October 27, 1995 Number 131

Helping Residents Who Suffer from Arthritis

Often 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.

Understanding Arthritis

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.

Taking Medications

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 joint swelling.

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 reduce stiffness.
• 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.