Rheumatoid arthritis (RA) is characterized as a multisystem inflammatory condition, which affects 1% of the population.1 The condition is further complicated by co-morbid diseases which includes cognitive dysfunction, cardiovascular disease, fatigue, and depression.1(1)2 As an aggregate, such illnesses can systematically diminish an individual’s health and quality of life. Thus, it is imperative to consider interventions, such as exercise, which can help manage co-morbidities associated with RA. As such, the following will explore the same.
Azeez et al1(2) stated that cognitive impairment is a less recognized condition occurring amongst individuals with RA. Although the development of cognitive dysfunction (CD) in RA has not been fully explained, proposed mechanisms include the adverse effects of inflammation on the brain (likely from inflammatory consequences of RA).1(2) CD is also likely to be driven by the associated vascular risk factors from inflammation which can create pain, fatigue, and sleep disturbances. Most relevantly, Azees et al1(2) stated that cognitive function improves with regular physical activity, and walking/cycling/swimming can serve as simple mediums to achieve the same.
Another co-morbidity strongly associated with RA is cardiovascular disease (CVD); a condition in which up to 50% of patients with RA die from.2(219-220) As with CD, the reasons for such cardiovascular-associated deaths have not been fully elucidated.2(220) However, chronic inflammatory states, a characteristic of RA, is thought to be at least one impetus behind CVD.2(220) Exercise has been shown to be an effective lifestyle intervention to reduce CVD risk in the general population as well as in people with an already increased risk, such as those with RA.2(220) Finally, exercise can reduce the risk for recurrence of cardiac events amongst individuals with CVD.2(220)
Fatigue is considered a subjective and complex experience; a condition often characterized as an overwhelming and chronic sense of exhaustion and decreased capacity for mental and physical work.3 Furthermore, fatigue tends to correlate strongly with sleep disturbances, depression, and pain.3(1586) Kucharski et al3(1586) determined that exercise (aerobic and strength training) for >65 year old individuals with RA using moderate-to-high intensity exercise reduced physical and mental measures of fatigue. Interestingly, said exercise also had positive effects on symptoms of depression amongst older adults with RA3(1590,1592)
In conclusion, RA is characterized as a multisystem inflammatory condition, which affects 1% of the population. The condition is further complicated by co-morbid diseases which includes cognitive dysfunction, cardiovascular disease, fatigue, and depression. Left unchecked, RA can systematically diminish an individual’s health and quality of life. However, evidence suggests that moderate to high intensity aerobic exercise, and strength training, can help control co-morbidities associated with RA; interventions that are generally low-cost and low-risk in nature.
1. Azeez M, Clancy C, O’Dwyer T, et al. Benefits of exercise in patients with rheumatoid arthritis: a randomised controlled trial of a patient-specific exercise program. Clin Rheumatol. 2020;1-10. doi: https://doi.org/10.1007/s10067-020-04937-4.
2. Zanten JJCSV, Sandoo A, Metsios GS, et al. Comparison of the effects of exercise and anti-TNF treatment on cardiovascular health in rheumatoid arthritis: results from two controlled trials. Rheumatol Int. 2019;39(2):219-225. doi:10.1007/s00296-018-4183-1.
3. Kucharski D, Lange E, Ross AB, et al. Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis. Rheumatol Int. 2019;39(9):1585-1594. doi:https://doi.org/10.1007/s00296-019-04384-8.