There are periods of time when the patient "feels good" and times when the patient "feels worse". There will likely
be times that a patient with RA "feels cured" It is important to understand that there are very few patients that have complete
remission of the disease and it is essential that the RA patient does not stop the treatment program established by knowledgable
health care practisioners. Rarely does the disease "go away",although at times the symptoms might temporarily remit. The
pain of arthritis varies greatly from person to person,for reasons that doctors do not yet understand, completely. Factors
that contribute to the pain include swelling within the joint the amount of heat or redness present or damage that has
occured within the joint. The number of joints involved is a important consideration in therapy.Most RA patients have many
double digit painful joints affected.In addition activities affect pain differently so that some patients note pain in their
joints after getting out of bed in the morning whereas others develop pain after prolonged use of the joint. Each
individual has a different threshold and tolerance for pain often affected by both emotional and physical factors. These can
include depression,anxiety and even hypersensivity at the affected site due to inflammation and tissue injury. This increased
sensivity appears to affect the amount of pain perceived by the individual Pain is a private, unique experience that cannot
be seen. The most common way to measure pain is for the doctor to ask the patient, e.g., The doctor may ask you to describe-"the
level of pain you feel on a scale of 1 to10". You may use words like aching,burning,stinging,or throbbing .These words
will give the doctor a cleaner picture of the pain you are experiencing. The patient must relay the pain experience
to your doctor since he or she will use it as a guide for their treatment plan. During physical activity
your body releases certain chemicals (endorphins) that block signals from reaching your brain. "Endorphins are the body's
natural pain relieving chemicals that are in many cases more powerful than morphine," says a pain specialist. The more endorphins
that you produce on your own,the less you will have to rely on external forms of pain management such as medications. These
chemicals also help alleviate anxiety and depression, conditions that can make your pain more difficult to control.
Heat and cold can both be used to reduce the pain of inflmmation. Both therapies come in different forms,and
the patient and doctor can determine which works best for the individual. Studies have shown heat and cold therapies usually
work equally (depends on patient) in reducing pain,although they are usually avoided in acute gout. Heat therapy
increases blood flow,tolerance for pain,and flexibility. Heat therapy,can involve treatment with paraffin wax,microwaves,ultrasound,or
mosit heat (placing warm towels or hot packs on the inflamed joint or taking a warm bath or shower.) During heat application,the
patient should note a comfortable,soothing warmth. If the patient is noted to "move around" during the application,then the
temperature of the heat needs to be checked to ensure that it is not too hot. Cold therapy numbs the nerves around
the joint (which reduces pain) and relieves inflammation and spasms in some patients. Cold therapy can involve cold packs,
ice massage,soaking in cold water,or over-the-counter sprays or ointments that cool the joints and skin. In the case of an
acute inflammation resulting in a swollen joint,the benifits of cold may outweigh the benefits of heat. Except in cases where
cold application is contraindicated (e.g. Raynaud's Disease),allow the patient to decide which modality works best. Hydrotherapy
involves exercising or relaxing in warm water,which helps relax tense muscles and relieve pain. Exercising in a pool is easier
because water takes weight off painful joints. This type of exercise improves muscle strength and joint movement. Mobilization
therapies include traction (gentle,steady pulling),massage and manipulation (using the hands to restore normal movement in
stiff joints). When done by a trained professional in rheumatic diseases,these methods can help control pain,increase joint
motion,and improve muscle and tendon flexibility. Relaxation therapy helps reduce pain by teaching patients various
ways to release muscle tension throughout the body. In one method of relaxation therapy,known as progressive relaxation,the
patient tightens a muscle group and then slowly releases the tension. doctors and trained physical therappists can teach patients
other relaxation therapies. A splint or brace should be used only when recommended by a doctor or therapist,who
will show the patient the correct way to put the device on,ensure that it fits properly,and explain when and for how long
it should be worn. The incorrect use of a splint or brace can cause joint damage,stiffness,and pain. A person
with arthritis can use other kinds of devices to ease the pain. The use of a cane when walking can reduce some of the weight
placed on the arthritic knee or hip. A shoe insert (orthtic) can ease the pain of walking caused by arthritis of the foot
or knee. Surgery may be required to repair damage to a joint caused by arthritis. The doctor may recommend
arthroscopic surgery,bone fusion (surgery in which bones in the joint are fused or joined together),or arthroplasty (also
known as total joint reolacement,in which the damaged joint is removed and replaced by an artificial one). Exercise:
The irony,of course,is that when people have a disease that causes pain and stiffness--such as rheumatoid arthritis--physical
activity and exercise will not seem that appealing. When the body aches,the thought of walking might be negative. A 1998 survey
by the Arthritis Foundation revealed that 70 % of these respondents with RA give up exercise when their disease is at its
worst. Unfortunately,that's the wrong course to follow. When a persons condition threatens to immobolize them,light-movement
keeps them mobile, Even small movement helps. The key to achieving many of the benefits is to take in a regular
exercise program that includes flexibility,strengthening and aerobic exercise. Your exercise program should be tailored to
your condition. This can increase your health benefits and decrease the chance of injury. Your doctor should be able to recommend
specific activities to benefit your condition. Remember to start low and progress slow. Do not push through severe pain. Consistency
is more important than intensity.Exercise isn't a cure all so you will need to continue with your regular treatment regimen.
