rheumatoid arthritis
1- What is Rheumatoid Arthritis?
The immune system , The function of the joint ,How rheumatoid arthritis affects the joint Rheumatoid arthritis and osteoarthritis: the differences ,The importance of an early diagnosis ,The unpredictability of rheumatoid arthritis A personal scenario
2-Pain and Discomfort
Coping with pain Understanding pain The pain gate The TENS machine Massag Acupuncture
Distraction Natural pain-killers Nutrition Relaxation Posture The pain diary Splinting Medication Surgery A personal scenario
3-Understanding Medication
Non-steroidal anti-inflammatory drugs Disease modifying anti-rheumatic drug Biological therapies New biological therapies Corticosteroids (steriods)
4 Complementary Approaches
Beneficial foods and food supplements
Nutrition
Other dietary considerations
Complementary therapies
A personal scenario
5 How to Protect Your Joints and Reduce Pain
Conserving your energy
Avoiding static positions
Discouraging deformities
A personal scenario
6 Equipment and Adaptations
Equipment for the kitchen
Equipment and tips for personal care
Clothing
Selecting furniture
Adaptations
7 The Importance of Exercise and Good Posture
Planning your exercise
Exercise at the table
Useful yoga exercises
Exercises for the car
Exercises for the chair
Standing exercises
Exercises at the kitchen sink
Exercises on the bed
Exercises for the bath
Hydrotherapy and swimming
The benefits of exercise
A personal scenario
Good posture
Guidelines for good posture
8 How to Relax and Manage Your Stress
Symptoms of stress
A definition of stress
Why stress occurs
Restoring the balance
The fight or flight response
Learning to relax
The postures of stress
Getting started
A personal scenario
9 Work and Leisure
The benefits of employment
Factors that help you stay in employment
Changing work
Disability benefits
A personal scenario
Avoiding the downward spiral
10 Rheumatoid Arthritis and Relationships
Asking for help
Making changes
Rheumatoid arthritis and sex
A personal scenario
11 Achieving a Positive Outlook
Dealing with the diagnosis
How we deal with loss
Becoming an expert patient
The benefits of active coping
Helpful support
A personal scenario
Helping yourself
Appendix
The Work of the Occupational Therapist
A-Z Guide to Well-being
Tips and Ideas for Easy Living
Useful Resources
Acknowledgements
I would like to thank Sue Morris for reading the text and giving me some very helpful suggestions. I would also like to thank Lynette Hartgill for doing the illustrations at such short notice. I am grateful to Dr Adam Young, my rheumatologist, for taking the time to read my book and ensuring that the medical information is accurate. He has also written a foreword for me.
A special thank you goes to Marian Ferguson for helping me to manage my rheumatoid arthritis and also for inspiring me to become an occupational therapist in the process. Finally I would like to thank Keith, my husband, as well as Carolyn, Sonia and Alison who encouraged me and supported me in writing this book as well as helping out with the editing.
Preface
This third edition is an easily readable, self-help guide for everyone with rheumatoid arthritis (RA), particularly those who are newly diagnosed. It is also useful for family carers, those working in the caring professions and health and social care students. In this new edition there are a few additions and changes as follows.
I have added in the new drugs that have become available since the last edition. There are still some new types of medication undergoing trials and it is important that people with RA contact the National Rheumatoid Arthritis Society (NRAS) by telephone or by using their website in order to keep informed.
I have also added a new chapter called Complementary Approaches in order to include some extra information on food, supplements and other complementary therapies. There is growing research in this field and I am hopeful that one day more of these therapies will be funded by the NHS. I have included the treatments that seem to be the most beneficial.
While I was thinking about what would be most useful for this new edition I came up with the idea of adding a new section of helpful suggestions and tips. I am grateful to the members of NRAS for their many suggestions and I have included these tips along with my own ideas.
Recently there has been a lot of discussion around the proposed changes to the disability employment benefits and other disability benefits like the Disability Living Allowance (DLA). I have therefore updated the disability benefits information to include some information on these latest changes.
