Rheumatoid Arthritis Watch

OCTOBER 12, 2011


Exercise and RA: Know Your Goal

One of the proven ways for patients to cope with the symptoms of rheumatoid arthritis (RA) is to exercise regularly. However, many patients with RA do not know which exercises are appropriate or how to achieve exercise goals. 

In a study published in the journal Arthritis Care & Research on August 25, 2011, researchers examined physical activity, achievement of goals in relation to self-reported pain, and quality of life in 271 patients with RA.

The patients completed questionnaires assessing physical activity, motivation, and self-efficacy for physical activity, arthritis pain, and quality of life. The participants completed this questionnaire again 6 months later, and also indicated to what extent they had achieved their baseline activity goals.

Of the 106 participants who completed both surveys, 75% said their level of goal achievement was 50% or higher. A majority also said that the achievement of goals directly affected quality of life and decreased self-reported arthritis pain. The researchers concluded that assisting patients in putting together detailed exercise plans may be beneficial. These exercise plans should be patient-owned, short-term, and as realistic as possible. Providing regular feedback is also necessary, and using devices like pedometers can also be beneficial.

Oral Contraceptive Use May Help RA Symptoms

Scientists have long been puzzled by the fact that the incidence of RA is higher in women than in men, and numerous theories regarding hormonal balance abound. A study published in the August 2011 issue of Arthritis & Rheumatism addressed whether oral contraceptives could be protective against arthritis.

The researchers studied patient-reported history of oral contraceptive use in 663 women with the use of health assessment questionnaires (HAQs). These women were born after 1945, had inflammatory polyarthritis, and had not used oral contraceptives during follow-up. The researchers found that the 523 women who used oral contraceptives before enrollment had lower baseline HAQ scores than women who never used oral contraceptives. The results also showed that women who used oral contraceptives before symptom onset, when adjusted for parity, symptom duration, and age and calendar year at symptom onset, had HAQ scores significantly lower than those patients who had not used oral contraceptives before symptom onset (mean difference -0.21; 95% confidence interval -0.40 to -0.02).

Many mechanisms explaining this apparent relation between oral contraceptive use and arthritis incidence have been suggested. Some scientists believe that because RA symptoms have been shown to be reduced just after ovulation, the phase associated with high levels of estrogen and progesterone, combined oral contraceptives may work by maintaining this high hormonal phase. Another theory is that oral contraceptive use may result in an increased level of heat-shock proteins, which leads to an immunotolerance that tempers RA symptoms. More research, particularly less subjective studies, is needed to address this possible link. 

More Research Needed on Use of Alternative Medicine in RA

The chronic nature of RA leads many patients to look for methods of treatment not supported by conventional medicine. Complementary and alternative medicines, or CAMs, are by definition not integrated into the dominant health care system, and their use has traditionally not been robustly supported by clinical research.

In a review article published in the June 2011 issue of the journal Rheumatology, researchers from England sought to analyze the paucity of trials available studying the use of CAMs, including common US remedies like feverfew, rose hips, vitamin E, and selenium, in RA. Of all the studies published regarding these and 14 other CAMs, only 34 randomized-controlled trials were available.

Although 2 studies regarding the use of borage seed oil and thundergod vine were a bit more positive and may warrant further investigation, most studies showed no consistent evidence of efficacy over standard treatment, and only 3 of these CAMs had more than 1 randomized controlled trial studying them.

The lack of substantial data poses a serious problem for promoting or discouraging the use of these agents, the authors write. “The low number of trials conducted for most CAMs means that although we cannot conclude that they are efficacious, neither is the evidence strong enough for any one compound to be sure that it is not efficacious.” PT

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