What do we mean by a flare of rheumatoid arthritis?

Abstract

53% at age 16–24 to 16% at 65 plus. Similarly only 12% of women over 65 meet the recommended levels compared with 28–36% of younger women. Older people with musculoskeletal pain, commonly caused by OA and allied disorders, or less frequently by inflammatory arthropathies such as gout or RA, have reduced levels of everyday physical activity. The impact of chronic pain assessed by pain interference with daily activities increases throughout life into the oldest years. It is clear that regular physical activity improves both pain and quality of life, increases functional independence and reduces the risk of further chronic illness in those with joint pain, and should therefore be a target for intervention in older people with chronic pain. Developing interventions that increase rates of physical activity in older people with chronic musculoskeletal pain is challenging since they need to address pain-related factors such as fear of injury and fear of falling. There is also considerable patient uncertainty about the benefits of exercise, and interventions need to be implementable. While increasing exercise levels is a national and international priority, the mechanisms to achieve this remain unclear. Two recent systematic reviews and meta-analyses reported that exercise referral schemes in primary care were ineffective, but advice and counselling interventions were associated with small to medium short-term increases in selfreported physical activity. Walking is one way of increasing physical activity and has been described as near perfect exercise. Walking is already the most common form of exercise employed by older adults and has been identified as a priority for research by patients with joint pain. Interventions to promote walking have the potential to be successful since walking is perceived to be popular, familiar, convenient, social and free. Despite this there is a lack of effective interventions to promote walking for older people who have chronic pain. This presentation will summarize the current state of knowledge on behavioural interventions to increases walking in older people by addressing three main questions: What intervention should be delivered to promote walking in older people with chronic pain? How should the intervention be delivered? Who should deliver the intervention? Disclosure statement: The author has declared no conflicts of interest.