Dr. Sveaas spoke about ongoing work with her research team to evaluate the effect of pain medications (NSAIDs, acetaminophen and opioids) on physical function and exercise in patients with rheumatoid arthritis (RA), axial spondyloarthritis (SpA) and hip and knee OA. In evaluating the major Cochrane reviews, meta-analyses and randomized clinical trials in the field, Dr. Sveaas and colleagues described the evidence for short-term beneficial effects of NSAIDs on physical function in patients with RA, axial SpA and OA. They also described a small, short-term benefit from treatment with opioids in OA patients and no clear benefit in patients treated with acetaminophen.
Interestingly, although pain is often a barrier to achieving target goals for physical activity, exercise itself appears to reduce pain symptoms in these patients. In the Exercise for Spondyloarthritis (ESpA) study, a multi-center, randomized, controlled trial of 100 patients with axial SpA, three months of high intensity exercise in the intervention group showed a significant treatment effect on the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS), the Bath AS Disease Activity Index (BASDAI), inflammatory markers, physical function and cardiovascular health.3 Dr. Sveaas explained that similar effects have also been shown in patients with OA.4
Surgery
The final speaker in the session addressed the role of hip and knee arthroplasty in the treatment of degenerative and painful joints, as well as the effects of such surgery on improving physical activity. This topic is significant, because the lifetime risk of total knee replacement surgery due to OA in Western countries is as high as one in five among women and one in seven among men.5 Additionally, the lifetime risk of total hip replacement surgery is one in seven for women and 1 in 10 for men.6
Maaike Gademan, PhD, a clinical epidemiologist and human movement scientist at Leiden University Medical Center, The Netherlands, noted that in a systematic review and meta-analysis of seven studies evaluating changes in physical activity at six and 12 months after total hip or knee arthroplasty, no significant increase in physical activity occurred at six months. At 12 months, only a small to moderate increase in physical activity was shown.7
Several possible reasons exist for this lack of significantly increased physical activity after arthroplasty. They may include difficult-to-change sedentary lifestyle habits that were habituated prior to surgery and the restrictive recommendations for suggested exercises after arthroplasty. Dr. Gademan noted that, in The Netherlands, surveys of orthopedic surgeons revealed that either no advice is given, or patients are discouraged from such activities as badminton, handball, running or volleyball. Although details of which sports are or are not recommended may represent minutiae, the overarching point is that patients may be either discouraged from physical activity or confused by what activities are or are not recommended, resulting in less activity after surgery.
