Counseling Points - October 2007 - (Page 10)

Table 2. Disease Activity Assessment At each visit, patients should be evaluated for: • Degree of joint pain • Duration of morning stiffness • Duration of fatigue • Presence of actively inflamed joints on examination • Limitation of function • Disease activity or progression – Evidence of disease progression on physical exam with loss of motion, instability, malalignment, and/or deformity – Progression of radiographic damage of involved joints • Other parameters for assessing response to treatment, such as physician/patient assessment and standardized questionnaires tant role in patient education about these nonpharmacologic treatments.3 Exercise Exercises that are tailored to the patient’s level of function and extent of joint damage are used by physiotherapists to help relieve pain. There are three main forms of exercise therapy: • Exercises to improve the range of joint motion; • Exercises to strengthen muscles, which are the main stabilizers and shock absorbers for joints; and • Exercises to improve endurance, aid general aerobic fitness and function, and increase psychological wellbeing.24 Treatment Strategies Over the past 10 years, improved understanding of the pathophysiology of RA has led to several key advances in the approach to therapy.19 First, early diagnosis and treatment have been recognized to be crucial in decreasing disease progression. It has been demonstrated that a delay in therapy initiation of as little as 3 months can cause irreversible joint damage. In addition, the use of combinations of disease-modifying antirheumatic drugs (DMARDs) has been proven to be highly effective in the management of RA. Furthermore, treatment with newer biologic drugs that target cytokines, such as TNF-α, has been demonstrated to provide enhanced efficacy.19 However, effective treatment strategies for RA include not only pharmacologic agents, but also the use of nonpharmacologic therapies. Living with RA involves emotionally coping with the realization that one has a chronic disease that needs to be continually managed.3 Adjunctive therapy with joint protection techniques, energy conservation, exercise programs, and stress reduction are vital to the successful management of the disease and the well-being of the patient. 3 Rheumatologists, nurses, physical therapists, occupational therapists, and other health care professionals make up an interdisciplinary team that plays an imporCOUNSELING POINTS™ 10 Rest Perhaps the most fundamental principle in reducing joint inflammation is adequate rest. General bed rest reduces the activity of systemic inflammatory arthritis and local rest relieves pain and inflammation of single joints.24 However, too much rest can be counterproductive for the patient. Prolonged inactivity may lead to stiffness and loss of joint motion, as well as muscle wasting and osteoporosis.Therefore, an appropriate balance of rest and exercise is key to successful therapy. Stress Reduction It has been well established that psychological stress can affect the health of individuals in a variety ways. For example, stress can impact the neurological system with headaches, the gastrointestinal system with ulcers, nausea, and vomiting, and the cardiovascular system with increased blood pressure and heart attacks. Stress also can suppress the immune system and aggravate the muscular skeletal system resulting in joint swelling and pain.24 Patients with RA may find regular exercise, a healthy diet, relaxation techniques, and psychotherapy helpful in reducing and managing stress. Pharmacologic Treatment With regard to drug therapy, it is important to keep in mind the pathophysiology and progressive nature of RA. A treatment plan that includes therapy with agents

Table of Contents Feed for the Digital Edition of Counseling Points - October 2007

Counseling Points - October 2007 Welcome Introduction Overview of RA RA Morbidity and Mortality RA Costs and Quality of Life RA Risk Factors Pathophysiology of RA Diagnosis and Natural History of RA Diagnostic Tests and Radiography Natural History and Progression of RA Disease Management Treatment Strategies Summary Continuing Education Posttest Evaluation Form

Counseling Points - October 2007

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