Avoid activities that put too much direct pressure on your fingers or thumbs. Pushing down on your dinner knife with your finger when cutting meat is an example of direct pressure. Instead, try holding the knife like a dagger or using a pizza cutter. Use a knife to open a milk carton or a box, instead of pushing with your thumb. To avoid opening push-button car doors with your thumb, use a door opener aid with a lever handle.

 

Avoid tight pinching, squeezing, or twisting motions. Spread your hand flat over a sponge or rag, instead of squeezing. To open a screw-top jar, lean on the jar lid with the palm of your hand and turn the lid with a shoulder motion to reduce stress to your fingers. Use a rubber gripper, or use a drawer to hold the jar while you twist the cap. You can also purchase a jar opener that allows you to hold the jar with two hands while turning it. Remind the family not to close jar lids so tightly the next time! Use push type ratchet or power screwdrivers, instead of twisting the standard type handles.

 

Use good posture to protect your neck, back, hips, and knees. When you have pain or stiffness in any of these areas, you need to pay special attention. Use a book rack, so you don't have to strain your neck looking down.

Whether  you sit or stand to work surfaces should be at a correct height. Your elbows should be at right angles and your shoulders should be relaxed when you work. To make it easier to get out of a chair, use pillows to make a seat higher. Learn proper body mechanics for lifting, bending, reaching, and rising from a chair.

Extra pounds put more stress on weight-bearing joints (hips, knees, back, and feet). This extra stress can lead to further joint pain and damage. Losing weight will be helpful to your joints. Check with your doctor to find the best weight-loss program for you. You'll also look better, probably have more energy, and feel healthier, too!

 

When joints or muscles are kept in the same position for a long time, pain and stiffness may increase. For example, writing a long letter or doing needlework keeps your hand in the same position for a long time. Do a quick body check of your jaw, neck, shoulders, arms, hips, legs, and ankles. It's a good idea to frequently relax and stretch these areas, especially any area that feels tight or stiff. Shrug or rotate your shoulders in big circles to reduce the tension that collects there.
Remember to use the strongest joints and muscles whenever possible. By using larger joints or your whole body, you can reduce the stress on smaller joints.

 

Here are some examples:

Carry a purse with a shoulder strap, rather than holding it in your hand, or use a backpack or fanny pack.

Push open a heavy door with the side of your arm, not with your hand, or lean into it using your body or hip.
 Add cloth loops to drawer pulls and the refrigerator door handle so they can be opened using your forearm.
 When using stairs, go up with your stronger leg first and go down using your weaker leg first. Always use a hand rail if available.

 

Pay attention to body mechanics

When lifting something that is low or on the ground, bend your knees and lift by straightening your legs. Try to keep your back straight. Use reachers instead of bending to get something from the floor or cupboards. If you have to bend, try to keep your back straight.
 
To get up from a chair, slide forward to the edge of the chair. Keep your feet flat on the floor. Lean forward, then push down with your palms-not your fingers-on the arms or seat of the chair. If you have wrist pain, you can push off with your forearms against the top of your thighs. Stand up by straightening your hips and knees.

 

Distribute weight
Spread the weight of an object over many joints to reduce the stress placed on any one joint. For example, use the palms of both hands to lift and hold cups, plates, pots, or pans, rather than gripping them with your fingers or one hand only. Use padded oven mitts for hot dishes. Carry heavy loads in your arms close to your body, instead of gripping them with your fingers or hands

.

Balance rest and activity
Both work and leisure activities are important for people with arthritis, but you can overdo them. It is wise to take short breaks and alternate heavy and light activities throughout the day. Learn to balance periods of work with rest breaks, so you don't place too much stress on your joints or get too tired. You may need to take longer and perhaps more frequent rest breaks when your disease is more active.

 

Part of this balancing includes pacing yourself during the day, and also from day to day. Allow plenty of time to finish the things you start, so you won't feel rushed. Don't try to do too much at one time. Pacing also includes doing the hardest things when you're feeling your best.

 

Plan ahead
You can make your life easier by planning ahead. Perhaps each night you could prepare a written schedule of the next day's tasks. Think about what the tasks involve--the amount of time they require and how tiring they are. Remember to build in rest periods, and to alternate heavier with lighter tasks.

 

Be realistic. Look at all of the activities you do in a normal day and week, and eliminate the ones that are not necessary. Delegate some of the others. Set priorities for the remaining tasks, but remember that you can change your priorities if needed.

