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Dec 2, 2024

Rheumatoid Arthritis





Managing Rheumatoid Arthritis: Practical Tips

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune condition that can impact your entire body, not just your joints (Misra 2024). While it's commonly known for causing pain and fatigue, it can also lead to other health issues, such as cardiovascular, renal, pulmonary and other complications (Misra, 2024). Understanding the full scope of RA helps you take an active role in managing your health and minimizing its effects.

How can I manage my rheumatoid arthritis naturally and reduce reliance on medications?

Medications like DMARDs (disease-modifying anti-rheumatic drugs) are recognised as essential in managing RA (Cubberley & Maharaj 2024)(Li & Wang 2023)(Aletaha & Smolen 2018). While it’s important to follow your doctor’s or specialist's guidance, there are several lifestyle changes that can help complement your treatment, discussed below.



Will physical activity make my rheumatoid arthritis worse?

Physical activity and exercise offer several benefits for managing rheumatoid arthritis (RA). Research shows that regular movement can:


  • Improve cardiovascular health: People with RA are at higher risk for heart-related issues, so exercise can help protect your heart (Li & Wang 2023)(Metsios et al., 2015).

  • Enhance fitness and physical capacity: Exercise helps you build strength and stamina, making everyday tasks easier and more manageable (Li & Wang 2023)(Metsios et al., 2015).

  • Alleviate pain: Regular physical activity can reduce pain and improve your ability to move comfortably (Li & Wang 2023)(Metsios et al., 2015).

  • Reduce joint stiffness and swelling: Staying active can keep your joints more flexible and help reduce inflammation (Li & Wang 2023)(Sveaas et al., 2017).

  • Supporting better sleep and mental well-being: Physical activity can have a positive effect on mood, reduce stress, and improve sleep quality (Li & Wang 2023)(Metsios et al., 2015).

  • Promoting bone health: RA increases the risk of osteoporosis (Misra 2024), but weight-bearing activities like walking or strength training can help protect bones and maintain density.


And possibly most importantly it seems to be safe and does not worsen RA (Li & Wang 2023).



What are the best exercises for rheumatoid arthritis?

When it comes to exercise for rheumatoid arthritis (RA), both aerobic and resistance exercises can be  beneficial for managing symptoms, improving mobility, and supporting overall health (Li & Wang 2023).

 

Some examples for aerobic exercises include:


  • Walking

  • Swimming

  • Cycling


Some examples for resistance training include:


  • Weight training

  • Bodyweight exercises

  • Resistance bands

  • Pilates



How can I manage the emotional and psychological toll of living with rheumatoid arthritis?

Living with RA can be emotionally challenging, from coping with chronic pain to managing stress and fatigue. In fact, people with RA are twice as likely to have Depression (Lwin et al., 2020). Psychotherapy can help you navigate these challenges by offering support and improving pain, anxiety, and reducing the impact of RA on your life (Shen et al., 2020)(Nagy et al., 2023). It teaches coping strategies and enhances emotional well-being. Therapy works alongside your medical treatment, helping you manage RA with more resilience and improving your overall quality of life.



What role does diet play in managing rheumatoid arthritis?

Current evidence suggests that for some individuals with RA, dietary changes can have a positive impact on inflammatory markers (Sokoya et al., 2024). Specifically, a combination of fasting followed by either a gluten-free diet or a personalized food reintroduction plan appears to be the most effective and well-studied approach (Sokoya et al., 2024). Additionally, research indicates that a Mediterranean diet may help reduce pain in people with RA (Schonenberger et al., 2023). This diet focuses on consuming a variety of fruits, vegetables, whole grains, legumes, healthy fats (particularly olive oil), fish, moderate amounts of dairy, and minimal red meat, with an emphasis on using herbs and spices for flavor. To get a personalized plan, dietitians are the most qualified and appropriate healthcare professionals who can assist you.



How can I improve my sleep with rheumatoid arthritis?

Sleep impairments are common in people with rheumatoid arthritis (RA), affecting approximately 70% of individuals, and there appears to be a bi-directional relationship between the two, where poor sleep worsens RA symptoms and RA negatively impacts sleep quality (Coskun, 2018; Grabovac et al., 2018). Several mechanisms have been proposed, including the link between poor sleep and increased inflammation (Coskun, 2018; Grabovac et al., 2018), with pain acting as a key mediating factor in this relationship (Grabovac et al., 2018). If you would like to know your options on how to improve your sleep please read our blog sleep & persistent pain.



How do I prevent this condition from worsening over time?

Currently, there is no known cure for rheumatoid arthritis (RA) (Aletaha & Smolen, 2018), but for the majority of people, treatments can lead to remission (75-80%), enabling individuals to live a relatively normal life (Aletaha & Smolen, 2018).



How can I manage flare-ups of rheumatoid arthritis?

Firstly, you may have been prescribed certain medications to assist in flare-ups during RA, for example glucocorticoids (Cubberley & Maharaj 2024). It is important to note that these medications in the long-term are discouraged (Cubberley & Maharaj 2024).



