Caring for people with arthritis.
Arthritis is the name given to more than 120 musculoskeletal diseases.
These diseases can have a debilitating effect on the individual. They cause chronic pain and weaken and degrade joint function so that it becomes impossible to complete activities of daily living without assistance.
Each type of arthritis acts on the body in a different way, and no two people’s experience of arthritis will be the same.
Dr Mona Marabani is a practicing rheumatologist and the president of Arthritis Australia. On the Aged Care Channel’s upcoming Caring for a Person with Arthritis program, she discusses the most common kinds of arthritis.
“Osteoarthritis is the most common kind. At the age of 80 you’ve got a 50/50 chance of getting symptomatic osteoarthritis,” she says.
“Inflammatory arthritis is a very general condition. It can not only affect the joints but also other parts of the body. When your immune system doesn’t do what it is supposed to, it can cause problems with not only the joints but with the lungs, the heart and many other tissues.”
Gout is a common and painful condition, often affecting the joints of men between the ages of 40 and 45, or older people taking diuretics, says Jacqui Louth from Arthritis NSW, who also appears on the program.
Rheumatoid Arthritis is the most common form of inflammatory arthritis and the most common autoimmune disease. It affects close to 2.5 per cent of Australians and the instance is much higher in women, says Jacqui.
“Perhaps arthritis is taken less seriously in the older population by the elderly themselves. And on the other hand some health professionals may also forget it’s very important for people to have pain relief,” says Mona.
With a chronic disease like arthritis, the disease state can fluctuate, sometimes from day to day, affecting a person’s capabilities and their mood.
“People who have arthritis need to be frequently assessed,” says Jacqui. “This information can then be used to determine if a person’s disease state has altered, in which case their plan of care should be updated. This assessment should require a person to complete a daily activity, a cognitive and a communication test.
“Their nutrition and hydration levels should be monitored, as well as their mobility and experience of pain, and whether they are able to self-administer some of their medications,” she says.
Informal assessment can be done every day, if the care team works together to make sure that the person is getting the best possible quality of care.
“So be alert to verbal and non-verbal cues for pain,” says Jacqui. “Does a person in your care seem tired – have their sleeping patterns changed? Are they sleeping more, or less? Has their general mood changed – have they become withdrawn? Are they less mobile?”
Each assessment should involve a case conference between the case manager, and members of the multidisciplinary team, including a physiotherapist, diversional and occupational therapists and a GP.
Pain makes muscles tense. Tension can then increase as the individual focuses on the pain they are feeling. Being diverted from pain and negative thoughts relating to pain can provide a person with much needed perspective, and help to break this negative cycle, says Jacqui.
“Comfort is a state of ease and satisfaction of bodily wants, with freedom from pain and anxiety. Each individual in your care should have a plan that provides access to pain relief, exercise, relaxation, restful sleep and entertainment, so that they achieve maximum comfort,” she says.
SUB: Pain relief and drugs
Analgesics are pain relieving drugs they have no action other than to reduce pain. They’re often used alone in osteoarthritis, whereas in inflammatory types of arthritis analgesics are used in combination with the other treatments.
“NSAIDS, or non-steroidal anti-inflammatory drugs, are probably the most common drugs for most types of arthritis. They help reduce the symptoms but they don’t change the disease process,” explains Mona. Examples are Nurofen, Voltaren and even Aspirin.
NSAIDS should be taken with food to help prevent any gastrointestinal upsets.
Cox-2 inhibitors are the second generation of non-steroidal drugs, designed to have a more specific effect on the inflammation pathways and be safer on the stomach. Examples are Celebrex and Mobic.
“But these drugs do come with their own set of risks. For people who have problems with their blood pressure, kidneys or heart, the risk of heart attack, stroke and kidney failure may be increased in a small number of people,” warns Jacqui.
Disease modifying drugs are used for rheumatoid arthritis and possible connective tissue diseases like lupus. These may be given by intravenous infusion, or injections.
Disease modifying anti-rheumatic drugs, known as DMARDS, can help to reduce the damage to joints by suppressing the immune system.
Corticosteroids, drugs like cortisone, prednisone, are a group of very powerful drugs that switch off inflammation. They also have very significant side effects if they are used in large doses for a long time.
The most common drugs for gout are in the allopurinol group. These drugs affect the way that your body handles uric acid and prevents attacks from occurring.
SUB: Complimentary therapies
Complimentary therapies for arthritis are starting to come into the mainstream. There is research that suggests glucosamine can be helpful in people with osteoarthritis. Glucosamine is one of the building blocks of cartilage and there are some studies which indicate that knee osteoarthritis can be treated effectively with doses of glucosamine, around 1500 milligrams a day, says Mona.
Fish oil is also known to reduce inflammation and some studies suggest it is helpful in rheumatoid arthritis. You need a lot of fish oil to get an anti-inflammatory effect, about 2.7 grams of omega three fats a day and about 8 standard caps of fish oil.
Heat can also help to relieve the pain of arthritis. A heat pack may be good for people who have osteoarthritis to alleviate soreness and stiffness. Wrap it in a towel or cloth to prevent skin burns, and place it on the painful area for 15 minutes. Skin temperature should be normal before re-applying a heat pack to prevent tissue damage.
Massaging the muscles surrounding the joints can also be very soothing and decrease tension.
Capsaicin, the substance that makes chili peppers so hot, has been found to reduce the pain of arthritis for some people, when repeatedly applied topically as a cream. There is a wide range of these creams available on the market, and an individual should consult with their GP before selecting and trialing one.
Keeping active is important for people with arthritis, even on their bad days they need to keep those joints gently moving, says Jacqui.
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