Many of the contact details have gone out of date in the years since the last edition was published and I have therefore updated the contact details and added some new ones.
Apart from these new updates the format remains the same and I hope that it helps you to become an expert on rheumatoid arthritis.
Foreword
There have been some major changes and initiatives in the last few years in the management of rheumatoid arthritis. Some of these have been in a better understanding of the underlying mechanisms of inflammation and the development of new and effective drugs. Another very important area has been the opportunity for great patient and patient–carer involvement. Patient-led organisations have become a vital and driving force to improve the level of government funding for care of patients with rheumatoid arthritis in an ever increasing and competitive arena of health care.Rheumatoid arthritis is a complex condition and its effects vary considerably from patient to patient. It can last for decades, and best and possible therapies are continually changing. This book covers such an important aspect of the care of rheumatoid arthritis. It reflects the need for greater input from both patients and their carers. It is unique in that a highly trained occupational therapist offers her experience both as a patient and as a therapist in what to expect and how to cope with this condition. Patients, their relatives and carers, and therapists in training, will find this account very readable. It is illuminating, sensitive and reassuring. It comes at a most opportune time.
Introduction
Over 30 years ago, I visited my doctor. I had severe pain in my fingers, toes and wrists. The doctor gave me anti-inflammatory drugs but he gave me no indication at all of what was wrong. These attacks occurred three more times during the next ten years; each relapse happening when each of my three daughters was three months old. I was still not aware of why all this was happening and I still received anti-inflammatory medication and no explanation.
Ten years later I visited my doctor because I couldn’t understand why I had no movement in my wrist. I wanted to discover the reason for this and find out what I could do about it. I became more assertive and asked for an explanation for these attacks. Finally I was given a blood test and a referral to the consultant rheumatologist who consequently informed me that I had rheumatoid arthritis (RA). This was a devastating situation. I was 32 and I had three small children. I also had virtually no wrist movement and the joints in my fingers, toes and elbows were damaged. I was given a referral to the Occupational Therapy (OT) department. At that time I had not heard of Occupational Therapy but I decided to attend hoping that it might prove useful. I did not know then what a prominent part it would play in my life subsequently.
At the Occupational Therapy department I learnt all about my condition and how to look after my joints. I learnt exercises to improve my strength and to maintain the movements of my finger joints. I began to understand the importance of posture and how to problem solve. I was given equipment for the kitchen and I was able to discuss any problems that I had in my everyday life and find practical solutions to them. The OTdepartment made an impression on me. I enjoyed the calmness and the time that I was given for discussion as well as the practical help that I received.
I wanted to find out more about the therapist’s role in other areas of disability and I wanted to find out how to qualify. Eventually I started work as an OT assistant and later on I trained to become a fully qualified Occupational Therapist. At the time that I commenced training I was 40 and I had had rheumatoid arthritis for 18 years. It was a positive outcome from a very negative situation. I write this book from the perspective of practitioner and patient in the hope that it will enable others to gain a more positive outlook.
What is Rheumatoid Arthritis?
To know the disease is the commencement of the cure.
I am sure many readers are only too familiar with explanations about rheumatoid arthritis (RA). Nevertheless I feel that I need to explain about it to those people who are newly diagnosed or those who have not encountered the disease first hand.
Rheumatoid arthritis is a disease that occurs all over the world. The National Rheumatoid Arthritis Society1 confirms that at present 0.8% of the adult population of the UK has rheumatoid arthritis (NRAS, 2006). This is approximately 387,000 people. The Arthritis Care booklet on rheumatoid arthritis tells us that one to three people in every hundred develop rheumatoid arthritis (Arthritis Care, 2008).2 There are more females with the disease than males and onset is often between 30 and 55, although it can occur at any age. A study in 19993 stated, ‘Rheumatoid arthritis is rarely seen as a serious public health issue, yet it is the single largest cause of disability in the UK.’
