Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , Antirheumatic Agents/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Still's Disease, Adult-Onset/drug therapy , Adult , Humans , Interleukin-6/antagonists & inhibitors , Male , Myocarditis/etiology , Pericarditis/etiology , Pleurisy/etiology , Retreatment , Still's Disease, Adult-Onset/complications , Treatment FailureABSTRACT
Exercise is commonly used in the management of patients with rheumatoid arthritis (RA); however, there is little consensus in the literature to support its use. This systemic review aimed to determine the effects of dynamic exercise on patients with RA. A systematic search of Medline (19492007), Cinahl (19822007), Embase (19742007) and Cochrane library was performed for randomised-controlled trials using the keywords "rheumatoid arthritis" and "exercise" or "training" or "sport". The methodological quality of studies was assessed using a ten-point scale. Eighteen papers relating to 12 different studies met inclusion criteria. The mean methodological quality score was 6.9/10. Studies using aerobic training, strength training and combinations of both were included. Patients with early, stable, and active RA were studied. A number of studies reported improvement in muscle strength, physical function and aerobic capacity with dynamic exercise. Some studies also reported improvements in disease activity measures, and small improvements in hip bone mineral density. One study reported significantly less progression of small joint radiographic damage of the feet in the dynamic exercise group. However, one study also reported worse large joint radiographic damage in patients using dynamic exercise who had pre-existing large joint damage, though this was a retrospective analysis. No studies reported worse outcomes for function, disease activity or aerobic capacity with dynamic exercise. Cardiovascular outcomes were not reported in any study, and no data were presented to assess the effect of exercise on patients with significant underlying cardiovascular disease. This systematic review suggests that the majority of patients with RA should be encouraged to undertake aerobic and/or strength training exercise. Exercise programmes should be carefully tailored to the individual, particularly for patients with underlying large joint damage or pre-existing cardiovascular disease.
Subject(s)
Arthritis, Rheumatoid/therapy , Exercise Therapy/methods , Bone Density/physiology , Humans , Male , Muscle Strength/physiology , Randomized Controlled Trials as TopicSubject(s)
Back Pain/etiology , Gout/diagnosis , Sacroiliac Joint/pathology , Uric Acid/analysis , Anti-Inflammatory Agents/therapeutic use , Colchicine/therapeutic use , Female , Gout/drug therapy , Gout Suppressants/therapeutic use , Humans , Knee Joint/pathology , Middle Aged , Prednisolone/therapeutic use , Synovial Fluid/chemistryABSTRACT
Most human peripheral blood monocytes strongly express surface CD14, but not CD16 (CD14+ +/CD 16-). A smaller group of monocytes express lower levels of CD14 and also express CD16 (CD14+/CD16+). This subgroup has different functional characteristics and is expanded in a number of disease states. We aimed to determine the percentage of circulating CD14+ /CD16+ monocytes in rheumatoid arthritis and systemic lupus erythematosus (SLE) and relate this to disease measures. Peripheral blood was sampled from 31 SLE patients, 19 rheumatoid arthritis patients, and 19 healthy controls. The percentage of CD14+/CD16+ monocytes was determined by immunofluorescence labelling and dual colour flow cytometry. The percentage of CD14+/CD16+ monocytes was significantly lower in rheumatoid arthritis (median 4.90%) than in normal subjects (median 7.30%, P = 0.014), and in rheumatoid arthritis than in SLE patients (median 9.40%, P = 0.009). The percentage of CD14+/CD16+ monocytes in SLE was not significantly different from that in healthy subjects. This lower percentage of CD14+/CD16+ monocytes in rheumatoid arthritis may be important in the pathogenesis of this disease.
