Living with rheumatoid arthritis
By Lisa Evans - Published on Thursday, 10 February 2011 16:47
Mrs K.D. is a 43 year old wife and mother of two young children who has been suffering from severe rheumatoid arthritis for ten years. The disease has caused the deformity of her hands and feet. In her blog, she writes: “My fingers are recognizably gnarled and have bumps, called nodules. My wrists have nearly fused so that I can move them very little. My toes have cocked up and I have calluses under the pads at the bottom of my feet. My knees are chronically swollen as are many of the small joints in my knuckles”. Like many rheumatoid arthritis sufferers, Mrs K.D. finds simple everyday tasks such as sleeping, bathing, brushing her teeth, driving a car and even getting dressed can be excruciatingly painful and challenging.
Mrs K.D. writes: “I tend to use clothing that does not require much buttoning. It is very difficult for my fingers to work a button. Many of my shirts are pullover or have velcro attachments. I do have a button hooker that I use when buttoning is needed. ... Most of my pants have elastic waistbands and do not require buttoning or zipping. My shoes are especially wide and most often during the day I wear running shoes for comfort. "
This is the face of rheumatoid arthritis - a progressive disease that causes inflammation in the joints and the surrounding tissue. Chronic inflammation eventually leads to the destruction of cartilage, bone and ligaments, causing joint deformity; such as that described by Mrs. K.D.
Rheumatoid arthritis typically affects the hands and feet and larger joints such as knees, hips and shoulders. The joints become swollen, tender and stiff affecting range of motion. The disease affects women three times more often than men and onset is most likely to occur between 40 to 50 years of age, although symptoms can begin to appear at any age.
A painful and debilitating disease that can lead to substantial loss of mobility and function, rheumatoid arthritis is a disease that requires continuous treatment and a change of lifestyle for both sufferers and their families.
Causes of Rheumatoid Arthritis:
The cause of rheumatoid arthritis is an area of worldwide research. While scientists remain mystified as to its origin, some studies have suggested that it could be linked to genetics. Certain infections or environmental factors, such as smoking tobacco, may trigger the activation of the immune system in susceptible individuals.
Symptoms of Rheumatoid Arthritis:
Rheumatoid arthritis typically manifests with inflammation in the small joints of the hands and feet. The affected joints become swollen, warm, painful and stiff, particularly in the early morning hours or following periods of prolonged inactivity. Other symptoms include fatigue, loss of appetite, low-grade fever and chronic muscle aches.
Treatment:
There is no known cure for rheumatoid arthritis, but many different types of treatment can alleviate the symptoms and slow its progression. There are two types of treatment: that which attempts to control the symptoms of inflammation and pain, and that prevents the future destruction and deformity of the joints.
Drugs such as aspirin and cortisone are used to reduce pain and inflammation. Non-pharmacological treatments such as physical therapy, nutritional therapy and occupational therapy can also help, although they don’t stop the progression of joint destruction.
Gold and drugs such as methotrexate and hydroxycloroquine (Plaquenil) can help to prevent progressive joint destruction.
Early medical intervention is crucial when treating rheumatoid arthritis. In some severe cases, patients may opt to receive joint replacement surgery. This is most common with patients who experience severe pain in their knees and hips.
Living with Rheumatoid Arthritis:
There is no question that arthritis imposes barriers to daily living. Simple everyday tasks such as washing or brushing one’s hair and getting dressed can be excruciating for someone suffering with arthritis. Feeling chronically tired can make things worse. But breaking down these barriers is necessary in order to live as full a life as possible. Living with arthritis requires some lifestyle changes for both the sufferer and their families.
1 – Change Daily Habits
For patients with severe arthritis, simple everyday tasks such as getting dressed can seem an impossible task. Wearing clothing that doesn’t require buttoning such as pullover shirts and pants with elastic waistbands instead of zippers, can help to make life easier. Using an electric toothbrush instead of a plastic one and purchasing a raised toilet seat attachment to make it easier to get up and sit down are some of the adjustments arthritis sufferers can use to make everyday life a little easier.
2 – Managing Morning Stiffness
It is common for arthritis sufferers to complain of increased stiffness in the early morning hours. Setting the alarm clock a half hour early to allow for time to do some gentle movements may help to relieve symptoms in early stages of the disease. Moderate exercise such as restorative yoga may also help to reduce joint pain and inflammation.
3 – Fighting Fatigue
Chronic fatigue is a common factor for many arthritis sufferers. Getting plenty of rest and pacing oneself throughout the day is key to fighting fatigue. The Canadian Arthritis Society suggests planning ahead and prioritizing daily activities. One of the best ways to fight fatigue is to learn how to spend energy wisely. They suggest plotting weekly activities on a calendar and observing whether activities are spread out over the week or bunched into only a few days, and whether period of increased pain tend to coincide with certain activities. This will give an idea as to whether changes are needed to one’s daily schedule.
While the disease is limiting, patients can continue to live an active lifestyle, while remembering their limitations. The Canadian Arthritis Society suggests developing a schedule that allows for alternating periods of activity and rest. To develop this plan, they suggest patients complete the following three sentences.
1 – “I can sit for ____ minutes before I have to change positions”.
2 - “I can stand for ____ minutes before I become uncomfortable”.
3 – “I can walk for ____ minutes (or ___ blocks) before I feel tired”.
Using the answers to these questions as a guideline, patients can try to break daily tasks into smaller units. Instead of sitting at a desk for four hours working on an assignment, allowing a 10 minute break to stretch and rest after every hour can mean the difference between a moderate-pain day and an intense-pain day. Instead of deciding to vacuum the entire house, think about breaking the task down. Can one room be vacuumed in the morning and another in the afternoon? Breaking down tasks into chunks and allowing for rest breaks can help to fight arthritis fatigue.
4 – Ask for help
While we all like to feel in control, sometimes having control over our disease means delegating tasks to someone else. Are there things you do for other people that they could do for themselves? Can your children make their own beds or do their own laundry? Learn to ask for help from friends and family when you feel overburdened and don’t feel guilty about saying no to someone when their expectations of you are higher than what your body is physically capable of doing.
5 - Get a good night sleep
Investing in a good quality mattress that provides firm and comfortable support can go a long way to ensuring a good nights’ sleep. Establishing a sleep routine, getting to bed at and waking up every morning at the same time can help to fight arthritis fatigue. A warm bath or shower before bedtime can help relax knotted muscles and relieve joint pain, which can keep arthritis sufferers up at night. The sleep environment is also important. Perhaps the bedroom is too light, too noisy or too quiet, too warm or too cold. Adjusting the sleep environment to ensure there are no distractions that prevent a good night sleep can go a long way to fighting fatigue.
6 – Protecting the joints
What might be normal movements for others can place tremendous stress on the joints of someone suffering from arthritis. Swollen and inflamed joints, especially of the small joints in the hands and feet, are especially vulnerable to further debilitation. Orthotics, splints and insoles can stabilize and protect fragile joints.
References:
http://www.arthritis.ca/splash/default.asp?s=1&returnurl=/arthritis%20home/default.asp?s=1 – The Canadian Arthritis Society
http://www.medicinenet.com/living-with-rheumatoid-arthritis/article.htm - Mrs K.D.’s journal entry