 

Organize your tasks. Combine steps and find shortcuts. For example, you can save time and energy by fixing simple meals that require little preparation. If you want to serve more complex dishes, choose a day when you have more time. Cook extra portions and freeze them to use on days when you don't feel like cooking.

 

If you have a basement laundry area, bag your laundry and drop or drag it down the steps to avoid carrying heavy loads and making several trips. Plan to stay there until the laundry is finished. Have a place to relax while waiting, or use the time to catch up on reading or letter writing.

 

Organize work and storage areas: Keep all the equipment necessary for any task together in one area, within easy reach. For example:

Keep your baking equipment in one place.
Keep pots by the stove.
Keep the same cleaning supplies in several places: kitchen and bathrooms, both upstairs and downstairs.
Store heavy jars and boxes at elbow level.
If you must store objects up high, be sure they are lightweight. Use a long-handled reacher or tongs to get them down.
Keep appliances that you use most often (such as a toaster) out on the counter.
Keep shelves shallow (preferably only one row deep), or use space savers, such as Lazy Susans and pullout shelves.
Use a pegboard at the workbench for easy access to tools.

Sit to work

If possible, sit at a comfortable height to work. Many of the tasks you usually do standing can be done seated, and this will take the weight off your hips, knees, and ankles. For example, sit to cook, iron, wash dishes, work at your tool bench, and even to dress. A high stool may be useful for some of these tasks. Use good posture to avoid straining your shoulders and neck.

 

Use labor-saving devices
Many different devices have been developed to make tasks easier and more efficient. You can find these in local hardware and variety stores, pharmacies, and medical supply shops. Check with an occupational therapist who can answer your questions and help you choose the best device for you. It can be costly to order from catalogues and find the item doesn't work for you.

 

Use devices that  can:
provide leverage to give you more force
keep joints in the best position for function
extend your reach when range of motion is limited
help you avoid strain on joints

 

Ask for help
While it may be hard to admit that some things are more difficult to do than before, it is important to get help when needed, especially for activities that are particularly stressful to your joints. Your family and friends will understand you better if you share your feelings with them and let them know how they can best help you. You might try telling them on a scale of one to ten (with "ten" being the worst}, how much pain or fatigue you're having.

 

You may even find that your family and friends have some of the same emotional reactions to your arthritis as you do. They may feel shut out or frustrated when they aren't able to help. Tell them that the amount of pain and stiffness you feel varies throughout the day and from day to day. Try to involve your family in decisions about sharing chores and making new arrangements of shelves and furniture. Ask your friends for their understanding if you have to change or postpone plans you've made.

 

Respect pain: Try to avoid or modify activities that cause pain. If you have painful hands but must work at a computer, try to rest your hands frequently or talk to your supervisor about making changes. These might include adjusting the level of your keyboard or using a wrist support at the edge of the keyboard. Avoid activities that involve a tight grip or squeezing. Use tools with built-up handles. Build up pens and pencils with foam rubber. Use scissors that spring open. Use good posture. Use work surfaces that allow you to keep your back straight and your shoulders relaxed. If you work at a desk, you can use a slanted top, a drafting table, or a document holder to reduce the strain on your neck and upper back.

 

Avoid staying in one position: Change your body position and move your neck, shoulders, arms, hips, and legs often to avoid stiffness. If your job requires a lot of standing, shift your weight from one leg to the other by placing one foot on a box, footrest, or stool in front of you. Wear comfortable, supportive shoes.

 

Use your strongest joints and muscles: Remember proper body mechanics. To lift something, bend with your knees, not your back. Carry your briefcase with a shoulder strap.

 

Balance rest and activity: If your job requires a lot of standing or walking, take frequent rest periods. Try to lie down for a while during your lunch break, or sit if lying down is not possible.

 

Organize work areas: If you use tools, place them at a convenient level. Use a Lazy Susan or desktop organizer to keep items within easy reach.

 

Sit to work, when possible: A well-designed chair for working should provide good back support, and should swivel or be easily moved. It also should be adjustable to the proper height for any activity.

 

Use labor-saving items: Use specially designed tools such as pistol grip ratchets and ergonomic hammers that keep your wrist in a stable position. Use a rolling cart or luggage tote instead of carrying heavy objects in your hands.

Ask for help: Have a talk with your supervisor (or the personnel director) about your needs. Most employers will want to protect their investment in your training and experience. An occupational therapist may be able to help sort out your needs.