But with proper guidance and dedication, exercise can be a effective part of your pain management program.
It's important to remember that there is no quick fix for chronic pain and managing pain isn't about making
it disappear. Rather,it's about keeping pain tolerable. If pain appears while exercising,stop. Exercise should be enjoyable
and soothing. The sad fact is that despite the best intentions,many people who start a exercise program quit after six months.
In RA management and treatment that should not be a option to follow. Living with any type of arthritis
day after day can be emotionally draining and cause depression. The stress of a illness may make you feel sad or blue. You
don't feel like doing anything going anywhere or being with friends and family. These feelings can make you feel tired. Being
tired all the time in turn can contribute to depression. It's a cycle that at times can be difficult to escape. Many
patients will say-"After all my years of living with RA I still find it hard to pace myself. The fatigue is always there in
varying degrees. Sometimes it is difficult to know when I've reached my limits. I don't always listen to the signals of pain
and fatigue. When I feel good I push myself to hard. It will not be possible to keep up with our friends at times .Resulting
in having to "pay" for it later. With chronic-the real picture is not bleak as it sounds-you may find at first
what's hardest isn't the physical pain but rather the emotional consequences it can bring. You may fear that chronic means
you'll never experience any relief. Like many others you may find strugglinng with thoughts such as - I'm losing control of
my life-I'll lose my independence-I'll lose my appearance-I won't be able to work-I'll be in constant pain-I'm falling apart.
The fact is,that most of these fears are never realized. You may have a chronic condition that requires a new kind of awareness-and
yes in that case it is something you will need to pay attention to for the rest of your life. But chronic doesn't have to
mean constant most types of chronic arthritis flare up more then normal but it doesn't cause relentless pain every day. When
you're hurting and searching for relief its easy to become discouraged. But hang in there. It's important to
understand that because the nature of chronic arthritis,medical treatment is based on a certain trial and error approach.
That means that although there are many effective medicines and treatments for pain,it takes time to find the combination
that's effective for you. Your doctor may have to try you on several different drugs,for several months each, for example.
And eventhough it's hard to wait for the most effective relief,this trial and error approach is proper treatment. Have
faith in the process,and realize that though the wait may be frustrating,it will pay off in the end. Protecting
your joints means using your joints in ways that avoid excess mechanical stress from daily tasks. benefits include less pain,and
greater ease in doing tasks. e.g. when opening a door lean your body into the door. Pacing,by alternating heavy
or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest. Pacing
and planning also provide you with ways to deal with the fatigue that is associated with RA. Positioning joints
wisely helps you use them in ways that avoid extra stress(e.g., use larger stronger joints to carry loads and change position
frequently) Some people will be given splints or othotic deices that affected joints such as the fingers,to rest in a good
position. Using assistive devices,such as canes,raised chairs,grip and reaching aids,can help simplify daily
tasks. Using grip bars and shower seats are important steps towards conserving energy and avoiding falls. People
with RA are generally not obese,and if so,it's usually become less active. Weight control means trying to maintain a recommended
,healthy weight. If you plan to lose weight try to discuss it with a dietician. Relaxation--There are many ways
to relax. Try deep breathing exercises. Listen to music or relaxation tapes,mediate or pray. Another way to relax is to imagine,or
visualize a pleasant activity or thought. Developing good relaxation and coping skills can give you a greater
feeling of contol over the disease and a more positive outlook. Many kinds of more immediate practical help are
available. There are effective physical treatments for pain,trained-therapists-who can help modify your home or workplace(if
it applies to you) so moving around is easier.Do visit the Arthritis Society so you'll know you are not alone., and abundant
gadgets and copeing skills to assist you. After a while,you may realize that managing your RA is a little
like dealing with rough weather, it comes and goes,but if you got your mental state in a positive position,"you'll manage".
