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ARTHRITIS
FOUNDATION OF VICTORIA RHEUMATOID ARTHRITIS .. Rheumatoid arthritis is a disease which affects the joints and may affect other systems of the body. In its mild form, it may cause no more then minor discomfort and does not lead to serious joint deformity. In its most serious form, it causes painful, badly damaged joints. As with other forms of arthritis, no cure has been found. However, advances in scientific research have meant that people with rheumatoid arthritis can be assured of effective treatment resulting in much less pain and fewer physical disabilities. Most commonly, it first develops between the ages of 25 and 50, but it is not uncommon amongst the elderly. A similar form of arthritis affects children. It is three times more common in women than men and often first occurs in women in their 30’s, at a time in their lives when they can least afford to be ill because of physical demands of home, family and employment. The causes are not known. For many years researchers sought to identify an infectious cause, a virus or bacterium, without success. It is now thought that it involves the body’s immune system and that a triggering agent causes the disease only in people with a genetic or inherited susceptibility. It results from overactivity of the body’s immune system. For reasons not fully understood, the body’s immune system attacks its own organs, in this case the tissues surrounding the joint. This auto-immune reaction causes inflammation of the joints, particularly of the synovial membrane which lines them. There is an over-production of synovial (joint) fluid and this, combined with the inflammation, causes joints to become swollen and painful. If the process continues, damage to the cartilage can cause joint deformities.
Rheumatoid arthritis can develop gradually, or can start with a sudden, severe attack. It is a chronic disease and may last a lifetime. Often, however, people experience periods of remission, when the disease subsides. Remissions can vary from short periods of time to many years and, in some cases, the disease does not reappear. The first requirement is a thorough physical examination and assessment by a general practitioner or rheumatologist (specialist in arthritis). Sometimes a diagnosis cannot be made straight away. Laboratory tests may be needed to assist diagnosis and blood tests used to identify an antigen called rheumatoid factor, present in about 80% of people with the disease. A test called the erythrocyte sedimentation rate (ESR) is sometimes used to assess the degree of disease activity. A high ESR indicates a more active disease. X-rays are not necessary to make a diagnosis, but they help to determine whether damage to bones or cartilage has occurred. However, it is rare for damage to occur in the early months of the disease. The management of rheumatoid arthritis usually involves a combination of education, medication, exercise, rest and understanding of how to protect the joints. An individual management program can be planned by the doctor and person involved, in consultation with other members of the health team. These may include a physiotherapist, occupational therapist, nurse, podiatrist and dietitian. If management is started early and the person affected carries out his or her program conscientiously the chances of long-term damage to joints are minimised. Management is a daily activity. It involves constant readjustment to the demands of life and of the disease. Research has shown that a person’s attitude and communication is of utmost importance. People with rheumatoid arthritis should have an adequate knowledge of the condition and its management. This will enable them to be actively involved in making decisions regarding management and helping themselves. Self-help means being willing to learn about and assume responsibility for the daily care of the condition. Important aspects of an education program include:
Arthritis Victoria runs self management courses to provide people with rheumatoid arthritis with information about management and a chance to meet other people with similar problems. The first line of treatment involves taking a non-steroidal anti-inflammatory (NSAID) medication to reduce the inflammation which causes swelling, pain and stiffness. Anti-inflammatory medications may cause gastric upset or heartburn and should be taken with food to reduce the likelihood of these side effects. If medications do cause side effects, a doctor should be consulted. For some people, more potent medication designed to slow down the activity of rheumatoid arthritis and to bring on a remission of the disease may be necessary. These medications include anti-malarial drugs, gold salts, penicillamine, sulphasalazine, cortico-steroids, and immunosupressive drugs. A great deal of research is directed at new drugs and new treatment methods. Equally important in the management of the disease is a proper balance of rest and exercise. Rest helps to reduce swelling and pain around the joint and reduces fatigue. It is important that the day is planned to allow activity to be broken up with frequent periods of rest. The amount of rest needed depends of the state of the disease. When it is severe, or in a more active phase, more rest and less exercise is needed than during times of improvement. Exercise means a daily routine, specifically designed for the person concerned, to maintain muscle strength, healthy cartilage and joint mobility. Exercising in warm water (hydrotherapy) is beneficial. It is essential to involve members of the health team, especially the physiotherapist, in planning an exercise program. Joints which are inflamed and those in which changes have occurred are more likely to become damaged if they are strained. It is important to avoid wrenching movements and to try to distribute weight over several joints. Splints may be prescribed for wearing either at rest or when working. Walking sticks or crutches may be prescribed to reduce the weight carried by inflamed or weakened joints. An occupational therapist can advise on joint protection, aids and special equipment. A comprehensive range of aids and equipment is displayed at Independent Living Centre in all mainland state capital cities. It is important to telephone for an appointment. In severe cases, a doctor may recommend joint surgery to correct or prevent deformity, relieve pain, increase mobility and improve quality of life. Many people gain benefit from surgical repair and replacement of damaged joints. There is no specific diet for rheumatoid arthritis. A nourishing and well balanced diet is essential to maintain good health and combat fatigue. Feeling generally unwell with loss of appetite, combined with difficulty shopping and preparing food, may lead to poor nutrition. People should seek help to overcome these problems. Further information about diet is available from the Arthritis Foundation in your state or territory. REMEMBER! |
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