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PRISMA 2020 flow diagram for systematic reviews. (Identification) articles were identified through database searching and duplicates were removed; (Screening) titles and abstract of remaining articles were screened, full-text retrieval and assessment for eligible articles, citation searching for articles, and reasons provided for excluded articles; (Included) full-text articles included for systematic review. N, number.
Source publication
Background
Exercise is advocated in the treatment of rheumatoid arthritis (RA). However, uncertainty around the acute effects of exercise on pain and inflammation may be stopping people with RA from exercising more regularly.
Objectives
To determine the acute effects of exercise on pain symptoms, clinical inflammatory markers, and inflammatory cyt...
Citations
... Traditional strength programs for impairment mitigation should be of sufcient intensity to stimulate anabolism and limit muscle loss. However, resistance training with moderate to high-intensity loads (60%-80% of 1 repetition maximum (1RM)) [13] could likely be a barrier to participation secondary to discomfort and pain from the physical and psychological symptomatology of RA and OA [14][15][16][17][18][19]. Tus, the challenge lies in implementing alternative exercise interventions that are efective in combating muscle weakness yet tolerable to encourage long-term adherence. ...
Background: Previous meta‐analyses show contrasting findings regarding the effects of blood flow restriction training (BFRT) in different knee conditions. Furthermore, no previous dose‐response analysis has been conducted to determine the dose of BFRT required for maximal strength and functionality adaptations.
Objective: To analyze the evidence on the effects of BFRT on strength and functionality in patients with knee osteoarthritis or rheumatoid arthritis through a systematic review with dose‐response meta‐analysis.
Methods: Included studies met the following criteria: participants with knee osteoarthritis or rheumatoid arthritis; low‐load resistance BFRT as intervention; control group with traditional moderate or high intensity resistance training (MIRT and HIRT); include muscle strength and functionality as primary and secondary outcome measures, respectively; and only randomized controlled trials. A random‐effects and a dose‐response model estimated strength and functionality using estimates of the total repetitions performed.
Results: We included five studies with a sample of 205 participants. No statistically significant differences were found between BFRT and MIRT or HIRT for strength (SMD = −0.06; 95% CI = −0.78–0.67; and p > 0.05) and functionality (SMD = 0.07; 95% CI = −0.23–0.37; and p > 0.05). We found an inverted U‐shaped association between the increase in total repetitions and strength gain and between the increase in total repetitions and functional improvement.
Conclusions: People with knee osteoarthritis or rheumatoid arthritis can use low‐load BFRT for strength and functionality as a similarly effective alternative to MIRT and HIRT. A total of 2000 repetitions per BFRT program are necessary to maximize strength gains in these patients, while functional improvement requires 1800 total repetitions.
... By these actions, it can relieve pain [55][56][57], but clear evidence for the role of cytokines in EIA in humans is largely lacking. For example, in a review on rheumatoid arthritis (RA), it was concluded that following exercise, inflammatory markers and inflammatory cytokines were not different between people with or without RA [58]. ...
Chronic pain is a global health problem with major socioeconomic implications. Drug therapy for chronic pain is limited, prompting search for non-pharmacological treatments. One such approach is physical exercise, which has been found to be beneficial for numerous health issues. Research in recent years has yielded considerable evidence for the analgesic actions of exercise in humans and experimental animals, but the underlying mechanisms are far from clear. It was proposed that exercise influences the pain pathways by interacting with the immune system, mainly by reducing inflammatory responses, but the release of endogenous analgesic mediators is another possibility. Exercise acts on neurons and glial cells in both the central and peripheral nervous systems. This review focuses on the periphery, with emphasis on possible glia–neuron interactions. Key topics include interactions of Schwann cells with axons (myelinated and unmyelinated), satellite glial cells in sensory ganglia, enteric glial cells, and the sympathetic nervous system. An attempt is made to highlight several neurological diseases that are associated with pain and the roles that glial cells may play in exercise-induced pain alleviation. Among the diseases are fibromyalgia and Charcot–Marie–Tooth disease. The hypothesis that active skeletal muscles exert their effects on the nervous system by releasing myokines is discussed.
... Majoon-e-Suranjaan is a traditional polyherbal Unani formulation with Suranjaan (Colchicum luteum) as one of its key ingredients. Suranjaan possesses anti-inflammatory and analgesic properties, primarily due to the presence of strengthen and stabilize the muscles surrounding affected joints [26]. Strengthening these muscles enables RA patients to move more freely and reduces joint stress, as muscle weakness can accelerate joint deterioration [27]. ...
... Isometric workouts promote the production of anti-inflammatory cytokines and enhance joint function [26], while the herbal components of Majoon-e-Suranjaan may suppress pro-inflammatory mediators and reduce oxidative damage at the molecular level [28]. When combined, these therapies may offer a more comprehensive therapeutic effect, alleviating pain, improving joint function, and slowing the progression of RA [29]. ...