In the great majority of cases,people with chronic RA will continue to live enjoyable , fulfilling lives that may be
modified in certain ways to adapt to your individual condition. A lot depends on you,as a individual-how you approach your
condition-it is a tough disease.but it can be controlled with the proper guidance. Remember,there are trained
health care professionals (nurses etc.), specifically trained in rheumatic disease treatment,and management-unfortunately,they
are few in numbers,and often limited by the time-factor. Thus the further need for self-education. The most recent
Centre for Disease Control and Prevention suggest that 30 minutes of moderate-intensity activity for most days of the week.
Depending upon your baseline,those 30 minutes can be spread out,so if one spends walking 15 minutes in the morning then
perhaps 15 minutes doing another activity in the afternoon,that amounts to the daily quota . We have to be careful of
the differential effects of exercise for losing weight and for RA patients whose joints are aching all over or even for just
overwell fitness for good well-being. There is a difference to consider. It has to do with intensity for one. i.e., If one
schedules walking for 30 minutes and if your body says 5 minutes then it is better than doing nothing. People
need to look at what the factors are,that are contributing to fatigue, pain,depression or inflammation (common in RA). Is
there another medical condition present? When one is able to isolate what these few things may be,then we apply treatment
strategies based on the cause People with arthritis are frustrated. They don't like or want to be feeling ill.
Some patients try a variety of trials. Some turn to herbs and supplements without understanding the dangers involved or the
treatment itself. Others may follow a strict dietary avenue. Rheumatoligists are RA experts and they really don't have any
scientific proof that diet,as a single agent without anything else,does anything to stop arthritis. They wish it did,but it
doesn't. A good well-balanced diet in addition to medical care is important,but as a sole therapy they don't hve any proof
that it helps except in perhaps the smallest minority. Medication will be tapered or discontinued,depending upon the medication,
when a person is in remission or feeling better. Some medications may be continued as a maintainence therapy. The
hallmark of a safe exercise program is a gradual progression in exercise intensity,complexity of movements,and duration. Often,patients
with arthritis have lower levels of fitness due to pain,stiffness or biomechanical abnormalities. Too much exercise during
a flare may result in increased pain,inflammation and damage to the joints. Thus,beginning witha few minutes of activity,and
alternating activity with rest should be the initial goals. Special emphasis should be placed on joint protection
strategies and avoidance of activities that require rapid repititions of a movement or those that are highly percussive in
nature. Because faster walking speeds increase joint stress, walking speed should be matched to biomechanical status. Special
attention must be paid to joints that are misaligned or unstable. Control of pronation and shock absorption through shoe selection
or use of orthotics may be indicated. Affected joints may be unstable and restricted in range of motion by pain,
stiffness, swelling,bone changes or fibrosis. These joints are at high risk for injury and care must be taken to ensure that
appropiate joint protection measures are in place. Activity during a flare is encouraged,concentrate on other unaffected joints,or
try a different type of activity with least strain. Beginning exercisers should be encouraged to identify the
type of physical activity they feel most comfortable with,and then begin this activity in short sessions. If people have had
a positive experience with a particular mode of exercise in the past,they are likely to have higher exercise self-efficiency.
e.g.,Among those who have enjoyed swimming in the past,water aerobics may be an ideal method to increase physical activity.
On the other hand,if individuals are not fond of swimming,encouraging them to get into a pool regularly is less likely to
be successful then to get into a pool regularily is less likely to be successful than encouraging them to begin a walking
program. Unfortunately,most people without arthritis begin a exercise program,and despite the best intentions,discontinue
within the first six months. This is not an option that rheumatoid arthritis patients can afford to follow. Physical
activity is essential to optimizing both phsical and mental health and can play a vital role in the management of arthritis.
Regular physical activity can keep the muscles around affected joints strong,decrease bone loss,help control joint swelling,and
pain in most patients. Regular activity replinishes lubrication to the cartilage of the joint ,reduces stiffness and pain.
