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Understanding
Arthritis

When Margaret turned 50, she went to the doctor because she "hurt all over." She was diagnosed with arthritis and decided to retire early from her job as a checker at a local grocery store. Now at age 69, Margaret says, "Everything I do seems to hurt."

  • Her left knee and hip do not bend all the way.

  • Her hands get swollen and do not close. When her hands are swollen, simple tasks like washing the dishes are painful and opening her medication bottle is unmanageable.

  • She can no longer cook for herself because cutting and chopping cause pain and opening a jar is impossible.

  • Margaret is embarrassed to call her friends or family because holding a phone for more than a few minutes makes her hand, elbow and shoulder feel stiff and sore — and she doesn’t want them to find out.

  • She had to cut her hair short because blow drying her longer hair became too painful and exhausting.

  • It hurts Margaret to stand for even 30 minutes because her back, knees and hips begin to hurt.

  • She can't kneel to wash her floors and she can no longer take care of the beautiful roses in her front yard.

 

Unfortunately, Margaret's case is not unique. Arthritis sufferers often live in chronic pain that interferes with activities of daily living and their quality of life.

  • An estimated 52 million adults in the United States have some form of arthritis. And, it is estimated that at least half of all adults over age 65 suffer from arthritis pain.

 

Keep reading to learn more about arthritis and how you can help clients like Margaret who are dealing with the pain and other symptoms of arthritis. You might also pick up some tips for protecting your own joints ... to help you avoid and/or manage the pain of arthritis as you get older.

It’s true that a joint is the place where two bones meet, but a joint involves more than just bones. Most joints in the body are moveable and consist of:

  • CARTILAGE. This is the white, shiny material on the ends of bones. Cartilage allows bones to glide smoothly against each other so that it doesn’t hurt to move a joint.

  • SYNOVIUM. This tissue lines the joint and seals it into its own little capsule.

  • SYNOVIAL FLUID. This is the clear, sticky fluid inside a joint. It is produced by the synovial membrane and is the consistency of oil. The synovial fluid lubricates the joint and provides nourishment and oxygen to cartilage cells.

  • LIGAMENTS. These tough, elastic bands of connective tissue surround a joint to give it support and to keep it from bending too far the wrong way.

  • TENDONS. Similar to ligaments, tendons are tough cords of connective tissue. Tendons attach to muscles on each side of a joint and help control the movement of the joint.

  • BURSAS. These are fluid-filled sacs that sit between bones and ligaments. Each bursa acts like a cushion and prevents excess friction in a joint.

 

SIX COMMON TYPES OF ARTHRITIS

1. OSTEOARTHRITIS: Osteoarthritis is also known as degenerative joint disease. You might see it called OA or DJD, for short. It is one of the most common types of arthritis. It is considered a progressive disease because it gets worse, slowly, over a number of years.

What Happens?

  • With osteoarthritis, the cartilage in the joints breaks down slowly over time. After a while, the bones rub against each other which leads to pain and loss of movement in the joint.

  • OA occurs most often in the hands, knees, hips, ankles and other weight-bearing joints.

 

What are the symptoms?

The symptoms of osteoarthritis are different from person to person, but usually include:

  •  Loss of movement.

  •  Pain with movement ... and sometimes even at rest.

  •  Stiffness and swelling of the joints, especially in the morning.

  •  Joint abnormalities like bone spurs, deformities and weakness.

How you can help:

  • Encourage your client with osteoarthritis to take pain medications exactly as prescribed.

  • Recommend a warm bath for overall painful joints. This may be especially helpful the first thing in the morning.

  • A warm hand soak or warm compress may be helpful for painful joints in the hand.

  • Report to your supervisor if your client is unable to relieve pain with the current plan of care.

  • Encourage clients to perform as much self-care as their mobility allows.

  • Help immobile clients to change positions at least once every two hours.

  • Assist with active or passive range-of-motion exercises if ordered in the care plan.

  • Check crutches, cane, braces, or walker for proper fit.

 

2. RHEUMATOID ARTHRITIS: Rheumatoid arthritis, known as RA for short, is an autoimmune disorder. This means that the immune system of people with RA is out of whack. Instead of just fighting off bacteria and viruses, the immune system begins to attack
healthy joint tissue. This causes the joints to become inflamed and damaged. In most cases, RA is chronic, although it alternates between painful flare-ups and disease-free remissions.

 

What Happens?

  • RA causes inflammation in the lining of the joints. Typically, a number of different joints are affected — on both sides of the body.

 

What are the symptoms?

Rheumatoid arthritis affects the entire body, so along with swelling and redness of the joints, some people have the following symptoms:

  • Loss of appetite and weight loss.

