**6. Acknowledgment**

The authors would like to thank Dr. Jeremy Jones, Mrs. Anne Breslin, Dr. Emily Oliver, Lauren Mawn and Serena Halls for their valued contributions.

#### **7. References**

344 Rheumatoid Arthritis – Treatment

This highlights the importance of emphasising the benefits of exercise and giving specific exercise recommendations early in treatment. Furthermore, within the Obstacles to Action study (Hutton et al., 2010) 'insufficient advice from a healthcare provider' was a theme for the insufficiently active individuals, with queries relating to the type, frequency, and intensity of appropriate exercise. These correspond with recommendations by the American College of Sports Medicine, who describe exercise prescription using the 'FITT' principle (Swain, 2010). This incorporates the following: how often per week the patient should exercise (Frequency), how energetically or vigorously the patient should exercise (Intensity), how long the patient should exercise to obtain benefits (Time) and what type of exercises should be prescribed to the patient (Type) (Tancred & Tancred, 1996). This acronym offers a

An interesting point also stems from the quote below, indicating that means of continuing

*'...I would love to have some measurement that shows me that it's doing me some good.'* (66 year old

However, whilst working to develop these areas would be worthwhile, barriers for the health professional also exist. As previously mentioned, limited knowledge may hinder their ability and confidence to discuss the topic of exercise. Moreover, the time constraint of a standard appointment often means that medication and symptom control is prioritised (Calfas et al., 1996). In a study by Podl et al. (1999) involving family physicians, it was highlighted that an average of 45 seconds of consultation time involved conversation about exercise. This lack of consultation time was confirmed by Iversen et al., (1999) who found that when a medical regime was more complicated, there was less talk about exercise. Therefore, quick and effective means of prescribing exercise and providing continual followup and feedback would be of benefit. Future direction could also include referral to a trained clinical exercise physiologist, who would possess the skills to make physiological assessments and prescribe exercise. Additionally, as local communities vary widely in the availability of resources and programmes for individuals with arthritis (Wilcox et al., 2006),

In summary, clear exercise guidelines and prescription advice is necessary to address the fact that RA patients are often faced with ambiguous and incomplete information. This may mean that further information for those health professionals involved in the care of this patient group is necessary to instil the confidence and allegiance required to positively

The benefits of continued, regular exercise of a sufficient intensity for RA patients are clear. Furthermore, it appears that many patients are aware that exercise forms an advantageous part of their disease management. However, negative perceptions relating to joint health, pain and the clarity of exercise prescription for this patient group add to the barriers to exercise uptake that already exist in the general population. Therefore, to improve patient perceptions, the benefits require continual emphasis and the additional concerns regarding joint health, pain symptoms the specificity of exercise recommendations need to be acknowledged and addressed. Initiation of exercise discussion by the health professional

useful and simple framework upon which to base an exercise prescription.

incorporating home-based recommendations may be of value.

shape the perceptions of this patient group.

**5. Conclusions** 

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**17** 

*USA* 

**Complementary and Alternative** 

*Tufts Medical Center/ Tufts University School of Medicine* 

Treatment of rheumatoid arthritis, a systemic, diverse and dynamic disorder, has made major progress over the past few decades. Early active treatment with disease-modifying anti-rheumatic drugs and biological agents can be highly beneficial for controlling inflammatory activity and preventing disability in many patients. However, the most effective new drugs are expensive and many patients with rheumatoid arthritis continue to have significant pain, restricted mobility, reduced muscle strength and low endurance. In addition, it is increasingly recognized that co-morbid conditions play a pivotal role in rheumatoid arthritis outcomes. For example, cardiovascular complications are the leading contributor to mortality in rheumatoid arthritis, accounting for approximately one half of all deaths. Osteoporosis, resulting in bone fractures, also represents a major source of morbidity in rheumatoid arthritis. Complementary and alternative medicine treatment and lifestyle behavioral modification may play a role in preventing rheumatoid arthritis-

Rheumatoid arthritis is characterized by synovial inflammation that leads to joint destruction, resulting in substantial long-term disability and a significantly shorter life expectancy. Many patients with rheumatoid arthritis experience high levels of pain, functional impairment, psychological distress and negative emotions, but these symptoms have limited pharmacological therapeutic options. Given the complexity of the therapeutic armamentarium used in rheumatoid arthritis, non-pharmacological therapies are increasingly attractive to those with chronic rheumatic pain conditions. Recently, complementary and alternative medicine therapies for arthritis have been heavily advertised and increasing numbers of chronic pain patients report utilizing alternative therapies. At the same time, clinical trials and observational studies have provided encouraging evidence that Acupuncture, Mind-body Therapy, Chinese herbs and Tibetan Medicine have some benefits for patients with rheumatoid arthritis. Indeed, integrative approaches combine the best of conventional medicine and the wisdom of complementary and alternative medicine. Thus, this chapter synthesizes the current body of knowledge on the therapeutic benefits of several types of Complementary and Alternative Medicine on pain and symptom relief in patients with rheumatoid arthritis to better inform clinical

**1. Introduction** 

associated comorbidities and their complications.

decision-making for our patients.

**Medicine in the Treatment of** 

**Rheumatoid Arthritis** 

Chenchen Wang

