Mang Jose with rheumatoid arthritis states, “The only time I am without pain is when I lie in bed perfectly still”. During the convalescent stage, the nurse in charge with Mang Jose should encourage:
A. Active joint flexion and extension
B. Continued immobility until pain subsides
C. Range of motion exercises twice daily
D. Flexion exercises three times daily
Correct Answer: A. Active joint flexion and extension
Active exercises, alternating extension, flexion, abduction, and adduction, mobilize exudates in the joints relieves stiffness and pain. The role of exercise in promoting the joint health of a person with RA is of great importance, especially as this is the most pronounced and invariant element of the RA disease pathology.
Option B: Immobility would only allow the exudates to settle between the joints, aggravating the pain during future movement. Local effects of the joint effusion are likely to be responsible for the acute decrease in tendon stiffness whilst the systemic inflammatory processes of RA could be responsible for the long-term effects. Tendon stiffness can be increased, however, following strength training in older people and with endurance training.
Option C: Range of motion exercises are great for the joints but it should be done more frequently than twice daily. Exercise can reduce pain, morning stiffness, and even reduce fatigue in RA; exercise can improve functional ability and psychological well-being; exercise has not been shown to exacerbate disease activity.
Option D: Flexion exercises would be most effective if done together with other active exercises, such as extension, abduction, and adduction. The importance for the inclusion of exercise training in the treatment of RA is now clear and proven. Exercise in general seems to improve overall function in RA without any proven detrimental effects to disease activity. Thus all RA patients should be encouraged to include some form of aerobic and resistance exercise training as part of their routine care.