  • Fever.

  • Loss of energy.

  • Anemia.

  • Lumps of tissue (nodules) under the skin.

  • Deformities in joints. For example, fingers tend to move away from the thumb and may become permanently bent.

 

How you can help:

  • Recommend a hard mattress with a small pillow. A soft mattress with pillows that are too large prevents good body positioning and places stress on joints.

  • Offer massages and warm baths to promote relaxation and decrease pain.

  • Monitor and report any signs of new pain, stiffness or swelling right away so treatment can be adjusted.

  • Assist with range of motion exercises as ordered. However, passive range of motion should not be done on joints that are swollen.

  • When doing passive range of motion, be sure to support the limb above and below the joint to avoid muscle strain. Go through the movement smoothly and slowly.

  • Encourage REST during flare-ups.

 

3. FIBROMYALGIA: Fibromyalgia is a chronic arthritis-related condition that leads to overall body pain, fatigue, and tenderness in localized areas. No one is sure what causes it but some experts think that hormonal disturbances and chemical imbalances are involved. Other believe it is linked to stress, illness, or trauma. Still others think there it may be hereditary.

What Happens?

  • Fibromyalgia causes pain in muscles, ligaments and tendons — not joints. In fact, the symptoms of fibromyalgia do not include swollen joints at all.

 

What are the symptoms?
To diagnose fibromyalgia, doctors check 18 specific areas on the body to see if they are tender. To be diagnosed, a person must be tender in at least 11 of these sites. In addition to these tender spots, symptoms include:

  • Fatigue.

  • Mood changes, including depression.

  • Headaches.

  • Problems concentrating.

  • Numbness in the arms and legs.

How you can help:

  • Massage, combined with alternating heat and cold applications can soothe tense, sore muscles and increase circulation.

  • Gentle stretching, like with Yoga or Tai-chi can help prevent muscle stiffness and weakness.

  • Help clients with fibromyalgia limit intake of sugar, caffeine and alcohol. These irritate muscles.

  • Encourage clients with fibromyalgia to deal with stress. Meditation, imagery or deep breathing exercises may be helpful.

4. GOUT: Gout is a kind of arthritis that causes a sudden burning pain, stiffness and swelling in a joint. The pain comes on suddenly and is very intense. For some reason, the joint most often affected by gout is the big toe. You might also see gout in the knee, ankle, wrist or elbow.

 

What Happens?

  • Gout occurs when there is a build up of needle-like crystals in a joint. These crystals come from excess uric acid in the body.

 

What are the symptoms?
The symptoms of gout may include:

  •  Severe pain in the affected joint.

  •  Shiny, purplish skin around the joint.

  •  Hard lumps of crystals just under the skin. These lumps tend to develop in the outer edge of the ear, near the elbow, over the fingers or toes or around the heel.

How you can help:

  • Report right away if you notice an attack of gout coming on. You client may need to take an anti- inflammatory or may need a dose of cortisone.

  • A person with gout should never take aspirin. This increases uric acid.

  • Remind you client with gout to avoid eating too much meat or drinking too much alcohol. These substances increase the amount of uric acid in the body.

  •  A “cradle,” “foot board” or “blanket bar” may be needed to keep the weight of blankets off the feet or other swollen joints while the person is in bed.

5. PSORIATIC ARTHRITIS: Psoriatic (pronounced “sore-ee-at-ic”) arthritis (PsA, for short) is a form of arthritis that affects some people who have psoriasis — a condition that features red patches of skin topped with silvery scales. About 10 percent of people with psoriasis will develop psoriatic arthritis.

 

What Happens?

  • Psoriatic arthritis happens when the body's immune system begins to attack healthy cells and tissue. The abnormal immune response causes inflammation in the joints (the pain) as well as overproduction of skin cells (the scaly rash).

 

What are the symptoms?
The signs and symptoms of psoriatic arthritis are similar to those of rheumatoid arthritis. Both diseases cause joints to become painful, swollen and warm to the touch. However, psoriatic arthritis also causes:

  • Painful, sausage-like swelling of fingers and toes.

  • Foot pain, especially at the back of the heel and the sole of the foot.

  • Intense lower back pain.

How you can help.

  • During a flare-up of inflammation, the client should REST.

  • Special wrist splints, footwear, gentle massage or applying heat may help.

  • Check to see that your clients with foot pain have good shoes. The shoes should be well-fitting, rubber soled and flexible.

  • Help your client follow recommendations for joint protection.

  • When not in pain, encourage your clients with PsA to get some kind of exercise every day and to maintain a healthy weight.