 

In the kitchen
Plan meals ahead to lessen last minute tasks.
Use electric appliances such as can openers, mixers, blenders, fry pans, crockpots, microwave ovens, knives, and dishwashers to get the job done with less time and energy.
Place a mixing bowl in the sink when stirring. A damp cloth underneath will help to keep it from slipping.
Hammer rust-proof nails through a cutting board to secure vegetables while cutting.
Use a French Chef's knife, which keeps hands in good position for cutting, slicing, and chopping.
Use disposable aluminum baking pans for easier cleanup.
Spray a nonstick product on pans or line with foil before baking or frying.
Let dishes drain and dry in a rack.
Use lightweight baking dishes, plates, pots, and pans, and serve from them.
Use a wheeled cart to move heavy items from place to place.
Sit on a high stool while cooking or washing dishes.
Use convenience foods such as precut potatoes and onions.

 

Laundry and housecleaning

Do only the tasks that are really necessary. For example, buy permanent-press items that don't need ironing.
Use separate laundry baskets to sort clothes before taking them to the laundry room. After the clothes come out of the dryer, sort them into different baskets for each family member to put away.
Sit to sort, fold, and iron clothes.
Put casters on furniture.
Use a sponge mop with an easy squeezer, a "janitor's pail" with a wringer, or a pail on a wooden dolly.
Use a long-handled feather duster.
Dust with a mitt, using circular motions with your hand extended.
Wear an apron with big pockets for carrying cleaning supplies.
Store cleaning supplies everywhere they are used.
Use an automatic toilet bowl cleaner and spray-on mildew remover so you won't need to scrub.
Alternate heavy tasks, such as mopping floors, with light ones, such as dusting.
Just do one major cleaning task a day, such as washing clothes or cleaning the bathroom.

 

In the bathroom
Sit on a bath stool in the shower or tub.
Wash with a bath mitt or a long handled brush.
Extend or build up handles on brushes and combs with rulers, foam rubber, or pipe insulation.
Install lever-type faucets which can be controlled with the palm, or build up faucet handles or use a non-skid pad.
Put grab bars around the tub and toilet.
Use a rubber suction mat or nonskid strips in the tub or shower.
Squeeze a toothpaste tube between your palms or put a washcloth under the tube and lean on it. You can also buy toothpaste in a pump dispenser.
Use an electric toothbrush or one with a built-up handle.
Use a raised toilet seat, if you have trouble sitting or rising from the toilet.
Use a free-standing mirror to put on makeup, so you don't have to lean over the sink and strain your back.

 

In the bedroom
Use long-handled shoe horns and sock aids.
Wear shoes that fit and provide good support. Some shoes have velcro closures or elastic shoelaces.
Wear pre-tied neckties.
If possible, replace buttons with velcro or use a button hook.
Use a zipper pull or add a loop, chain, or large paper clip to make a zipper easier to grasp.
When making the bed, finish one side at a time.

 

Leisure
Use a card rack or holder or a brush to hold playing cards.
Lay newspapers open on a table to read; use a book stand.
Use felt-tip pens, which require less pressure, or larger pens, which are easier to grip.
Use a push-button phone or a pen tip to dial. Get a headset so you don't have to hold the receiver.
Use specially-made, lightweight tools with built-up or extended handles for gardening and other yard work.
Use a gardening stool designed to reduce the stress on your back and legs.
Break up long shopping trips into several shorter ones.
Use a fishing rod holder or camera strap to free your hands.
Play golf for nine holes and then rest before starting the second set. Ride a golf cart and use lightweight clubs.
Use a three-wheeled bike for greater stability.

 

In the car
Have power steering, brakes, windows, and seat controls.
Build up tops of keys or use key holders to make turning easier.
Use a car door opener (self-help device) to reduce stress on your hands.
Use a wide-angled mirror if you have trouble turning your neck.

 

Although it is important that you use your affected joints wisely all the time, it may take a while before this seems natural to you. If you continue to find things too hard or painful to do, talk to your doctor or therapist. There are many techniques, aids, and devices other than the ones described here that might help solve your problems

 

Increased pain. Fatigue often comes along with pain. One person with arthritis said, "Pain itself is very fatiguing. When I'm tired, I can't cope as well with the pain."  A loss of control. Sometimes fatigue may make you feel helpless. You may feel you have little control over life.  A loss of concentration. Decisions become more difficult. It's as if your mind is tired, too.  Irritable. It may be difficult to be pleasant or happy when you're constantly tired. This may put a strain on your relationships. One person with arthritis commented, "I'm grouchy when I'm fatigued and I just don't care."

