week
* Accumulate 150 to 300 minutes (2½ to 5 hours) of moderate intensity physical activity or 75 to 150 minutes (1¼ to 2½ hours) of vigorous intensity physical activity, or an equivalent combination of both moderate and vigorous activities, each week
* Do muscle strengthening activities on at least 2 days each week
If more debilitating, chronic forms of arthritis are exhibited, it may help to follow specific Rheumatoid Arthritis Guidelines in conjunction with the Australian Physical Activity Guidelines provided above.

## Further reading

* Australian Physical Activity and Sedentary Behaviour Guidelines <http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#apaadult>
* Royal Australian College of General Practitioners Clinical Guidelines for Musculoskeletal Disease <http://www.racgp.org.au/your-practice/guidelines/musculoskeletal/>
* Arthritis Australia <http://www.arthritisaustralia.com.au/>

## References

* 1 2 3 Hughes D, (2009) Osteoarthritis and Inflammatory Arthritis. Surgery (Oxford). Volume 27 (issue 2): p75-79
* 1 2 3 4 Stevenson J, (2009) Inflammatory Arthritis. InnovAiT: The RCGP Journal for Associates in Training. Volume 2 (issue 10): p585-596
* ↑ Gullick N, Scott D, (2012) Drug Therapy of Inflammatory Arthritis. Clinical Medicine. Volume 12 (issue 4): p357-363
* 1 2 John H, Kitas G, (2012) Inflammatory Arthritis as a Novel Risk Factor for Cardiovascular Disease. European Journal of Medicine. Volume 23 (issue 7) p575-579
* 1 2 Jones N, Suppiah R, (2010) Correlation Between Physical Activity in Patients with Inflammatory Arthritis and Beliefs About Aerobic Exrcise – pilot study (1675). Medicine & Science in Sports & Exercise. Volume 42 (issue 5) p360
* ↑ Michaud K, Wolfe F, (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol. Volume 21, p885–906
* ↑ Shrivastava A, Pandey A, (2013) Inflammation and Rheumatoid Arthritis. Journal of Physiology and Biochemistry. Volume 69 (issue 2): p335-347
* 1 2 3 Beavers K, Brinkley T, Nicklas B, (2010) Effect of Exercise Training on Chronic Inflammation. Clinica Chimica Acta. Volume 411 (issue 11-12) p785-793
* 1 2 3 4 5 Cooney J. et al, (2011) Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research. Volume 2011
* 1 2 3 Tierney M, Fraser A, Kennedy N, (2012) Physical Activity in Rheumatoid Arthritis: A Systematic Review. Journal of Physical Activity and Health. Volume 9: p1036-1048
* 1 2 Australian Government: Department of Health (2014). Australia’s Physical Activity and Sedentary Behaviour Guidelines. Available from <http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#apaadult>
* ↑ Durstine L et al, (2003). ACSM's Exercise Managment for Persons with Chronic Diseases and Disabilities. USA: Human Kinetics. 3rd edition.