6. LYME DISEASE: Lyme disease is a bacterial illness spread by the bite of a deer tick. Deer ticks, feed on the blood of animals and humans and spread the bacteria when feeding. Deer ticks are brown and about the size of the head of a pin, which can make them difficult to see or feel.

 

What Happens?

  • If the tick feeds long enough on the human, it can transmit the bacteria. When the bacteria enters the bloodstream it usually causes a large, red, circular rash, known as a “bulls eye” rash.

  • If treated with appropriate antibiotics in the early stages of the disease, complete recovery is possible.

  • Left untreated, Lyme disease can cause chronic joint inflammation (known as Lyme arthritis), particularly of the knee.

 

What are the symptoms?
The symptoms of Lyme Disease include:

  •  Rash (can occur a few days to a month before any other symptoms appear).

  •  Flu-like symptoms.

  •  Joint pain.

How you can help:

  •  If you notice a tick on your client’s skin, use tweezers to gently grasp the tick near its head or mouth. Don't squeeze or crush the tick, but pull carefully and steadily. Once you've removed the entire tick, notify your supervisor right away.

  •  If you know your client has been bitten by a tick or if you see the bulls-eye rash, report the symptoms immediately so antibiotics can be started.

  •  If your client suffers from chronic joint pain from Lyme arthritis, then follow the recommendations for osteoarthritis and rheumatoid arthritis.

DIAGNOSIS AND TREATMENT

Doctors diagnose arthritis by:

  • Talking with patients about their symptoms.

  • Examining people, including watching them walk and move.

  • Taking X-rays so that they can see inside a joint. This lets them know the condition of the cartilage.

  • Using a CAT scan or MRI machine to take images of joints.

  • Performing blood tests to help them know which type of arthritis is

  • causing the problem.

  • Taking fluid from inside a swollen joint.

Doctors treat arthritis by prescribing or suggesting a combination of:

  • Medications

  • Pain Management

  • Nutrition

  • Exercise

  • Physical and Occupational Therapy

  • Surgery

  • Alternative Therapies (such as acupuncture)

HOW IS PAIN MANAGED?
Remember that the pain experienced by people with arthritis may be caused or made worse by:

  • Inflammation.

  • Pressure on a joint.

  • Fatigue.

  • Depression.

So, managing pain usually involves:

  • MEDICATIONS. Doctors prescribe drugs to help reduce inflammation and relieve pain.

  • COMFORT MEASURES. Items like special mattresses, splints and cushions help prevent pressure on sore joints. In addition, techniques like relaxation therapy, deep breathing and meditation provide comfort to people in pain.

  • REST. People with arthritis need to balance the amount of activity and exercise in their day with plenty of rest. This helps prevent fatigue and overuse of sensitive joints.

  • COPING MEASURES. Finding ways to maintain a positive attitude are very important to people who must live with a chronic condition like arthritis.

COMMON MEDICATIONS FOR ARTHRITIS AND THEIR SIDE EFFECTS

The type of arthritis medication prescribed for your client depends on the type of arthritis they have. Each medication has different side effects that you should keep in mind:

  • NSAIDs. These are non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen. Common side effects include stomach upset, indigestion and diarrhea.

  • COX-2 INHIBITORS. Celebrex is a commonly prescribed COX-2 inhibitor. These drugs also help with the pain and inflammation of arthritis. They may cause stomach upset, especially if mixed with alcoholic beverages.

  • CHEMOTHERAPY. Certain medications that were originally developed for cancer patients can be used to treat arthritis. One example is methotrexate. People who take this medication may experience mouth ulcers, nausea and vomiting.

  • STEROIDS. One commonly known steroid medication is prednisone. Possible side effects include upset stomach, bloating, increased appetite and weight gain.

  • NARCOTIC ANALGESICS. Some people require narcotic medications to manage the acute pain of an arthritis flare-up. The possible side effects of narcotics include drowsiness, dizziness, nausea, dry mouth and constipation.

  • BIOLOGIC RESPONSE MODIFIERS. An example of this type of medication is Etanercept. This drug is given as a twice-weekly injection. Side effects are minimal, but you might notice some redness and swelling at the injection site.

EATING RIGHT WITH ARTHRITIS

Unfortunately, arthritis symptoms cannot be relieved simply by eating a special diet. However, it’s important to keep in mind that:

  • Any chronic disease, including arthritis, places extra demands on the body.

  • It’s important for your clients to eat a balanced diet.

  • Some of your clients may need extra calories to give them the necessary energy required to live with arthritis. But other clients may need to watch their calories.

  • Regardless of the type of arthritis, extra weight puts additional stress on diseased joints, especially weight-bearing joints like the hips, knees and ankles.

