Exercise builds strength, improves limits in those who have arthritis

Dear Dr. Roach: I so appreciated your recent column on arthritis — specifically osteoarthritis. I’m a big exerciser; however, I have always heard that this arthritis is caused or exacerbated by wear and tear. I was surprised to hear otherwise!

I have modified or given up a handful of exercises that seem to cause my joints more pain, specifically full-body weight-bearing on wrists. Are these exercises I can incorporate back into my routine? I have found that certain activities, i.e. card shuffling, buttoning, etc., hurt my thumbs, so I have made adaptations. Should I work through the pain, assuming that I am not causing any more damage to my joints? — L.D.

Dear L.D.: Most exercise is not damaging to joints, but high-impact or high-frequency activities can certainly worsen arthritis pain.

For arthritis of the knees and hips, I recommend walking as the best exercise, starting slow and building up based on what a person can tolerate. It’s the movement, not the resistance, that’s most important, so swimming (or just walking in a pool) is a great option for people who feel too much pain from walking.

For the smaller joints of the hands and wrists, I would recommend activities that don’t hurt you as much. Stretching the joints and movements like squeezing are a good place to start. You might consider a “stress ball” or a hand therapy ball to provide some resistance and build up hand strength.

Adapting your activities to your limitations is a good idea, but you also want to work on improving those limitations. A physical or occupational therapist is your best partner in designing a program.

Don’t forget that overthe-counter topical anti-inflammatory medicines, like diclofenac, are pretty effective in small joints and are very safe.

Dear Dr. Roach: Would you discuss the difference between rheumatoid arthritis and the ankylosing spondylitis? — S.Y.

Dear S.Y.: Both rheumatoid arthritis and ankylosing spondylitis are uncommon (each affecting about 1% of the population), inflammatory, multi-system diseases. RA affects the synovium (the lining of the joint) and tends to first affect the hands, but can affect nearly any joint. The major area of activity of AS occurs where bones connect to ligaments, cartilage and tendons.

There is an auto-immune component to both diseases. Without treatment, RA leads to joint deformities, whereas AS causes new bone formation, leading to pain and reduced movement of the joints. The back and neck are most often affected in AS, but the hips and other joints may also be affected.

RA is treated early and aggressively with disease-modifying agents, such as methotrexate and hydroxychloroquine, or with biological agents.

Physical therapy is useful in RA but is a mainstay of therapy of AS. Medications are often needed in AS, usually starting with anti-inflammatory drugs and progressing to more potent agents if needed. About 30% will need biological agents, whereas 94% of people with RA need a disease-modifying drug.

A rheumatologist is the expert for both conditions, and a person with either condition should be referred to an expert as soon as the diagnosis is made.