Objective: The study aimed to evaluate the synergistic effects of Majoon-e-Suranjaan with and without isometric exercises in patients with rheumatoid arthritis (RA). Methods: A prospective, pragmatic, community-based, parallel group, single blinded randomized controlled trial conducted at Muhammad Physical Therapy and Rehabilitation Clinic and Rehabilitation Centre, Multan, from May to October 2023. The trial was approved and registered in the Iranian Registry of Clinical Trials (IRCT20230202057310N5). Ninety-five patients were randomly assigned to two groups. Group A received Majoon-e-Suranjaan (5 g orally, twice daily). Group B received the same dosage of Majoon-e-Suranjaan along with The isometric exercises. The exercise protocol for group B consisted of three weekly sessions, each lasting 40 minutes. Patients were evaluated at baseline and at the 24 th week based on serological markers, including rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), disease activity score (DAS), and C-reactive protein (CRP), as well as X-ray findings such as nodules and bone degeneration in affected joints. Pain, morning stiffness, and functional activities were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Numerical Pain Rating Scale (NPRS). Results: Of the 95 patients randomized, 90 completed the 24-week treatment. Among them, 60 (66.6%) were female, and 30 (33.3%) were male. Group B showed significantly greater improvements compared to Group A in in WOMAC activities of daily living (P=0.001), WOMAC stiffness (P=0.004), WOMAC pain and DAS (P=0.000), NPRS (P=0.001). Additionally, Group B demonstrated significant improvements in RF (P=0.001), ESR (P=0.002), and CRP (P=0.003) compared to group A. Conclusions: This study demonstrated the synergistic effect of Majoon-e-Suranjaan and isometric exercises in RA patients, highlighting the potential for more effective RA treatment strategies.
... RA is a chronic, systemic and autoimmune disease, characterized by an inflammatory process in the synovial joints [6]. The current pathogenetic paradigm of RA suggests that the disease is triggered by a complex interaction of genetic, environmental and hormonal factors that break immune tolerance and lead to the production of anti-citrullinated protein antibodies (ACPAs) [7]. ...
Background: Immune cells from rheumatoid arthritis (RA) patients display a reduced in vitro response to Porphyromonas gingivalis (P. gingivalis), which may have functional immune consequences. The aim of this study was to characterize, by flow cytometry, the frequency/activity of monocytes and naturally occurring myeloid dendritic cells (mDCs) in peripheral blood samples from patients with periodontitis and patients with periodontitis and RA. Methods: The relative frequency of monocytes and mDCs in the whole blood, the frequency of these cells producing TNFα or IL-6 and the protein expression levels for each cytokine, before and after stimulation with lipopolysaccharide (LPS) from Escherichia coli plus interferon-γ (IFN-γ), were assessed by flow cytometry, in peripheral blood samples from 10 healthy individuals (HEALTHY), 10 patients with periodontitis (PERIO) and 17 patients with periodontitis and RA (PERIO+RA). Results: The frequency of monocytes and mDCs producing IL-6 or TNF-α and the expression of IL-6 and TNF-α in the PERIO group were generally higher. Within the PERIO+RA group, P. gingivalis and related antibodies were negatively correlated with the monocyte and mDC expression of IL-6. A subgroup of the PERIO+RA patients that displayed statistically significantly lower frequencies of monocytes producing IL-6 after activation presented statistically significantly higher peptidylarginine deiminase (PAD)2/4 activity, anti-arg-gingipain (RgpB) IgG levels, mean probing depth (PD), periodontal inflamed surface area (PISA) and bleeding on probing (BoP). Conclusions: In the patients with PERIO+RA, innate immune cells seemed to produce lower amounts of pro-inflammatory cytokines, which are correlated with worse periodontitis-related clinical and microbiological parameters.
... The acute effect of PEP seems unfavorable. There are no significant differences in the pain sensation, CRP and ESR rate (clinical inflammatory markers), and interleukin 6 and tumor necrosis factor-alpha (inflammatory cytokines) between RA patients and healthy individuals (Balchin et al., 2022;Di Giuseppe et al., 2015). Moreover, both in patients with RA and healthy subjects, a single session of PEP can effectively lower the serum brain-derived neurotrophic factor levels (it plays a crucial role in the survival of neurons and growth, acts as a neurotransmitter modulator, and participates in neuronal plasticity, which is essential for learning and memory) (Bağlan Yentur et al., 2023). ...
Modified Physical Exercise Program (MPEP) is necessary for people with rheumatoid arthritis (RA). This study aims to investigate the effects of MPEP on the Rheumatoid Factor (RF), C-Reactive Protein (CRP), and Erythrocyte Sedimentation Rate (ESR); to evaluate the correlation between CRP-ESR. This is a quasi-experimental study. Ten RA women who were recommended by the Dukuhseti PHC have participated. The procedure is ethically approved. The venous blood samples were used to measure the dependent variables. Eight-teen sessions of MPEP were done. A two-tailed paired t-test to elucidate the differences in pre-post data; the bivariate Pearson correlation test for CRP-ESR. The RF increased significantly (pre: 19,40±2,46 and post: 22,40±2,41). CRP increased (pre: 0,30±0,07 and post: 0,37±0,06; p 0,05). The change in ESR is not significant. There is a strong-positive, significant correlation (r: 0,831) between CRP-ESR. We concluded that MPEP is not able to lower the RA parameters, and there is a positive feedback correlation between CRP-ESR.
