Sock's Treatment And Management Of Rheumatoid Arthritis Pages
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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.

 

 

Take Care Of Your Joints:
 
When you don’t move a joint regularly, it can stiffen and the muscles around it may weaken and tighten. When you try to move, you may have pain.

Many things affect how your joints and muscles feel. Pain may be caused by swelling, joint damage, muscle tightness or spasm. Muscles may hurt after you exercise or do activities you aren’t used to. Sometimes when the joint is inflamed or damaged, even simple activities stress the joint.

When your joints are inflamed or damaged, you need to take certain precautions with your daily activities to avoid further joint damage. Your doctor, physical therapist or occupational therapist can teach you helpful exercises and ways to use heat and cold to decrease pain. You also can learn easy ways to move that put less stress on your joints. It is important to lessen the stress on your joints during daily activities so that you don’t aggravate the arthritis or damage your joints.

Use Your Body Wisely
Using your body wisely means protecting your joints and saving energy. Techniques include doing daily activities in ways that put less stress on your joints. These tips will help reduce your pain.

Joint Protection Principles
  • Respect pain.
  • Avoid stressful positions.
  • Change positions frequently.
  • Use your largest, strongest joints and muscles for a task.
  • Keep your muscles strong and your joints flexible.
  • Use splints or helpful devices to make joint movements less painful.

1. Check your Posture. Poor posture can increase your pain and make you tired. Using good posture protects your neck, back, hips and knees. Practicing good posture means putting your body in the most efficient and least stressful position.

Standing
To stand correctly, imagine that a straight line connects your ears, shoulders, hips, knees and heels. Stand with your feet slightly apart or with one foot in front of the other to keep your balance. Do not lock your knees, but do bend them slightly. Tighten your stomach muscles and tuck your buttocks under. Hold your shoulders back and tuck your chin in a comfortable position.

Standing this way will help prevent pain. If standing for long periods becomes painful, lean against a wall or put your foot up on a stool, which will flatten your lower back and prevent slouching.

Sitting
Your spine should be stable and supported when you sit. You may want to place a pillow or a rolled-up towel behind your lower back for support. Keep your hips, knees and ankles at a 90-degree angle (use a footrest if necessary). Keep your shoulders back, and tuck your chin in a comfortable position.

Relax your shoulders with your arms at your sides. Keep your elbows at a 90-degree angle or lower. Your wrists should be straight or slightly bent upward. When working at a desk or counter, you may need to use an adjustable chair to position your joints properly. Sit in a higher chair if you have trouble standing up and sitting down because of pain in your knees or hips. When reading, use a bookstand to prevent neck strain from bending your neck forward.

Lying Down
When lying on your back, use a cervical (neck) pillow or a small rolled-up towel instead of a regular pillow to avoid stressing your neck or neck muscles. Don’t use pillows under your knees because they can lead to contractures of your knees so that you won’t be able to straighten them out.

When lying on your side, place several pillows around your body and one between your knees, or use a large body pillow to support your arms and legs.

2. Handle heavy loads. To make heavy loads easier to handle, use your largest, strongest joints and muscles to take stress off smaller hand joints and to spread the load over larger surface areas. For example, carry a purse on your forearm or shoulder, rather than in your hand, or use a waist pack.

When you lift or carry items, use the palms of both hands (with your fingers straight) rather than grip with your fingers; use your arms instead of your hands. Hold items close to your body, which is less stressful for your joints. Slide objects whenever possible rather than lift them.

Lead with your stronger leg when going up stairs and lead with your weaker leg when going down. Always use a handrail if possible to prevent falls.

3. Change positions often. Keeping muscles and joints in the same position adds to stiffness and pain. Try to get up and move every 15-20 minutes when you are doing a sedentary activity, including reading, using a computer or playing the piano. Do a quick movement check of your jaw, neck, shoulders, arms, wrists, fingers, hips, legs, ankles and toes. Stretch and relax areas that are tired or tight. Tight or tense muscles can increase joint pain.

4. Control your weight. Extra pounds put more stress on your back, hips, knees, back and feet. The extra stress can lead to further joint pain and damage. If you are overweight, ask your doctor for advice about a weight-loss and exercise program. You’ll have more energy and feel healthier.

5. Balance rest and activity. Pace yourself during work and leisure activities by taking short breaks and alternating heavy and light activities throughout the day. Balance periods of work with rest breaks so you don’t place stress on your joints or get too tired. You may need to take longer or more frequent rest breaks when your disease is more active. Rest helps to reduce pain and inflammation as well as to control fatigue.

6. Get organized. Organize your work and storage areas. Keep all equipment and tools within easy reach and at a comfortable level. Use a Lazy Susan or plastic bins to keep items you need close by.

7. Listen to your body. Pain is one of your body’s signals that something is wrong. If your pain increases during or after activity or exercise, then you’ve overstressed your joints. If your pain lasts more than two hours after completing a task, do a little less or do the task in a different way. Stop an activity before you are fatigued or have increased pain. Set a timer if necessary to remind you to stop. Check with your doctor or therapist for ways to manage various types of pain.

8. Use helpful devices. In most cases, you should try to use your own range of motion and strength to perform tasks. But when you’re tired, stiff or in pain, helpful devices can make tasks easier, more efficient and less stressful for your muscles and joints. Many assistive devices can help you use your joints wisely and prevent further deformity. They also can help by providing additional strength, extending your reach, preventing strain, and keeping your body in the best position for certain tasks. Ask your doctor or physical or occupational therapist about helpful devices.

9. Ask for help. Getting help when you need it is important, especially for activities that cause pain, fatigue or put stress on your joints. Tell your family and friends 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 in your home. Ask your friends for their understanding if you have to change or postpone plans you’ve made