 

Fatigue may be accompanied by pain, irritability, and/or loss of energy, concentration, or sense of control.  What causes you the most worry and concern? What situations make you feel anxious, nervous or afraid? Once you know what the stressful aspects of your life are, decide whether or not you can change them.

 

Keep a "stress diary" to record the events in your life that cause stress. Record any physical symptoms you have. Try some of the ways to manage stress suggested in this program, noting if they helped you. Soon you will learn what upsets you the most, and which ways help you cope the best. Then try to prevent those situations from occurring. For example, if important family events usually make you anxious, plan to get extra rest ahead of time so you are better able to cope.

 

Share your thoughts and feelings It's usually helpful to talk to someone about your concerns. Perhaps a family member, friend, co-worker or member of the clergy can help you see your problems in a different way.  Learn to tell people when you can't do certain things. Saying "no" to people is important and you shouldn't feel guilty when you do. You may find that turning down extra duties--even for a short period of time--reduces your stress.

 

Respect your limits of energy, pain, and time. If you don't, you can become so worn out that you can't be the kind of friend, lover, or parent you want to be.

 

Realize that you have the right to decide if you want to discuss your arthritis. If having arthritis limits your activity, that may be a good reason to mention it. Otherwise, your arthritis is a private matter. Learn to express anger and other negative emotions without hurting others. It's all right to be angry! However, try to say, "I'm feeling angry, " instead of, "you are making me angry. " This lets you express your feelings without blaming someone else. "Striking" someone with words will only make that person feel under attack. This can make the conflict harder to resolve. Learning to express your feelings will enable you to improve relationships with the people who are important to you.

 

Try to avoid depression A condition such as arthritis can bring about feelings of depression. You may feel sad or "blue, " or have more serious thoughts of hopelessness and despair. Depression can make you feel miserable and also increase your pain.  You may wonder, "why me?" or "why are other people able to do things I can't do?" You may be angry or feel sorry for yourself. It might help to know that these are common feelings of people who have arthritis.

 

Usually feeling depressed depends on how you deal with events in your life, whether they are real or imagined. If you believe you're a helpless victim of depression, you probably won't do anything to overcome it.

 

Realize that you are responsible for how you feel. If you are aware that your state of mind is up to you, then you are more likely to take an active approach to improving your mood.  Take care of yourself. You're special--so pamper yourself. Try something good to eat, take a leisurely bath, or buy something nice for yourself.  Be a "doer." When you're sad or lonely, go to an event. Get involved in neighborhood or volunteer organizations. Don't forget the joy of giving.  Find new activities to replace old ones so you can continue to grow and develop. Discover new creative outlets, such as hobbies, skills or interests.  Remember that it's all right to cry. A good cry can be a healthy way to relieve tension.

Keep in touch with family and friends, by phone if you can't get out. Don't let your arthritis set you apart from others.

 

Try to discover what set off your depression and learn to avoid those events in the future.  Be alert for signs of depression that last for more than two weeks. If you continue to have signs such as eating or sleeping too much or too little, or feeling hopeless, forgetful, restless, or more tired than usual, tell your doctor. Sometimes this type of depression is caused by a change or an imbalance in the body's chemistry. Often certain drugs can correct such an imbalance.

 

Simplify your life Look at your activities. Decide which ones are most valuable and omit those that aren't. Many tasks or chores may seem necessary. But are they? They may be important only in your mind. Your family and friends enjoy you more when you're rested and healthy. Therefore, don't get worn out trying to do too much. Instead, do a few things well. In addition, ask for help when you need it, and accept it gratefully. You may also use aids and devices to make your everyday tasks easier.

 

Manage time and conserve energy

When you usually have pain and limited energy, it's natural to work harder on days you feel well. Instead of getting worn out trying to do everything, organize each day the night before or in the morning. Plan to do the most stressful or hardest task early in the day. Schedule rest periods, and remember to take them before you get worn out. Pace your activities by doing a heavy task and then light ones. Don't try to do too many heavy chores in one day.

 

Set goals Goals give you something to work for, and they give you satisfaction once you achieve them. Set short-term, achievable goals, taking one day at a time. Remember to include hobbies and friends. Because of the uncertainty of your arthritis, be flexible about the time needed to complete a goal. Take some time to think about your long-term goals. How has your life changed since you last thought about your goals? Has your arthritis affected them? What is most important to you now? What do you want to achieve?

