Twenty-seven years ago, Richard Shirley woke up with a swollen knee. This was the beginning of his journey that would lead to a diagnosis of rheumatoid arthritis (RA). "I did all I could to fight the disease," he said. While Richard’s regimen included stretching, swimming, and use of multiple medicines, there are a number of things that patients with RA can do to improve their daily lives.

WAKING UP TO A CHRONIC CONDITION
Rheumatoid arthritis (RA) is a chronic condition that can cause pain and loss of joint motion. The course of RA varies widely. Early diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) are crucial for limiting joint damage. All people who suspect they have RA should see a rheumatologist to receive an early diagnosis and appropriate treatment as soon as possible.

"There is a definite need for physicians to identify rheumatoid arthritis earlier, since we know the greatest amount of structural damage occurs within the first two years of the disease onset, leading to disability. Based on the evidence, it is clear that referral of suspected RA patients (to a rheumatologist) should be considered a medical emergency."

- Paul Emery, MD, Head of Rheumatology and Rehabilitation Research, University of Leeds, United Kingdom

“Rheumatoid arthritis is a disease that affects the whole person. It affects their sense of well being, their work, their family life and their community life. It affects everything that they do.

- Eric Matteson, MD, MPH, Rheumatologist, Mayo Clinic, Rochester, Minnesota

THE IMPACT ON FAMILY AND FRIENDS
Although rheumatoid arthritis (RA) can occur at any age, it most commonly occurs among women and adults between the ages of 20 and 45. These statistics suggest that the impact on families with children is widespread. When RA causes an individual to become less active, family members and friends can be affected by RA. For example, when parents with RA have joint pain or are feeling tired, they may be less able to participate in family activities, such as helping children with homework or completing simple tasks around the house.

One patient, who was interviewed for this article, said “my husband reacted by burying himself in his work, and my kids completely ignored it”. She was troubled by their reaction, but at the same time she understood, since they didn’t realize how serious the disease could be. They have since become more supportive and play an active role in her treatment.

THE EMOTIONAL CONSEQUENCES
The physical symptoms of rheumatoid arthritis (RA) are well documented. However, the emotional impact of RA is also important as patients try to minimize its effects on their daily lives. According to experts, patients with RA can feel stress, depression, anger, and anxiety because of their condition. Even as patients learn to cope with the physical aspects of their disease, they may find that their fears, pain, and potential for disability can cause them to feel helpless or to have less self-confidence.

Patients with RA may become less involved in their communities or experience difficulties at school or work. Often, social problems are increased by coworkers, employers, or friends and family who do not understand that the symptoms of RA, such as fatigue or joint pain, can affect a person’s ability to participate in their normal life activities—even in people who appear outwardly healthy.

A FINANCIAL BURDEN
Rheumatoid arthritis (RA) can have significant economic costs, which include a loss of income caused by limitations at work or missing work altogether. Researchers have found that arthritis of all kinds, including RA, is the second leading reason for missed days of work—only heart disease causes more missed days of work.

In addition, people with RA may be more likely than those without this condition to stop working. For example, scientists conducting a 5-year study found that approximately 30% of patients with RA who were employed at the beginning of the study were no longer working due to RA when it ended.

When people with rheumatoid arthritis (RA) are compared to those without RA who are the same age and gender, people with RA have

• 2 times higher chance of being hospitalized
• 3 times the direct medical costs
• 10 times higher chance of going on work disability

Despite these discouraging statistics, there is good news for people with RA.

THE ROAD TO MORE NORMAL DAYS
Although rheumatoid arthritis (RA) is a chronic and often painful condition, lifestyle changes can help people with RA to retain their independence and remain active. Key lifestyle adaptations include knowing when to rest and exercise, implementing proper joint care, and reducing stress.

When talking about her experiences with RA, one patient from Alabama, says that, "you have to cope with the stress, do things on a more structured basis…I had to be more disciplined, when I was working, it was during business hours only. And most of all I put my family first."

"Many patients get stiff joints even after a single hour of rest, so activity shouldn’t be avoided…when it comes to exercise, it depends on how serious your disease is, the bottom line is, you’ve got to be extra careful, don’t over do it."

