THE CLINIC: Coping with Inflammatory Arthritis

Thu, 6 Sept. 2012 - 12:52 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I’ve been running since the early 1980s. Last summer I had arthroscopic knee surgery for severe chondromalacia (loss of cartilage) and two meniscal tears. I had been competing in duathlons and was named a USA Triathlon All-American. I stopped running after surgery, but since then I’ve been diagnosed with psoriatic arthritis. I have two sausage digits, a finger and a toe, as well as other sore fingers, elbows and wrists. The rheumatologist also told me that I have fibromyalgia as well. I am currently weight training to keep the supporting muscles of my partially torn right shoulder strong. I take Enbrel, 50 mg once a week and just added 10 mg of methotrexate. 

 

My rheumatologist recommends exercising by walking 30 minutes three times a week. I am currently cycling two to four times a week for one to one and a half hours, weight training twice a week, and walking 45 to 60 minutes the weeks when I cycle less. I don’t want to reduce my exercise load to less than this. I have already cut out running, which is my first love. The doctor thinks the exercise level I’m doing is making me sore. I think it’s helping to stay mobile. Of course, I do get sore; I always have. I could switch to water aerobics, though I was told not to swim due to the shoulder. I’m trying to listen to my body, but how do I know what level of exercise is reasonable?

 

Joan Wakefield

Rockville, MD

 

ANSWER:

I am a practicing rheumatologist in upstate NY. My thoughts and advice are generalizations, as it is impossible to comment with complete accuracy having not evaluated you. You are a vigorous exerciser and would fall into the category of elite athlete. If the orthopedist advised against running after the surgery, I would have to think it is for a good reason; if one has severe chondromalacia, further running is only likely to hasten more damage, leading to even more pain and declining function in that joint. 

 

Psoriatic arthritis is systemic and inflammatory. You appear to be on appropriate drug therapy for this, but you do have considerable joint involvement. Individuals can often have secondary fibromyalgia with diseases such as rheumatoid arthritis, psoriatic arthritis, lupus, etc., and this only increases symptoms and discomfort overall.

 

In general, low- or zero-impact exercises are best. Walking (not running or jogging) is good exercise provided it does not worsen the pain and stiffness. Aquajogging or using a kick board in the pool would be reasonable. A stationary bike is acceptable, as long as the duration of the activity is within reason. A rule of thumb is: if your joints bother you for more than two hours following the activity, you need to cut back. Psoriatic arthritis causes actively inflamed joints, and the key to recovery is real rest. You’ll need to adapt in the face of these medical problems, but you’ll certainly not need to quit exercising.

 

Donald A. Raddatz, MD

Cooperstown, NY

 

ANSWER:

Here are my suggestions, which without a proper doctor-patient relationship are of course not definite. Your psoriatic arthritis needs to be suppressed totally, so if you have sausage toes, active joint swelling, or anemia, you ought to either increase the methotrexate or switch from Enbrel to Remicade, Humira, or both.

 

Think about using a heart rate monitor to gauge the intensity and duration of your training, as you need to know precisely what type and intensity of what exercise causes joint swelling, and how much. A little soreness is acceptable, but you should certainly never be sore or swollen for days on end. Be careful not to stress the feet and ankles if you aquajog; barring that, this activity would be great. Determine how much effort you think you can take by gauging it with your heart rate monitor, and then accept the new duration with pride.

 

Lorne A. Runge, MD, FACR

Syracuse, NY 


DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.


(RUNNING & FITNEWS® January / February 2008 • Volume 26, Number 1)




Latest News
Luxury Cruise Fitness: It Can Be Done
Luxury Cruise Fitness: It Can Be Done

Aug 02 1:02 p.m.

Article by: Jeff Venables

Comrades Ultra - Loose and Fun = Success
Comrades Ultra - Loose and Fun = Success

Jun 04 12:26 p.m.

Article by: Rick Ganzi, M.D.

Young Milers in Anaheim CA love running
Young Milers in Anaheim CA love running

May 15 3:03 p.m.

Article by: Jeff Venables

Catch Them If You Can
Catch Them If You Can

Apr 08 7:22 p.m.

Article by: Jeff Venables

New Roles of Sports Chiropractic
New Roles of Sports Chiropractic

Feb 21 11:15 a.m.

Article by: Jeff Venables