Who is this booklet for?
This booklet is for people who have rheumatoid arthritis (RA) who want to reduce aches, pain and strain in joints by altering the way they do things. It may also be useful for people with other kinds of inflammatory arthritis such as psoriatic arthritis. The section on how to reduce tiredness will also be helpful to people with any type of arthritis who are suffering from fatigue.
How can I use this booklet?
This booklet gives advice about how to look after your joints and on how you can reduce fatigue. It is also a workbook as it suggests different activities you can do to help achieve this.
What sort of problems can arthritis cause?
Many people with arthritis describe how their joints hurt, their muscles ache and they often feel really tired, especially at the end of the day. Some feel very frustrated at the extra time it takes to do everyday jobs. For example, even a simple job such as opening a jar can be difficult. Some people worry about the future and about becoming a burden to others.
What can I do to help myself?
This booklet tells you why it is important to change the way you do some things and that it is important to start making the changes now, to help avoid problems becoming worse.
Things you can do to help yourself are:
- looking after your joints by reducing strain, which should also ease aches and pain
- reducing tiredness by pacing your jobs, planning ahead to improve efficiency and setting priorities
- trying to keep as fit as possible through regular exercise
- getting a good night’s sleep.
Why should I look after my joints?
Most people eventually find their own ways to reduce the aches and pains in joints. This booklet will help you take a short cut to start making the necessary changes to the way you do your everyday jobs.
Out of every 100 people who get rheumatoid arthritis, 20 will have a mild form of the disease, with few problems, 75 will have moderate disease with recurring problems and 5 will have severe disease. (See arc booklet ‘Rheumatoid Arthritis’.) After a year, 50% of people with rheumatoid arthritis have some problems using their hands, for example bending their fingers and gripping things, and after 5 years half will have some hand deformity, although not necessarily severe. So you need to start looking after joints as soon as you know you have rheumatoid arthritis. Medication helps to protect joints by controlling the disease process. Taking strain off your joints will also help.
Why do joints ache and hurt?
Swelling (inflammation) inside joints irritates nerve endings and this causes pain. If bones become damaged this also can be painful. Putting more pressure on joints, such as when lifting things, can make pain worse. Many people find that if they are busy, for example pushing themselves to get a job in the house, garden or at work done, then they ache more the next day. When joints are affected by arthritis, ligaments become slacker (see ‘Why do joints become deformed?’ below). This means that muscles have to work harder to keep the bones in place, and this makes the muscles ache. (See also arc booklet ‘Pain and Arthritis’.)
Why do joints become deformed?
There are three main things which keep joints stable. These are:
- the close fit of the bones
- the capsule and ligaments, which are like strong elastic and keep the bones together
- the muscles and tendons which make the joint move.
With repeated joint swelling, ligaments are stretched and can become slack. Bones and tendons get damaged and muscles become weaker causing the joint to become unstable. This means that joints slip out of shape and deformities develop. In the hands this starts to happen early on in the disease. (See arc booklet ‘Rheumatoid Arthritis’.)
The way you use your joints can contribute to the development of deformities. Hands are particularly vulnerable as we place a lot of strain on them during the course of the day. Typical deformities in the hands are shown in the diagrams below. These are:
- the wrist or knuckles slip downwards (this is when joints partially dislocate, called subluxation)
- the fingers bend over towards the little finger (ulnar drift)
- finger or thumb joints buckle (called swan neck or boutonniere deformities)
Have a look at your own hands to see if any of these have started to happen.
How can I reduce aches, pain and strain?
The first thing to do is to become more aware of how you are using the joints which ache. For example, watch yourself making a hot drink. What is happening to your fingers while you are turning on the tap and opening the coffee jar? Are they being pushed towards the little finger?
What is happening to your wrist as you lift a heavy kettle? Can you feel any aching or pulling at your wrist?
Can you think of another way of doing these activities which reduces those aches and strains?
You might have tried picking up the kettle with two hands. You may find you do this when your hands are painful. But it is important to do this all the time, not just when your hands are hurting.
This is an example of ‘joint protection’: that is, doing things differently to take the strain off certain joints. Health care professionals often use this phrase to explain this approach to reducing aches, pain and strain. It doesn’t mean you should stop using your joints – just that you should use them differently.
Here are more ‘joint protection’ ideas followed by suggestions for putting them into practice. You may like to try some of them out. Put a mark by those you find especially helpful so you can refer to them more easily in the future. The ideas listed below are explained in more detail in the pages which follow.