– Euna Lee, M.D., Rheumatologist, Manhattan, New York

• Maintaining muscle strength
• Preserving joint function
• Improving sleep patterns
• Reducing pain
• Maintaining a positive outlook
• Reaching or maintaining a healthy weight

JOINT CARE
The experts at NIAMS suggest that proper joint care may include using a splint for short periods to allow painful or swollen joints to rest. In addition, use of "assistive devices" to help people with everyday tasks and reduce stress on their joints can be helpful at home and at work. Examples of these devices include long-handled shoe horns and equipment that helps people get into or out of chairs. In addition, occupational and physical therapists can help patients learn how to perform tasks in ways that place less stress on affected joints.

STRESS REDUCTION
Although stress does not cause rheumatoid arthritis (RA), it can make this condition more difficult to manage. Stress can even increase the amount of pain a person feels. Experts suggest many ways to reduce stress, including regular rest periods, relaxation exercises, and exercise programs. They also suggest participation in arthritis support groups.

MANAGING RA
Despite the physical, emotional, and social challenges posed by rheumatoid arthritis (RA), there are a variety of options available to help people manage the condition. These include changing your lifestyle as well as early and aggressive use of disease-modifying medicines. These medicines reduce the symptoms of RA while also slowing joint deterioration. In addition, scientists continue to research new and innovative treatments for RA.

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Making Work a Little Less Work
Although rheumatoid arthritis (RA) is a chronic and painful condition, there are a number of ways to help remain active and productive at work. The following suggestions can enhance the safety and well-being of all employees, not just those with RA.

The 90° Work Environment
For employees who work in an office, the position of chairs, desks, and other accessories, such as trays for computer keyboards, is important. The "90° rule" can be applied. This means that a seated person’s hips, knees, and ankles should be kept at a 90° angle. The elbows should be kept at an angle of 90° or lower. The spine should be stable and supported by the chair. If needed, a pillow or rolled up towel may be used to provide additional back support. A footrest or computer keyboard tray also may be needed to be sure that the body is properly positioned when seated.

Proper Body Posture and Lifting Techniques

For employees who work in a non-office setting, for example in a factory, be sure that you understand how to lift heavy loads properly by using your largest and strongest joints. The Arthritis Foundation also offers the following tips for people with RA:

• Lift using the palms of the hands rather than gripping items with fingers
• Use arms for lifting rather than hands
• Hold items close to the body
• Slide items on the floor when possible
• Change positions often

Workplace Suggestions

Small changes in your daily routine may make your time at work easier and more comfortable. The following suggestions are offered to show how you can improve your productivity at work.

• Frequent short breaks taken throughout the day may help you conserve energy.
• An occupational or physical therapist can teach you how to perform work-related tasks in ways that will not stress joints.
• Assistive devices, such as tools to make using a computer easier or book stands to avoid neck strain while reading, may be useful.
• A flexible work schedule or other options, such as working by computer from home, may be helpful.
• Participating in a car pool is another way to conserve your energy.

Treating Emotions

If you or someone you are close to has RA, consider talking to a doctor or another health care provider about emotional or interpersonal problems caused by RA. These professionals also can recommend support groups or other programs, such as those offered by the Arthritis Foundation, to help people with RA.

Studies have shown that patients who understand their condition and participate actively in their own treatment report less pain and make fewer visits to their doctors. In addition, learning about RA is the best way for people with this condition to remain active, cope with the challenges of the disease, and build confidence in their ability to lead active and productive lives.

Here is an example of the type of program available through the Arthritis Foundation:

Arthritis Self-Help Course

This course is designed to help you learn and practice the different skills needed to build your own individualized self-management program and manage your arthritis on a day-to-day basis.

Building Bridges
Scientists have found that people who have a strong support network can improve their overall health. People with RA can build their own support networks to include family members, close friends, coworkers, and health care providers. Having a wide support group will help to ensure that people with RA have the emotional, social, spiritual, and physical support that they need to better manage their condition. Here are a few examples of how to do this.

• Involve your family in decisions about chores around the house. Teach children how to do simple tasks, such as doing laundry or vacuuming. As an added bonus, children will benefit from knowing that they are helping and will become more self-confident.
• Educate friends and coworkers about RA. If they understand how the condition affects your life, they are more likely to be supportive if you need to postpone plans or need help at work.