September 19, 2022
6 minutes read
Li did not report any relevant financial disclosures.
The future of rheumatoid arthritis treatment has thus expanded beyond treating the disease itself Linda Li, PT, PhD, Professor and Harold Robinson/Arthritis Society Chair in Arthritic Disorders at the University of British Columbia.
Linda Li, PT, PhD
Li has noticed a major shift toward prioritizing quality of life in patients with RA, with a focus on promoting exercise and active lifestyles that can help patients manage their disease and prevent flare-ups.
In an interview with Healio, Li discussed new approaches to guiding patients with RA through an active lifestyle, the way the thought process has changed in recent years, and developments in technology integration that play a key role in support patients can play in coping with their illness.
Healio: What is the most effective approach to recommending exercise and lifestyle changes for RA patients?
Li: Part of that is understanding how rheumatoid arthritis affects them. They want to know if they have active joints or if the disease is well controlled because it affects how much they can do. We know that fatigue is a major problem for people with RA, especially when the disease is not well controlled, as is pain. All of these things must be taken into account when prescribing.
The other part is not just the knowledge and ability to do it, but whether they have the environment and what motivates them to do physical activity. People often know that they need to exercise or be active to stay healthy and manage their RA, but when they don’t have a way to exercise or have access to facilities or equipment, or even a quiet place to to practice the exercise you are asked to do this, then it will not happen.
Part of that is understanding a little bit more about their environment, what’s available to them, and what the base is. Were you physically active when you started and did you play sports? Where do you start and what do you need to build on? This includes understanding the whole person, not just the joints and physical sensitivities, but also their circumstances and context.
Healio: What are some of the best ways for patients with RA to stay active?
Li: Knowing what to do is paramount. People need to be sure that what they’re doing is good for them and won’t damage their joints even more. Having the prescription and knowing what to do and knowing how to monitor their condition is important to help them get physically active and exercise.
The other part to consider is that people understand and feel that they are making progress. Providing suggestions on how to monitor their physical activity, symptoms and how they feel will help them understand how they react to working overtime. Some apps and wearables can be very useful for people to monitor and understand what makes them feel good, what makes them feel worse, and when their illness flares up, when to back off.
In general, we tell people that anything you can do in terms of experience, physical activity, and sport, if you do it and it doesn’t cause joint flare-ups, you’re welcome to try. Someone who has an active flare up will be different in what they can do than an Olympian living with RA, but having RA is not something that limits people’s options. Now when having a flare activity in a pool, usually water-based, a warm environment helps soothe the joint, the buoyancy helps people move their joints and get moving. These are good ways for people to keep up their movement while having a torch, but the sky’s the limit if someone is good at it. Some of the people living with RA and participating in competitive sports often work with a physical therapist who is knowledgeable about RA and will adjust their training according to how they are doing with the disease activity.
Heal: As has understanding for Best practices for patient quality of life with RA recently changed?
Li: A long time ago it was said: rest, do not overdo it, be careful and careful. At the time, we didn’t fully understand how being active and exercising could be helpful for someone with RA.
#2, the medical treatment wasn’t that good. You would really worry that if someone has a push, you’re doing too much, damaging the joint and it’s all downhill from there. But the world has changed. Better treatment, better monitoring. So when people are doing well, the integrity of the joint can be relatively healthy, and exercise adds another element of ensuring the joint is moving well, the surrounding muscles are strong, and the protective mechanism is supported in people living with RA Life.
Two other things that are important: Physical activity has an anti-inflammatory property. Not like you’re taking medication, but it supports the medication people are taking. The other thing is that people with RA used to have a shorter life expectancy. Now we see that people with RA age gracefully, but it comes with aging with imperfect joints. They have limited mobility and balance and are at high risk of falling. Being physically active not only helps the joint itself, but also balance. It prevents falls and is good for heart and brain health. Those are some of the things that are very different than they used to be, and the attitude that you can do whatever you want as long as you don’t light up the joint.
Unhurt: What kind of shift do you see in the focus on quality of life?
Li: The whole mindset around helping people to be active in the activity that makes sense for them while living with RA is an integral part of improving the quality of life. I think this shift comes as patients are also becoming more involved in their healthcare and research, which fuels the conversation about treating the disease and treating the person. This is a credit to the patients and patient advocates who truly express the importance not just of the joints, but look at them as a whole person and that quality of life is truly a primary focus of treatment.
There is much more acceptance and practice around shared decision-making. They don’t just get what they’re told. It’s more about: “We have that from your examinations, these are the treatment options, what is important to you? How can we work around your condition while you can enjoy your quality of life?”
Shared decision-making really helps, and so does a lot of other things that we’ve seen over the past decade.
Unhurt: How do you approach the mental and emotional aspect of treating a patient? with RA?
Li: This is why a multidisciplinary team approach is so important. No health professional can do it all alone. When it comes to mental and emotional health, which is directly related to the disease itself, mental health and symptoms improve when well controlled, but some may need a little more.
I’m a physical therapist by trade so I can deal with the physical side, but sometimes people need a little more advice and support, if it’s something that’s preventing them from returning to work or being unable to work it helps some of the mental ones to relieve agony. Occupational therapists or vocational rehabilitation must be there, and psychological counseling may also have to be there. It takes a team. It takes an individual approach.
And I would say I recognize that sometimes the access to care isn’t quite fair for a variety of reasons, but sometimes we know what needs to be done and part of that is really addressing the mental health aspect, that arthritis management needs to address access to care.
Unhurt: Wcap are there some interesting new treatments or techniques to improve patients’ quality of life?
Li: I’m a health services researcher by trade, and one of the things we work with a lot is using digital tools. We’re collaborating with computer scientists and visual artists to develop technology to help people track symptoms and get as much feedback as possible. The whole idea that we as a specialty have done a lot of work over the last few decades to support self-management and help people find skills and ways to live healthier lives. What we haven’t done well is giving people the information they can use to self-adjust.
Using technology really helps people understand a little bit more. If my doctor asked me how active I was, people would guess. Now we can actually see what you’re using to track your steps and physical activity, and get feedback on how you’re doing over weeks and months. You can use this to simultaneously track your symptoms so you can better understand what’s helping, what’s not, what’s triggering and how I’m doing in the months and years to come. That’s really empowering.
Integrating technology into the treatment model for RA is one of the things that I consider to be the most exciting piece. It allows people to have more information about themselves, but it can be scaled. As we have more tools and technology, the price goes down, the technology gets better, we have more data, for example using AI to better tailor things to giving feedback or even prescribing medication. That would be an area of innovation that I’m most excited about because it has the potential to transform how healthcare professionals deal with RA and how individuals self-manage. There’s nothing better than that.