October 27, 1995 Number 131
|Helping Residents Who Suffer from Arthritis
called the "nation's primary crippler," arthritis
is a common and debilitating condition which causes pain,
swelling, and possible damage in the joints. About 37 million
Americans -- approximately one out of seven -- have some type
of arthritis. One in three families has an immediate family
member with arthritis and one million new cases of the condition
are diagnosed each year. Arthritis can result in a severe
loss of functional ability, as well as lead to feelings of
anger, anxiety, and depression. The following two-part Council
Close-Up series examines the common forms and symptoms
of arthritis and covers the treatment programs that nursing
facilities can implement to increase resident independence.
People sometimes use the word "arthritis" to describe
an ache, a pain, or almost anything that hurts. In medicine,
arthritis means specifically inflammation of the joints.
A joint is a junction where two bones meet in a way that permits
each to move in relation to the other. Altogether there are
68 joints in the human body.
Arthritis is not a disease in itself, but rather is a state
or condition that is the result or manifestation of many diseases.
Arthritis has been associated with more than 100 different
illnesses. The condition can cause pain, joint damage, and
a loss of movement, affecting a person's' ability to successfully
complete daily activities.
Most arthritic conditions are diagnosed after the age of
45, although persons of all ages can develop arthritic symptoms.
About two out of three arthritic conditions are experienced
by women. However, several forms of arthritis, including gout
and spinal arthritis, affect mostly men.
Except for a few types of infectious arthritis, no one knows
exactly what causes arthritis. Most forms of this condition
are chronic, with people experiencing ups and downs with its
symptoms. Periods when they feel no symptoms are called remissions
and times when the disease gets worse are called flares.
Current medical treatments have proven to be effective in
controlling pain and minimizing joint damage for most individuals.
The key is getting proper medical help early and faithfully
following a prescribed treatment program.
Common Forms of Arthritis
Osteoarthritis -- Affecting over 15 million Americans,
osteoarthritis is the most common form of arthritis. Osteoarthritis
is a condition which causes joint cartilage to degenerate
or break down. People with osteoarthritis may feel pain and
stiffness in the affected joints, but usually have little
or no swelling. This condition most often appears in the hands,
neck, spine, knees, hips, or base of the big toe. This form
of arthritis is very common amongst the elderly, with 90%
of women and 65% of men over the age of 65 having some degree
of osteoarthritis in their hands and feet.
Rheumatoid arthritis -- This condition causes joints
to inflame and swell. Usually beginning between the ages of
20-40, rheumatoid arthritis afflicts about 2.1 million Americans.
Most people with early rheumatoid arthritis feel tired, achy,
and stiff. Over time, their joints continue to stiffen, swell,
and become tender, impairing motion. Eventually, the condition
can damage bones, ligaments, tendons, and cartilage. With
aggressive medical treatment, most persons with rheumatoid
arthritis can lead normal lives.
Fibrositis or Fibromylagia -- Fibrositis is a chronic
condition causing widespread pain in all or most body parts
and which leads to deep fatigue. Persons with fibrositis have
many tender points, in both the upper and lower parts of their
bodies, that cause much pain. From three to six million Americans
suffer from this condition. Fibrositis most often affects
women between the ages of 25 to 50 years old.
Gout -- Affecting nearly two million Americans, mostly
men, gout is a form of arthritis often affecting the large
joint in the big toe. However, it can flare up in any joint.
Contrary to the myth that this arthritis develops from overeating
rich foods, gout is a disease of too much uric acid in the
body. People with gout cannot process and remove uric acid
properly, with this chemical moving into their joints, irritating
and inflaming the joint lining. Medications have proven to
be very effective in controlling gout.
The Warning Signs of Arthritis
The Arthritis Foundation suggests that individuals
consider these warning signs as an indication of possible
arthritis and the need to see a physician:
- Swelling in one or more joints (such as rings not fitting
in the morning because one's hands are too swollen).
- Early morning stiffness. It may take an individual some
time to get the hands, knees, or joints moving in the morning.
- Reappearing pain or tenderness in a joint.
- The inability to move a joint normally, so that a person
has trouble doing daily tasks.
- Redness and warmth in a joint.
- Unexplained weight loss, fever, or weakness -- when combined
with joint pain.
The Treatment of Arthritis
Physicians develop treatment plans to help persons with arthritis
in relieving joint pain, reducing swelling, and improving
joint movement. Specific arthritis treatment programs include
one or more of the following
- Taking medications
- Applying heat or cold to affected joints
- Providing protection and aids for joints
- Doing exercises
- Utilizing relaxation techniques
Often, the treatment of arthritis is a slow and frustrating
process. Individuals must be patient in experimenting with
different medications, treatments, and exercises to discover
which approaches work the best.
Arthritis medications have proven to be very effective in
relieving pain and swelling and in slowing down the disease
process. Doctors may begin a treatment program by recommending
that persons take low doses of aspirin or acetaminophen. Higher
doses of these medications may later be prescribed to stop
Another group of drugs commonly used to reduce arthritic
swelling are Non-Steroidal Anti-Inflammatory Drugs (NSAIDS).
These medications include Motrin, Advil, Ibuprofen, and Naprosyn.
Steroids such as Prednisone may also be prescribed to reduce
swelling and discomfort. These are usually injected into the
painful joint and are used for more severe symptom flares.
With the use of these medications, staff must be aware of
their possible side effects, including stomach irritation,
peptic ulcers, headaches, and kidney damage.
Applying Heat or Cold to Affected Joints
Heat is a fundamental part of treatment in almost every type
of arthritis. With the use of heat, stiff joints and muscles
loosen. Many persons respond well to the use of moist heat,
such as a warm shower or warm towels to reduce swelling and
pain. Another way to alleviate the symptoms of arthritis is
to use cold treatments. It may be helpful to apply ice to
an inflamed joint for 10 to 15 minutes several times each
day. Ice is often most helpful when arthritis is acute or
severe. Some persons find the best relief when cold treatments
are alternated with heat treatments. Residents with arthritis
may need to experiment to see if heat, cold, or a combination
of the two provide the most relief.
Providing Protection and Aids for Joints
Many simple actions can be taken to protect joints from overuse
and strain, which can lead to earlier and more severe deformity.
If joints are stressed or injured, pain and swelling can severely
increase. Staff should recommend the following techniques
to residents to reduce joint stress and fatigue:
- Change body positions often, to keep joints limber and
- Take short rests throughout the day to reduce stress.
- Sit and walk straight and keep sore joints in normal,
relaxed positions when at rest.
- Avoid a tight hand grip. Avoid carrying heavy objects
by the handles (such as handbags) or using certain tools
such as scissors and pliers.
- Spread out the strain. Pick up a heavy cup with two hands
instead of the index finger. Instead of carrying objects
in one's hands, when possible put them on one's forearms.
Slide your whole hand under a plate and support it with
the other hand.
- Avoid pressure against the back of the fingers. Pressure
here adds to loosening and deformities of the joints and
bases of the fingers.
- Be aware of pain. When a joint is in pain, try changing
posture or the way an activity is being performed. Listen
closely to the signals being given by the body.
Joints can also be protected through the use of walkers,
canes and splints. Physical therapists can work with residents
to teach them how these devices provide targeted rest for
affected joints. Facilities should also look into the wide
variety of helpful adaptive devices available for persons
with arthritis. Such devices include door knob extendors,
Velcro fasteners for clothing, large light switch knobs, and
levers on faucets.