... Finally, Coelho-Oliveira AC et al. [48] investigated the effect of acute whole-body vibration exercise under the hands, on handgrip strength, range of motion, and electromyography signals of women with RA, and demonstrated that it promotes neuromuscular modifications during the handgrip of women with stable RA. On the contrary, a recent systematic literature review that investigated the acute effects of exercise on pain symptoms, clinical inflammatory markers, and inflammatory cytokines in RA concluded that post-exercise responses for pain, clinical inflammatory markers and inflammatory cytokines were not different between people with or without RA [49]. ...
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation. The purpose of this systematic review is to evaluate the effectiveness of exercise training on functional capacity and quality of life (QoL) in patients with RA. We performed a search in four databases, selecting clinical trials that included community or outpatient exercise training programs in patients with RA. The primary outcome was functional capacity assessed by peak VO2 or the 6 min walking test, and the secondary outcome was QoL assessed by questionnaires. Seven studies were finally included, identifying a total number of 448 patients. The results of the present systematic review show a statistically significant increase in peak VO2 after exercise training in four out of seven studies. In fact, the improvement was significantly higher in two out of these four studies compared to the controls. Six out of seven studies provided data on the patients’ QoL, with five of them managing to show statistically significant improvement after exercise training, especially in pain, fatigue, vitality, and symptoms of anxiety and depression. This systematic review demonstrates the beneficial effects of exercise training on functional capacity and QoL in patients with RA.
... Throughout the course of the pathology, bone erosion occurs and predominantly surrounds the peripheral synovial joints. The clinical symptoms of RA include pain, edema development, and tenderness of the synovial joints located symmetrically and peripherally [3]. A great deal of progress has been made in the treatment of RA with antagonists of proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin-6 (IL-6), and IL-1β. ...
Rheumatoid arthritis (RA) is a chronic, systemic, and inflammatory autoimmune condition characterized by synovitis, pannus formation (with adjacent bone erosion), and joint destruction. In the perpetuation of RA, fibroblast-like synoviocytes (FLSs), macrophages, B cells, and CD4+ T-cells—specifically Th1 and Th17 cells—play crucial roles. Additionally, dendritic cells, neutrophils, mast cells, and monocytes contribute to the disease progression. Monocytes, circulating cells primarily derived from the bone marrow, participate in RA pathogenesis. Notably, CCR2 interacts with CCL2, and CX3CR1 (expressed by monocytes) cooperates with CX3CL1 (produced by FLSs), facilitating the migration involved in RA. Canonical “classical” monocytes predominantly acquire the phenotype of an “intermediate” subset, which differentially expresses proinflammatory cytokines (IL-1β, IL-6, and TNF) and surface markers (CD14, CD16, HLA-DR, TLRs, and β1- and β2-integrins). However, classical monocytes have greater potential to differentiate into osteoclasts, which contribute to bone resorption in the inflammatory milieu; in RA, Th17 cells stimulate FLSs to produce RANKL, triggering osteoclastogenesis. This review aims to explore the monocyte heterogeneity, plasticity, antigenic expression, and their differentiation into macrophages and osteoclasts. Additionally, we investigate the monocyte migration into the synovium and the role of their cytokines in RA.
... In general, inflammatory cytokine level decreases within a few hours after an exercise (83,84). However, evidence of the acute effect of exercise on inflammatory response in patients with RA is inconsistent (85). Two observational studies examined the acute effect of a single-session exercise on inflammatory cytokine (e.g., IL-6) in patients with RA; one of the studies found no significant change in IL-6 (86), whereas the other observed IL-6 level sharply increased in the first one hour, then gradually decreased, and returned to pre-exercise level in 24 hours (87). ...
Rheumatoid arthritis (RA) is a common systematic, chronic inflammatory, autoimmune, and polyarticular disease, causing a range of clinical manifestations, including joint swelling, redness, pain, stiffness, fatigue, decreased quality of life, progressive disability, cardiovascular problems, and other comorbidities. Strong evidence has shown that exercise is effective for RA treatment in various clinical domains. Exercise training for relatively longer periods (e.g., ≥ 12 weeks) can decrease disease activity of RA. However, the mechanism underlying the effectiveness of exercise in reducing RA disease activity remains unclear. This review first summarizes and highlights the effectiveness of exercise in RA treatment. Then, we integrate current evidence and propose biological mechanisms responsible for the potential effects of exercise on immune cells and immunity, inflammatory response, matrix metalloproteinases, oxidative stress, and epigenetic regulation. However, a large body of evidence was obtained from the non-RA populations. Future studies are needed to further examine the proposed biological mechanisms responsible for the effectiveness of exercise in decreasing disease activity in RA populations. Such knowledge will contribute to the basic science and strengthen the scientific basis of the prescription of exercise therapy for RA in the clinical routine.