Exercise also enhances energy and stamina,decreasing fatigue and improvin sleep. The goals of an exercise program
for individuals with arthritis are to: 1) preserve or restore range of motion and flexibility around aaffected joints. 2)
increase muscle strength and endurance,and 3) to increase aerobic condition to improve mood and decrease health risks associated
with a sedetary life.
Living With RA:
Exercise helps lessen symptoms of RA and can make you feel better overall. Appropiate and moderate
streaching and strengthening exercises will help relieve the pain and keep the muscles and tendons strong around the affected
joint,flexible and strong. Low impact exercises like swimming,walking,water aerobics and stationary bicycling (consult
your doctor) can all reduce pain while maintaining,flexibility and healthy cardiovascular function.
*There are three types of exercise:*Range of motion exercise reduce stiffness and helps keep joints
mobile. A range of motion exercise for the shoulder would be to move your arm in a large circle. *Strengthening exercises
maintain or increase muscle strength. Light weights may be applicable for some patients. *Endurance exercises strengthen
your heart ,give you energy and control your weight. These include cycling , walking,and swimming.
Physical therapists trained in treating rheumatic disease patients will teach patients other techniques
to manage the pain and restore joint motion and muscle strength. Together with occupational therapists,they
can assist in maintaining optimal function at work,in the home and during leisure activities. The Arthritis Society have
self-help programs, with videos in coping with RA that includes exercise.consult any branch.
More than one visit to your health-care provider may be necessary to establish (or rule out) a diagnosis of rheumatoid
arthritis. Consultation with more than one health-care provider also may be necessary. Additional visits will allow your health-care
provider to identify the best treatment for you and to monitor your response to treatment. As the diagnosis is being considered
and treatment begins, there are several important ways that you can minimize the effects of your disease.
Educate yourself: People with rheumatoid arthritis benefit from understanding the disease and its
effect on their lives. For example, recognizing in advance that rheumatoid arthritis is often cyclic, as symptoms tend to
wax and wane over time, may help you cope with fluctuating symptoms. Knowing more about your disease and various ways of adapting
to the illness can help you deal better with how it affects you. For example, structuring your workday to allow a nap in the
afternoon may make an enormous difference on the job, or learning how to grasp or grip a bottle jar in a different way can
make things easier in the kitchen. Your health-care provider can direct you to appropriate educational resources at your local
hospital, within your community and at reputable Internet sites.
Improve your attitude:As much as possible, try to stay focused on what you can do rather than on what
you cannot. This will help you to keep moving and maintain function. Researchers who study various coping strategies find
that people who take an active role and feel that they have some control over how they react to their disease manage better
than those who feel helpless.
Adjust,but don't give in: Find ways to adjust the way you do things in order to maintain good function.
Seek the advice of professionals who are skilled in the care of people with rheumatoid arthritis and consult with other people
who have the disease. For example, people with rheumatoid arthritis that affects the hands and thumb may have difficulty pinching
their thumb and forefinger together. For them, cooking and writing may become difficult. But some patients find that if they
use pens or utensils with larger handles or if they wear splints, they can do these things nearly as well as before.
Find the right balance: This is crucial. Figure out the right balance of rest and exercise. To do
this, it is essential that you learn to listen to your body. When your symptoms flare up and your joints are more sore, warm
and swollen than usual, you really have to make time to rest. This may mean that you don't make dinner, that you postpone
a meeting with a friend or colleague or that you find someone to help with your children until you feel better. During these
times, it is important to continue your exercises in order to keep your joints mobile, but be careful not to tire yourself
or push yourself to the point of pain. Then, when your joints feel better, you can increase your activity level. Moderate
weight-bearing exercises, such as walking and lifting weights, can strengthen weakened muscles and are usually well tolerated.
But if exercise produces more pain or joint swelling, cut back a bit.
Get a fresh perspective: It is natural to wonder if you are getting optimal treatment when you have
been diagnosed with a chronic, incurable disease. A good way to deal with this uncertainty is to get a second opinion, particularly
if things are not going well. A specialist who is not affiliated with your health-care provider may confirm that your current
treatment is best or may suggest a new and more effective approach. The benefit is yours either way, as you'll receive reassurance
or better treatment.