Summary of self-management tips

  1. Engage in exercise and stay physically active: • Start slow and gradually increase when possible • Modify exercises when necessary • Rest and recovery are vital! • Aim for engaging in something you enjoy • Consult with a professional for tailored exercise programs, advice and a plan

  2. RA can have emotional and psychological impacts, including a higher risk of depression. Psychotherapy can help manage stress, improve coping strategies, and enhance emotional resilience, complementing medical treatment for better quality of life.

  3. Consider dietary changes looking at ‘anti-inflammatory’ food options such as fruits, vegetables, whole grains, and healthy fats (especially olive oil). Work with a dietitian to tailor a plan that addresses inflammation and individual needs.

  4. Address sleep issues (if this is an issue). Create a consistent sleep routine (same bedtime, calming pre-sleep activities). Keep the bedroom cool, dark, and quiet to enhance sleep environment. Consider relaxation techniques like deep breathing or progressive muscle relaxation before bed.




References


  1. Aletaha, D., & Smolen, J. S. (2018). Diagnosis and Management of Rheumatoid Arthritis. JAMA, 320(13), 1360–1372. https://doi.org/10.1001/jama.2018.13103

  2. Coskun Benlidayi, I. (2018). Sleep impairment: an obstacle to achieve optimal quality of life in rheumatoid arthritis. Rheumatology International, 38(12), 2183–2192. https://doi.org/10.1007/s00296-018-4155-5

  3. Cubberley, C., & Maharaj, A. (2024). Global RA treatment recommendations: An update from the various international societies. Best Practice & Research Clinical Rheumatology, 102019. https://doi.org/10.1016/j.berh.2024.102019

  4. Grabovac, I., Haider, S., Berner, C., Lamprecht, T., Fenzl, K.-H., Erlacher, L., Quittan, M., & Dorner, T. (2018). Sleep Quality in Patients with Rheumatoid Arthritis and Associations with Pain, Disability, Disease Duration, and Activity. Journal of Clinical Medicine, 7(10), 336. https://doi.org/10.3390/jcm7100336

  5. Li, Z., & Wang, X.-Q. (2023). Clinical effect and biological mechanism of exercise for rheumatoid arthritis: A mini review. Frontiers in Immunology, 13. https://doi.org/10.3389/fimmu.2022.1089621

  6. Lwin, M. N., Serhal, L., Holroyd, C., & Edwards, C. J. (2020). Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review. Rheumatology and therapy, 7(3), 457–471. https://doi.org/10.1007/s40744-020-00217-4

  7. Metsios, G. S., Stavropoulos-Kalinoglou, A., & Kitas, G. D. (2015). The role of exercise in the management of rheumatoid arthritis. Expert review of clinical immunology, 11(10), 1121–1130. https://doi.org/10.1586/1744666X.2015.1067606

  8. Misra, D. P. (2024). Clinical manifestations of rheumatoid arthritis, including comorbidities, complications, and long-term follow-up. Best Practice & Research. Clinical Rheumatology, 102020. https://doi.org/10.1016/j.berh.2024.102020

  9. Nagy, Z., Szigedi, E., Takács, S., & Császár-Nagy, N. (2023). The Effectiveness of Psychological Interventions for Rheumatoid Arthritis (RA): A Systematic Review and Meta-Analysis. Life (Basel, Switzerland), 13(3), 849. https://doi.org/10.3390/life13030849

  10. Schönenberger, K. A., Schüpfer, A.-C. ., Gloy, V. L., Stanga, Z., Kägi-Braun, N., & Reber, E. (2021). The effect of anti-inflammatory diets on pain in rheumatoid arthritis: a systematic review and meta-analysis. Clinical Nutrition ESPEN, 46, S682–S683. https://doi.org/10.1016/j.clnesp.2021.09.394

  11. Sharma, P., Brown, S., & Sokoya, E. M. (2024). Re-evaluation of dietary interventions in rheumatoid arthritis: can we improve patient conversations around food choices? Rheumatology International. https://doi.org/10.1007/s00296-024-05541-4

  12. Shen, B., Li, Y., Du, X., Chen, H., Xu, Y., Li, H., & Xu, G. Y. (2020). Effects of cognitive behavioral therapy for patients with rheumatoid arthritis: a systematic review and meta-analysis. Psychology, health & medicine, 25(10), 1179–1191. https://doi.org/10.1080/13548506.2020.1736312

  13. Stavropoulos-Kalinoglou, A., Metsios, G. S., Veldhuijzen van Zanten, J. J., Nightingale, P., Kitas, G. D., & Koutedakis, Y. (2013). Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Annals of the rheumatic diseases, 72(11), 1819–1825. https://doi.org/10.1136/annrheumdis-2012-202075

  14. Sveaas, S. H., Smedslund, G., Hagen, K. B., & Dagfinrud, H. (2017). Effect of cardiorespiratory and strength exercises on disease activity in patients with inflammatory rheumatic diseases: a systematic review and meta-analysis. British journal of sports medicine, 51(14), 1065–1072. https://doi.org/10.1136/bjsports-2016-097149





This blog was written by Samuel Bulten


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