  • Studies have shown that losing as little as eleven pounds can reduce someone’s risk of developing OA of the knee by 50 percent!

  • There are many theories about certain foods being helpful to arthritis sufferers. These include fish oil, green lipped mussels, ginger and garlic. However, scientists have not been able to prove that any certain food relieves arthritis symptoms.

 

The best bet for your clients with arthritis is to:

  • Eat a variety of healthy foods from all the food groups.

  • Stay away from high fat and high cholesterol foods.

  • Avoid eating too many sugary foods.

  • Drink alcohol only moderately.

  • Maintain a healthy weight.

EXERCISING WITH ARTHRITIS
Clients experiencing arthritis pain may try to avoid exercise, thinking that their pain will increase if they move around. However, if they don’t exercise their joints, the pain will only get worse.

  • Medications help reduce arthritis pain and inflammation, but only exercise can keep a joint moving the way it should. Range of motion exercises increase flexibility while strengthening exercises help build muscles.

  • Range of motion exercises help stretch joints to keep them flexible. They also prevent stiffness and joint deformities.

  • Strengthening exercises increase the support around a joint by making muscles, ligaments and tendons stronger.

 

How you can help:

  • Look for ways to help every client get some daily exercise.

  • A therapist may develop exercise plans for your clients. You can help by learning the exercises and doing them along with the client.

 

WHAT IS JOINT PROTECTION?

“Joint protection” guidelines help people perform ordinary, everyday activities without putting additional strain on their joints. Joint protection includes:

  • Asking for help. This is especially important when a task causes pain in one or more joints.

  • Taking frequent breaks to stretch and shift position. This helps prevent joints from getting too stiff.

  • Using assistive devices. There are thousands of different assistive devices available to make everyday tasks easier. These include things like long-handled shoehorns and large-grip silverware.

  • Using good posture. This is important whether your client is sitting, standing or lying down.

  • Learning new ways to do everyday tasks. If possible, an occupational therapist can help your clients adapt their activities.

  • Getting regular exercise. It’s important for your clients to follow any special exercise plan provided by a doctor or therapist.

CAN SURGERY HELP?
Some people with arthritis can benefit from surgery. An operation on their joint can:

  • Improve the way the joint moves.

  • Relieve the pain of arthritis.

  • Fix a deformity so that the joint functions more normally.

 

There are several types of joint surgery:

  • Doctors can fuse two bones together at the joint so that the bones no longer rub together. This gets rid of pain, but the person loses the ability to bend the joint.

  • A joint can be partially or totally replaced. This is most commonly done with the knee and hip joints.

  • Bone spurs can be surgically removed. This eliminates some types of arthritis pain.

  • A joint can be realigned so that it is no longer deformed. This type of surgery allows a joint to function better and decreases pain.

FINAL TIPS!

  • Some days will be better than others for people with arthritis. Don’t be surprised if your clients can function pretty well one day and need lots of help the next.

  • Check the fit of your client’s shoes. Feet can change size as people age. If shoes are too small, they will put pressure on sensitive joints. If shoes are too large, they put your client at risk for falling.

  • Remind your clients to change position frequently. This includes the position of their jaw, neck, hands, shoulders, arms, hips, legs, back and feet. Encourage them to stretch any area that feels tense or stiff.

  • Keep in mind that people with arthritis may find it easier to climb stairs one at a time, leading with their stronger leg.

  • Remind your clients to use the strongest joint possible to complete a task. For example, rather than open a door with their arthritic hand, they can push it open with a shoulder instead.

  • Encourage your clients with arthritis to sit in chairs with arms so they can push on the arms when getting up.

  • Be sure to balance periods of exercise and activity with periods of rest.

  • Some of your clients may have specially made splints to help keep their joints in the correct position and reduce pain. You may need to help putting on and taking off these splints.

  • Encourage your clients to use proper posture. This helps prevent additional joint damage. (And, keep in mind that slouching actually requires more energy than sitting up straight!)

  • Sleeping with only one pillow under the neck is best. More than that raises the head too much and can cause neck pain.

  • Encourage your clients to use any self-help devices they may have to help them bathe, dress or eat. If they don’t know how to use a particular assistive device, let your supervisor know.

  • If your clients are trying to lose weight to reduce the pressure on their joints, help them learn about serving sizes. For example, one serving of meat is the size of the palm of your hand. One serving of cheese is like a pair of dominoes. One serving of vegetables is the size of your fist.

  • Learn all you can about managing pain and using assistive devices so that you can help clients cope with arthritis even more.

  • Let your supervisor know if a client has pain, stiffness or swelling in or around a joint.

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