The conclusions reached by the speakers in this session indicate that relying on traditional medications for pain management and resorting to arthroplasty for hip and knee OA may not lead to increased physical activity. Although symptoms of pain, stiffness and reduced mobility play a large role in whether patients with inflammatory arthritis or OA exercise, it is not clear that treating pain pharmacologically or surgically eliminates other factors that influence the degree to which patients choose to exercise.
The prospect of interdisciplinary, holistic care models, such as those described in Scandinavia, may be explored more and more in other parts of the world, though even this model will need to demonstrate efficacy and cost effectiveness. What does appear clear is that the area of research on exercise and physical activity in patients with rheumatic disease is ripe for further exploration and will hopefully yield information needed to help patients hit the road running.
Jason Liebowitz, MD, recently completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his MD. He is currently in practice with Arthritis, Rheumatic, and Back Disease Associates, New Jersey.
References
- Rausch Osthoff AK, Niedermann K, Braun J, et al. 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Ann Rheum Dis. 2018 Sep;77(9):1251–1260.
- Lilja M, Mandić M, Apró W, et al. High doses of anti-inflammatory drugs compromise muscle strength and hypertrophic adaptations to resistance training in young adults. Acta Physiol (Oxf). 2018 Feb;222(2).
- Sveaas SH, Bilberg A, Berg IJ, et al. High intensity exercise for three months reduces disease activity in axial spondyloarthritis (axSpA): A multicentre randomized trial of 100 patients. Br J Sports Med. 2019 Feb 11. pii: bjsports-2018-099943. [Epub ahead of print]
- Fransen M, McConnell S, Hernandez-Molina G, et al. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014 Apr 22;(4):CD007912.
- Ackerman IN, Bohensky MA, de Steiger R, et al. Substantial rise in the lifetime risk of primary total knee replacement surgery for osteoarthritis from 2003 to 2013: An international, population-level analysis. Osteoarthritis Cartilage. 2017 Apr;25(4):455–461.
- Ackerman IN, Bohensky MA, de Steiger R, et al. Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003 to 2013: A multinational analysis using national registry data. Arthritis Care Res (Hoboken). 2017 Nov;69(11):1659–1667.
- Hammett T, Simonian A, Austin M, et al. Changes in physical activity after total hip or knee arthroplasty: A systematic review and meta-analysis of six- and twelve-month outcomes. Arthritis Care Res (Hoboken). 2018 Jun;70(6):892–901.
