Chronic Disease Management:
Rheumatoid Arthritis Symptoms and Occupational Therapy
What is Rheumatoid Arthritis (RA)?
Rheumatoid arthritis is chronic inflammation of the joint lining. It is frequently referred to as an autoimmune disease where the body’s immune system attacks a person’s own body. It affects over 1 million Americans and is the most common type of inflammatory arthritis. Over 75 percent of all RA patients are female. This condition affects children, young adults, but most frequently begins in the middle age with people from all nationalities.
What causes RA?
The exact causes are unknown, but research suggests that there are genetic and environmental factors such as infections that play a major role in the development of condition.
What are the symptoms?
RA is a chronic disease and many individuals develop symptoms gradually, however many people experience a sudden onset of symptoms. Individuals will experience periods of decreased activities and remission when symptoms fade. It is important to note that there are individual differences among people with RA.
Here is a list of symptoms that are most commonly associated with RA. If you experience some of these 8 common symptoms it is important to make an appointment to speak with your physician:
- Morning stiffness and pain in your joints that lasts more than 1 hour
- Stiffness can also occur after a long rest
- Fatigue and loss of energy
- Joint inflammation, including swelling and warmth around the affected joints
- Symmetrical joint inflammation (both sides of the body)
- Low grade fever and flu symptoms
- Difficulty moving the affected joints
- Joint deformity and nodules/lumps under the skin (elbows, hands) are most often affected.
What can you do to feel better?
If stiff or painful joints, and joint deformities prevent you for carrying out your daily activities you may be a good candidate for occupational therapy. An occupational therapist (OTR) is a medical professional who is trained to help you perform activities and duties such as: work tasks, home tasks, leisure and recreational tasks.
For example, if you are an office worker who is having difficulty working on a computer since your diagnosis, the occupational therapist will be able to assist you in finding adaptive ways to perform your job.
An occupational therapist can help you maximize independence and analyze where you are stressing your joints unnecessarily and show you a better way to accomplish the tasks. Here are some specific services an occupational therapist may provide for individuals:
- Help design a program of exercises to maximize flexibility and strength
- Design custom hand splints for rest and support
- Provide a customized therapy program following hand surgery for arthritis
- Evaluate your home or workplace and make specific recommendations
- Design a work simplification and energy conservation program in all areas of your life.
- Design strategies to help reduce pain, reduce stress on the joints, and ultimately prevent further deformity
Susan is a 37 year old successful interior designer. She is divorced and loves gardening and has 2 small children. She works in a large metropolitan area and has a very big yard.
Susan noticed she was feeling pain when she worked in the garden, especially when she was using her garden tools and pulling weeds. She started having difficulty with wrist pain and hand pain that limited her ability to hang large prints on the job.
She was also having difficulty doing simple things such as turning on the facet and picking up small items for her children. She started to avoid the activities she loves such as cooking and gardening, however mentioned these problems to her rheumatologist who referred her to an occupational therapist.
The occupational therapist initially evaluated Susan to develop her main goals of therapy. Susan was given a wrist splint to use during the day and a resting splint to use at night. Susan loved using the wrist splint at work to lift heavy objects.
The occupational therapist visited her office and home to perform an assessment and review the activities that she frequently performs.
The OT had a list of suggestions such as: using a jar opener mounted under the kitchen cabinets which helped Susan open jars, modification of the faucet with a turner that she could turn without joint pain. She learned about ergonomics and which is learning how to move more efficiently and methods to handle her small children without injury.
Susan started to participate in an isometric strengthening program which helped her with her thumb joint. She also started to use paraffin wax prior to activity and found that it helped to relieve hand pain and stiffness. Susan started to enjoy gardening again especially when she was no longer plagued with thumb pain.
The OT also had suggestions for her to use at work such as using a rolling cart to avoid heavy lifting and carrying.
Here are other suggestions to help you feel better:
- Walking, cycling, swimming, and light weight training done three times a week for 30 minutes can offer these benefits, but check with your doctor to make sure they are safe for you.
- It is best to avoid heavy weights and beginning with short periods of exercise until you know how a workout will make you feel. If you have pain for more than an hour afterward, you’ve overdone it.
- Don’t exercise when joints are inflamed; take a break if you feel pain; and alternate positions periodically when performing tasks such as gardening or cooking. A physical therapist, exercise physiologist, occupational therapist, or personal trainer can help tailor a stretching program for your needs.
- People with RA tend to feel stiffer in the morning than at other times of the day, so take a shower to warm up your joints, and then stretch to help loosen you up for the rest of the day.
- Moist heat in particular seems to penetrate well and provides relief from rheumatoid arthritis pain. It is nice to take a warm bath or shower.
- Maintaining flexibility and use of resistance band exercises has been well documented in many clinical studies to be a safe and effective method of improving flexibility and strength.