Perpetually asking for advice is not helpful because there is such as thing as too many opinions. You
need not change health-care providers in order to get a second opinion if you already have a good relationship with your current
health-care provider. In fact, a conscientious health-care provider who is working hard to improve your health may welcome
a fresh perspective as much as you do.
Trust your-self and your health care support team
Symptoms of rheumatoid arthritis differ considerably from those of other types of
arthritis, such as gout and osteoarthritis. For example, gout tends to cause intermittent joint inflammation with a sudden
onset, and episodes last only a few days. Osteoarthritis, on the other hand, tends to cause chronic (long-term) use-related
pain. In addition, osteoarthritis is associated with minimal or no inflammation and involves fewer joints than does rheumatoid
arthritis. Morning stiffness, a typical feature of rheumatoid arthritis, is generally of shorter duration when present
in osteoarthritis. There are cases of erosive inflammatory element associated in some cases of osteoarthritis but it
is not a general feature of the disease. Osteoarthritis is classified as a noninflammatory type of disease.
If you’re like the average person, you probably walk between 2,500-5,000 steps each day. While at first glance that
may seem like a lot, you might want to think about adding more steps to your daily routine with an exercise walking program.
Consider the benefits to your physical and mental health:
- A brisk walk increases your intake of oxygen, strengthens your heart to pump more blood, improves circulation and lowers
blood pressure.
- Walking also slows development of degenerative joint disease, stops loss of bone mass in osteoporosis, and tones your
muscles gently.
- Walking reduces stress, helps you keep a positive outlook and can make you feel (and look) younger and sleep more deeply
and restfully.
If you are recovering from a recent injury or surgery or have a chronic condition, you may want to see your doctor before
beginning a walking program. You may be able to withstand the low stress effort of walking without aggravating your condition.
Walking has helped many people find relief from arthritis and back pain.
You can walk alone or with friends, almost anywhere and anytime it’s convenient for you. The only equipment you need
is a good pair of shoes. These should be comfortable and supportive and not cause blisters or calluses. Choose shoes that
support the arch and elevate the heel slightly. There should be stiff material surrounding the heel (the heel counter), that
keeps your heel from turning in or out or wobbling. The toe box should be roomy but not too long.
Starting your program
When you start your exercise program, warm up by walking as you normally would for five minutes, then pick up the pace
to whatever speed gets your heart beating faster and your lungs breathing deeper. Keep up the faster pace for about 15 minutes.
While you walk:
- Swing your arms.
- Keep your head up, back straight and abdomen flat.
- Point your toes straight ahead.
- Take long strides, but don’t strain.
Cool down by walking at your warm up speed again for five more minutes. Do gentle stretching exercises when you’re
done. Repeat this routine three or four days a week with days for rest in between. After two weeks add five minutes to the
strenuous part of your walk. Keep adding five minutes every two weeks as you gradually build strength and endurance.
Commit to physical activity
When you start an exercise walking program, you are making a commitment to yourself to be more physically active. This
should be a lifetime pursuit, as the major health benefits of exercise walking take place over time. Keep track of your progress
as you become more physically fit and increase the intensity of your workouts. You might consider getting a pedometer (available
at most sporting goods stores) that clips on your belt and automatically records every step you take. In addition to your
exercise walking routine, consider ways you can build more steps into each day, such as taking stairs instead of elevators
or parking your car at the far end of lots.
Tips for heat
- Soak in a warm bath, shower, jacuzzi, or whirlpool.
- Place a heating pad on the painful area. Don't sleep with the heating pad on, because you might burn yourself.
- Use an electric blanket or mattress pad. Turn it up before you rise, to combat morning stiffness.
- Use flannel sheets. They feel warmer against your skin.
- Use a hot water bottle wrapped in a towel to keep your feet, back, or hands warm.
- Before getting dressed, warm your clothes by placing them on top of the dryer for a few minutes.
- Place hot packs on the painful area. These are filled bags that are heated in water and covered with a towel. Be careful
not to let the pack get too hot.
- Dip your hands in a paraffin bath. This is a mixture of melted paraffin and mineral oil. The warm coating soothes stiff,
painful fingers. Ask your doctor or therapist about this method.
- Use a combination of heat and cold. This is called a contrast bath (see figure 1). Soak your hand or foot in warm water,
then cold water, then warm water again.
Tips for cold
- Place a cold pack or ice bag on the painful area. You can buy these at the drug store or you can make one by wrapping
a towel around a bag of frozen vegetables.
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