- take notice of any pain you feel – it can serve as a warning
- spread the load over several joints
- use larger stronger joints
- use less effort
- avoid positions which push your joints towards deformity
- avoid gripping things tightly
- use your joints in more stable positions.
What should I do when I am in pain?
The way you use your joints can give you increased aches, pain and strain. And, over time, the way you use your joints may increase any deformity. So this is why you should take notice of pain. Listen to your body – if you are still having more pain an hour after activity, you should do less. Wear splints if they have been recommended and rest with your feet up to help.
Resting splints are custom-made. They help with pain and swelling by resting your joints.
Elastic wrist splints help reduce pain when you are working.
How can I spread the load of what I lift over several joints?
How about trying this:
- using two hands
- keeping as much of your hand in contact with things as you can.
An example of this is seen in the second picture below. Why not try this when doing other activities? Use two hands to lift a pan, or other things that could be lifted more easily with two hands.
How can I use stronger joints to do a job?
How about trying the following:
- use your hip or shoulder to shut a drawer or door, rather than your hand
- hug larger objects close to your body as you carry them.
How can I use less effort to do things?
How about trying these tips:
- use labour-saving gadgets
- reduce the weight of what you lift, or better still:
- shift not lift – slide objects along a work surface, use a trolley or wheelbarrow.
How can I avoid positions which push my joints towards deformity?
By becoming aware of how you use your hands during activities, you can identify which movements push your joints in the direction of the deformities described earlier. For your hands, the important ones are:
- avoid lifting heavy things with your wrists bent downwards
- avoid pushing down on your knuckles
- avoid pushing your fingers over towards your little finger
- avoid twisting or over-straightening your fingers
Can you think of any activities you do which might push your joints into these deforming positions? You may like to try these new grips out and see if the ‘pulling’ feeling or pain in your joints is less.
How can I avoid gripping things tightly?
Tight grips produce a lot of strain on knuckles and thumb joints. You will tend to use a tight grip when you do things like writing, knitting and using a screwdriver. Take frequent breaks to rest your hands briefly. Reduce the length of time you spend doing them and try to relax your grip. Use padding to enlarge the grip on things such as your pen, knife, toothbrush or spanner. (See also arc booklet ‘Your Home and Arthritis’.)
How can I use joints in more stable positions?
Change position from one which puts strain on joints to one which spreads the weight evenly over several joints. Try doing as follows:
- when carrying things use a grip which keeps fingers and wrists straight
One hand holds the handle with the wrist straight and the fingers in line with the wrist while the other supports the can with the palm flat. (See also arc booklet ‘Gardening and Arthritis‘.
- when working at a table or bench, sit or stand as close as you can, and reduce stretching and bending
- if you are standing, keep your weight so it is supported evenly through both legs, standing squarely on.
How can I make changes?
Following the suggestions made above would be a lot to change all at once and changing the habits of a lifetime is often difficult to do. It is a good idea to change things bit by bit. You might like to set yourself a goal each week to change two or three things. Start with something which is causing you most pain and try following these steps:
- Using the advice above, work out another way of doing it which causes less pulling or pain on joints.
- Now practise the new movements until you get them right and feel comfortable doing them.
- Then practise some more until the new movements become automatic and you can do them without slipping back into old habits if you become distracted.
- If possible, get a friend or family member to remind you to do it properly.
How can I avoid getting so tired?
Many people feel tired, especially at the end of the day. This can also make your joints and muscles ache more. The disease itself is partly responsible for this tiredness. Living with pain can make more demands on your energy.
Many people find that making changes to their lifestyle helps to make their energy last longer. This is not always easy to do: it can be difficult to do a job less thoroughly, even if a job makes you tired. But in the long run you will find it is better to save your energy for the more enjoyable things, rather than being tired out by routine tasks.
Here are some things you can do to spread your energy further. You may like to try some of them and see what works for you.
- pacing your activity
- planning ahead and setting priorities
- better body positioning
- getting better organised
- getting a good night’s sleep.
How can I pace activities better?
Try taking a break for a few minutes every half hour. Change activities regularly and swap between light and heavier jobs. For example, after vacuuming a room, do some dusting, then sit down and take a break. When mowing the lawn, take a break before you get tired, change to some light weeding or potting out seedlings and go back to mowing later when you feel rested.
How can I plan ahead and set priorities?
You may find you have more energy if you spread heavier jobs out over the week, planning to do a bit each day. Some people use up a lot of energy doing ‘the chores’ and are too tired to do the enjoyable things. If you find this happens to you a lot, think about the things you have to do and the things you enjoy doing. You might keep a diary of such things. Set a balance between these when planning your week, making sure you will have time to do things you enjoy. You may find you need to cut some jobs out or ask someone else to help with them. If you plan to do more than you are actually able to do, it’s time to start asking some hard questions.