There is no known cause for rheumatoid arthritis and it is not directly inherited, although some predisposing factors may be. This means that it is likely that a genetic trait is then triggered by other factors like an infection, or a chemical in food, or an injury, or stress or any other as yet unknown trigger. Maybe two or three triggers are needed together, no one really knows. All that is known is that rheumatoid arthritis is an autoimmune disease. This means that the immune system is faulty and does not behave in the way that it should.
The immune system
The immune system is an inate mechanism that enables our body to defend itself against bacteria, viruses and other organisms that want to invade it. A healthy immune system knows which particles are foreign to the body and which ones belong. In order to protect the body it will attack outsiders that do not belong. The body also protects itself when there is damage caused by an accident resulting in a burn or a broken bone. In this case inflammation occurs as a necessary part of the repair process. In rheumatoid arthritis something goes wrong and the immune system attacks its own joints.
The function of the joint
In order to understand what happens when rheumatoid arthritis attacks the joints it is first necessary to understand a little about what a joint is and what its function in the body is. I have drawn a picture of a simple joint to show what a joint looks like and what it consists of (see Figure 1). Joints can be simple, as in the elbow joint which only has movement in one direction, or complex as in the shoulder, a joint that can be moved in many ways. In any case, joints are always found at the point where different bones meet so that the bones on either side of the joint can move independently. For example, there is a joint between the upper arm bone (humerus) and the lower bones of the arm (radius/ulna bones) so that we can move the lower part of the arm independently from the upper arm. The cartilage and fluid act as a shock absorber between the bones and this helps to protect them.
How rheumatoid arthritis affects the joint
During a flare-up of rheumatoid arthritis the synovial lining of the joint becomes inflamed although it is not known what triggers the inflammation. The synovial fluid that lubricates the joint, keeping the cartilage slippery, is overproduced. The lining of the joint becomes thicker and the cartilage is destroyed. The cartilage normally acts as a shock absorber between the bones, so there will be more pain on movement when it is destroyed. Eventually if it is all destroyed the bones will fuse together, preventing the joint from working at all. Even if the bones do not fuse together the increased amount of fluid in and around the joint means that the joints become swollen and feel uncomfortable. This restricts movement at the joints even before actual damage occurs. The joint capsule and ligaments also become stretched and loose and this leads to unstable joints and deformities.
Rheumatoid arthritis and osteoarthritis
the differences I have found that many people confuse osteoarthritis and rheumatoid arthritis. Although they both cause damage to joints the damage occurs for different reasons. Rheumatoid arthritis differs from osteoarthritis (OA) because in rheumatoid arthritis it is the faulty immune system that causes inflammation, whereas in osteoarthritis the joints become damaged through wear and tear (although inflammation may still occur). This means that osteoarthritis normally starts later in life than rheumatoid arthritis although osteoarthritis may start at 40. (People with rheumatoid arthritis may also have osteoarthritis.) In rheumatoid arthritis the joint damage is usually symmetrical but in osteoarthritis it normally is not. Another difference is that some rheumatoid arthritis sufferers may feel tired or have a feeling of being generally unwell when the inflammation occurs. In rheumatoid arthritis it is also possible to have inflammation in other organs as well as the joints, for example, the lungs and blood vessels, but usually it is the joints that are affected.
The importance of an early diagnosis
It is important to go to the doctor and obtain a diagnosis as early as possible if joint pain occurs because, as explained previously, untreated inflammation can lead to joint destruction and deformities. The early signs of rheumatoid arthritis are usually:
pain or discomfort in the fingers or feet; and
early morning stiffness.
The stiffness makes the limbs feel heavy and the joints feel puffy, movement becomes sluggish and it is more difficult to move the joints at all. The stiffness tends to reduce when the joints are gently moved. The disease often progresses intermittently with:
relapses – when the symptoms occur; and remissions (when the symptoms stop for a period of time )
No comments:
Post a Comment