Pharmacists: Advise Patients with Arthritis to Stay Active

SAN DIEGO—As the most accessible health care providers, pharmacists may be asked questions regarding physical activity from patients with arthritis, and it’s important to advise them to keep moving, according to a presentation at the American College of Rheumatology (ACR)/Association of Rheumatology Health Professionals Annual Meeting (ACR/ARHP) Annual Meeting 2017, held here recently.

Patricia Katz, PhD, whose research at University of California San Francisco focuses on the impact of rheumatic disease on psychological well-being, noted that even though people may have been counseled to “conserve energy” because of their arthritis, in fact, “there are no deleterious effects to physical activity and it should be recommended for patients with rheumatoid arthritis and osteoarthritis, regardless of disease severity or pain or functional status.”

That’s great news given the cluster of comorbidities that can accompany arthritis, and the negative psychological impacts of the pain, loss of function and cognitive issues that may accompany the disease. The challenge, however, may be convincing patients that exercise won’t harm their joints, motivating them to move and offering guidance on how to get moving, Katz said during the presentation on the psychosocial aspects of physical activity and arthritis at the meeting.

Studies in 2004 and 2007 have shown that only 20% to 30% of people with rheumatic conditions reported meeting guidelines from the CDC, which recommend that people get a minimum 150 minutes weekly of at least moderate physical activity, such as walking, Katz said.

Meanwhile, several studies in various populations, including those with rheumatic disease, have shown that a lack of physical activity leads to a higher risk of depression. Additionally, a more sedentary lifestyle increases the risk of depression, regardless of whether the person is getting physical activity, Katz said.

In addition to helping the overall health of patients with arthritis by decreasing obesity, which is a comorbidity of the disease, physical activity has wonderful benefits, Katz said. She cited study after study showing that moderate to vigorous physical exercise decreases pain, decreases the risk of depression, and decreases inflammation, which is common in many rheumatic conditions.

A systemic review of 29 studies of exercise intervention in treating depression in patients with rheumatic disease found an overall and consistent positive effect, Katz said.

The American Psychiatric Association guidelines for the treatment of depression cite physical activity as beneficial, particularly in conditions with comorbidities, she said. And the APA suggest physical activity should be considered a first-line treatment in cases when people do not want to take medications, she said.

For a patient population with an already high pill burden, physical activity is a great alternative.

Perhaps the biggest barrier is that patients are not getting a strong message from their health care provider as to how beneficial physical activity can be for their disease and mood. Of course, there’s an issue as to whether they disclose their mood and whether they are depressed. But often when activity is mentioned, there’s no guidance. And they need something to start with to overcome the inertia of those with a sedentary lifestyle, Katz said.

Reference

Katz P. 4M045 ARHP: Physical Activity & Psychosocial Aspects of Arthritis. Presented at: 2017 ACR/ARHP Annual Meeting; November 3-8, 2017; San Diego.