- Are there any activities you can do less often or drop entirely?
- Is there someone to whom you can delegate certain tasks, for example a relative or friend?
- Can you say ‘no’ when someone’s expectations of you are unrealistic?
- Can you say ‘no’ to yourself when your own expectations are too high?
- Can you make any of the suggested changes to your lifestyle to conserve more energy (pace, plan, prioritise, position yourself better)?
You may like to try the following activity.
Make a note of what you are doing every half hour during a ‘typical’ day. Make a note of how much pain you had and how tired you felt doing each activity. If you were tired at the end of the day ask yourself some of the questions you have just read above. Can you think of any changes you can make to make yourself less tired? Try out some of your ideas during the coming week. At the end of the week ask yourself, ‘Has it made a difference?’.
How can I find a less tiring position to work in?
Standing for long periods and working in a cramped position for a long time can make you ache and feel more tired. Try changing positions more often. Stretch out your arms and legs from time to time to prevent them feeling stiff. Make sure work surfaces are the correct height and that you are not having to stoop or stretch to work at them. A lot of activities that normally require standing can be done by ‘perching’ on a stool. If you are sitting it is important to consider whether the seat you are on is comfortable, supportive and the right height and depth for you. (See arc booklet ‘Are You Sitting Comfortably?’.
How can I get better organised?
Store things where you can reach them more easily. Organise your cupboards with the seldom-used things at the back. Throw out things you don’t use.
Look at how you are doing things and see if you can organise a job better:
- make sure you have all the things you need to hand before you start
- can any part of the job be cut out or done more efficiently?
- can you sit to work rather than stand?
- can you do the job a bit slower?
How can I get a good night’s sleep?
Think about why you are not sleeping well.
Is it pain and stiffness during the night?
Take some painkillers before bed. Try having a warm bath or shower to help you relax. Check your mattress is supportive and comfortable (you might consider buying a new one, but you need not go for the most expensive – try before you buy). If you have neck pain you may find using fewer pillows helps or ask your doctor for a soft surgical collar to wear while you sleep. Rearrange pillows into a V-shape to support painful shoulders, or you may be helped by a shaped neck pillow. If your hands are painful, resting splints may help.
Are you having difficulty winding down?
Avoid eating a big meal and avoid drinking tea, coffee or alcohol a couple of hours before bedtime. Try a hot, milky drink instead. Get into a bedtime routine. Try to go to bed at the same time every night. Do a few gentle stretching exercises, have a warm bath or shower and listen to some relaxing music. Take time for yourself!
Why should I exercise?
Exercising helps to keep your muscles strong and your joints moving. There are some exercises in the arc ‘Keep Moving’ leaflet which show how to do these without putting strain on your joints. Joint protection and exercise work together. Joint protection reduces strain on the joint capsule and ligaments. As mentioned, these can get slack in arthritis (see ‘Why do joints become deformed?’) and straining them can make this worse. Exercise helps keep the muscles around the joint stronger, to help support the joint if the capsule and ligaments are weak.
What evidence is there that joint protection techniques work?
Research has shown that using these joint protection methods does reduce pain and makes everyday activities easier.
People have less stiffness in the morning and fewer flare-ups when they use these methods as much as possible.
How can family and carers help?
Learning about the things described here can help family and carers to understand some of the problems people with arthritis face. Some people find it very helpful if their family or friends become involved as they practise some of the ideas mentioned in this booklet. If they are supportive, give you feedback on how you are doing, and help you to find solutions to problems you may find you are able to adopt the new movements or activities more quickly.
What further sources of help and information are there?
The allied health professionals (AHPs) attached to rheumatology units help support people in adapting their lifestyle. The occupational therapist (OT) will discuss this booklet with you and suggest more ways in which you can reduce aches, pain and strain, and which may help to slow down the development of joint deformities. Because changing the habits of a lifetime can be very difficult to do, many people find it helpful to get together with others who wish to do the same. Many OT departments offer ‘Joint Protection’ programmes where groups of people with rheumatoid arthritis support each other through learning and practising activities together. This may be part of an overall programme run by AHPs for people with arthritis.
If you find the self-help methods suggested here useful, you may like to join a local group. Arthritis Care, a national organisation with local branches, runs a programme called ‘Challenging Arthritis’ which teaches self-management techniques for people with any kind of arthritis.