 

Avoid drugs and alcohol Realize that drugs and alcohol don't solve life's problems. When people who smoke are under stress, they tend to smoke more. Some people use alcohol, marijuana, or other drugs in an attempt to solve or to escape from life's problems. These substances can only add to your health problems. They don't help you manage stress. In fact, in the long run they can increase your stress.  Seek support and education Try to stay healthy

 

Remember that having arthritis is only one part of your total health picture. Sometimes people feel so overwhelmed trying to manage their arthritis that they forget about the rest of their health. You control your diet, weight, exercise, and attitude, for example. By becoming as physically and mentally fit as possible, you can improve your energy, state of mind, and your level of stress.

 

Make time for humor and fun Schedule time for play and become involved in activities that make you laugh. There is almost a magical quality about laughter. No matter how sad your mood, laughing can make the world look brighter. Laughter dissolves tension--you can't be "uptight" and laugh at the same time! Joke with friends or see a funny movie. You know yourself--do what is fun for you. Seek help if you need it Get help to cope with constant, hard-to-solve problems. For instance, a mental health counselor or therapist may be able to help you work through a serious marital problem or severe depression. He or she might be able to help you find positive ways to express anger, if that has become a major concern.

 

Many people spend too much time and energy trying to reform their spouses, children or doctors. They want to make them different, or to have them act in a certain way. When these changes don't happen, people tend to feel frustrated, tense, and upset. No one has the power to change another person. When people change, it's generally because they wanted to do so. Accept imperfection Have the courage to be imperfect. Stop trying to be the ideal parent, spouse, child, patient, employee, or boss. No one is perfect! Trying to be perfect is admirable, but doing so takes its toll on your time, energy, and the way you feel about yourself.

 

Realize that life isn't always fair. Drugs have side effects, doctors may sometimes be grouchy, and families don't always understand.  Try to "roll with the punches." Being flexible helps you keep a positive attitude, despite hardships.

 

Antidepressant drugs. Living with arthritis can produce depression in some people. Studies of people with chronic diseases, including arthritis, have found that about one in five report feelings of depression. If your arthritis has caused feelings of depression, your doctor may prescribe one of the following tricyclic antidepressants: amitriptyline (Elavil, Endep), desipramine (Norpramin), imipramine (Tofranil, Norfranil) or nortriptyline (Pamelor, Aventyl). Many other antidepressants may be prescribed, including trazodone (Desyrel), maprotiline (Ludiomil), fluoxetine (Prozac, Sarafem) and sertraline (Zoloft).

 

Family members are often called upon to assist in the patient’s daily living activities, such as administering medications, applying support devices, assisting in transportation, etc. They can best help if they understand how you are affected by the condition. Additionally, you will need to understand how your family members feel about your condition and how it is affecting them.    

 

Enjoy your friends! That’s what they’re for. They also can come in very handy as a source of moral support during difficult periods. Sometimes, it can be very refreshing to review your home situation with an outsider in whom you can confide. Support comes in all kinds of packages and you never know who’s going to appreciate your condition.

 

Friends can occasionally be called upon to be caregivers and help in many other ways. Make new friends and consider interactive support groups. These might be found online or in your community. Access to further information and tips can come from national organizations, such as the Arthritis Foundation. These groups have as their primary goal helping people like you. They sometimes can even provide political support nationally!

 

Faith means different things for different people. Search your own faith for inspiration and direction. Reflect on who you are. Look to the leaders of your faith community for guidance and support. They have experience in relating to many people with chronic diseases and in offering helpful consolation.  Also, consider looking into what opportunities might exist within your local faith community for group support. Sometimes, these activities can open the doors to completely new ways to look at yourself and your situation.

 

Learn all you feel you need to know about your condition. Hear what your healthcare professionals are saying. Become familiar with your medication requirements, the monitoring needs of your illness and medications, and warning signs of problems. Then, take regular time away from your illness and emphasize the capabilities that you do have.

 

Eating a balanced diet and taking time to relax can rejuvenate you. Do something special (or a number of somethings) regularly for yourself. This might be exercising, yoga, reading, helping at a community group, or even watching leaves fall from a tree. Reserve time for yourself and use it. You will be in optimal condition to face the challenges of your illness if you’ve refreshed yourself.

 

Developing a positive attitude does help. Again, a positive attitude does not mean denying that you have a chronic illness. It means not focusing on the negative aspects of your illness all of the time and learning to minimize emphasizing the bothersome features of your disease.

 

If coping remains too difficult, let your doctor know your feelings. There may be many options that are available to you that you can access through the assistance of your doctor.