Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease, and the most common form of chronic joint inflammation. Inflammation leads to elevation of proinflammatory cytokines such as tumour necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and C-reactive protein (CRP). RA also results in downregulation of anabolic factors for muscle, for example, muscle levels of insulin-like growth factor I (IGF-1) . The circulating levels of cytokines reflect may also play a significant role in rheumatoid cachexia, which is defined as a loss of body cell mass which predominates in skeletal muscle .
Despite the significant improvement of pharmaceutical interventions, therapeutic exercise is an important part of RA management reducing joint pain and stiffness, increasing joint mobility and muscle strength and improving psychological well-being. Exercise can also help reduce the risk of other health problems, such as heart disease or diabetes, which can accompany RA . Despite the knowledge of health benefits, in a large multicenter study including a total of 5,235 patients from 58 sites in 21 countries (QUEST-RA- study), the majority of the patients were physically inactive with no regular weekly exercise.
According to a recent meta-analysis exercise is safe treatment for adults with RA as some studies reported decreases in functional capacity impairment and disease activity, and joint count . One study reported significantly less progression of small joint radiographic damage of the feet in the dynamic exercise group, while another showed that sports and games involving twisting and rapid joint loading exercises may have detrimental effect on large joints in patients with an extensive pre-existent large joint damage. Five studies have evaluated the impact of resistance exercises on VAS pain. The results of the meta-analysis showed that there was trend towards a small positive effect on pain and more importantly exercise did not aggravate pain.
“A rolling stone gathers no moss”
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