Molecular-level research for rheumatoid arthritis relief
Imagine that when you exercise, the millions of cells in your body all have their own tiny dumbbells.
Rheumatologist Brian Andonian and his colleagues at the Duke Molecular Physiology Institute (DMPI) are discovering that a sort of wee workout actually does happen at the cellular level. Andonian, a former fitness trainer who studies the effects of exercise for patients with rheumatoid arthritis (RA), said the institute’s research group has learned that its positive benefits are micro-measurable.
Their study took patients through a high-intensity interval training workout program for 12 weeks, collecting blood and muscle cells along the way. Lab work showed that overall immune system function improved and inflammation decreased because the body’s white blood cells were moving faster and more efficiently. Drs. Kim Huffman and David Bartlett co-led the study with Andonian.
“It’s like they’re more fit themselves,” Andonian said of the cells. “They’re able to do the work better. That’s what we’re trying to hone in on: What are the actual mechanisms of how that happens in the body to get it working better?”
Inflammation accelerates aging
Andonian said that his team is realizing that patients with rheumatic diseases such as RA, lupus, ankylosing spondylitis, and psoriatic arthritis are optimal subjects to study inflammation in the body.
While the swelling, pain, and joint deformity of rheumatoid arthritis would seem like the worst parts of the disease, RA can also affect the entire body: it’s common for people with rheumatic and other autoimmune diseases to suffer from more than one inflammation-related malady. In the heart, RA raises the risk of blocked arteries; in the lungs, it causes scarring that makes it harder to breathe; and in the blood, it increases the likelihood of lymphoma. Furthermore, in the joints that RA affects, chronic inflammation can hasten the onset of osteoarthritis, in which connective tissues degrade and wear out.
“There’s this accelerated aging process going on within patients with the rheumatic diseases,” Andonian said. “If we can better understand that in those conditions, we actually can help anyone who has a chronic condition linked to inflammation.”
Getting personal
In addition to the molecular-level lab work, Andonian acts as a coach-physician for his patients. Good coaches know that athletes are different in their motivations and the ways in which they optimize their performance, he said. So, when a chronic autoimmune disease is the issue, blanket approaches to exercise are often of limited value.
Andonian starts by asking patients about their goals. Do they want to be able to play on the floor with their grandkids? Hike a mile in the woods? Sew or do woodworking? Then he begins to tailor a specific plan to get them where they want to be.
“Anyone with any chronic condition should think about their day-to-day life like an athlete does,” Andonian said. “You’re thinking about like your overall performance, even though your goals might be different. The things that go into an athlete performing at their maximum is putting all this together: getting good sleep every night, making sure you’re focusing on nutrition by eating as well as you can, and allowing your body to recover between exercise.”
He said that exercise to help RA doesn’t have to be a total-immersion, join-the-gym, everyday proposition. It can start with taking the stairs, parking farther from the grocery store door, mowing the lawn with a push mower—regular activities that add up to a positive impact.
“It’s about finding things they like and what they want to do and not putting it in this confined box of what exercise is looks like,” Andonian said. “Meeting people where they’re at. There has to be that flexibility.”
Andonian is now studying a new practice—introducing exercise in the first six months after a person is diagnosed with RA. This approach is counter to the current practice of care which prescribes medication first. Andonian has found that’s not necessary. The sooner you start exercise, the sooner it helps.
What’s next
What does the future hold? Andonian will be the first to tell you that it’s not only about exercising more or better. The future is continuing to discover the way the exercise helps the body and developing more precise drugs to augment those pathways.
Numerous drugs are available for RA, but many are costly and they all have side effects that manifest differently from person to person. The most common side effect is infections because these drugs suppress the immune system to reduce pain and inflammation.
Andonian is hopeful that his research will help identify and better understand biologic pathways called “druggable targets” that could lead to the development of new, cheaper, more effective medicines without side effects.
“The Holy Grail of rheumatology research is trying to figure out how to achieve what we call tolerance, or having an immune system that’s not fighting against itself,” Andonian said. “I’m not just encouraging people to exercise more. It goes beyond saying exercise is good. We want to find out how it works and discover new medicines.”
Meantime, Andonian say the stories he hears from patients are encouraging. After one intensive 16-week exercise and diet program designed for patients with RA, one patient said they were finally able to walk around Disney World with their family. Another in the program went on an ATV adventure they never imagined they could do. And some came off medications entirely. As the science continues, Andonian plans to work right beside his patients like the trainer he once was. He won’t recommend an exercise if he hasn’t tried it himself.
“I can connect with patients on a personal level by continuing to try stuff,” he said. “It’s motivating for me for my own health because I feel like I’m helping my patients and informing my science. It all works in sync.”
