As part of National Arthritis Month, ADVANCE offers this guide for nurses to consult when caring for arthritic patients.
Although commonly regarded as a single disease, arthritis is actually defined by more than 100 different clinical diagnoses. The leading cause of disability in the United States, the condition has also become an informal way of referring to general joint pain or joint disease, according to the Arthritis Foundation.® Most common among women and occurring more frequently in older populations, arthritis affects more than 50 million adults and 300,000 children in some form, including osteoarthritis (the most common type), which affects more than 30 million U.S. adults, as well as gout, fibromyalgia, and rheumatoid arthritis.1 As part of Arthritis Awareness Month, ADVANCE offers this guide to symptoms, treatment, and resources for nurses to consult and share with their patients while providing education. The most common forms of the family of diseases will remain the primary focus.
Types of Arthritis
Sometimes referred to as “degenerative joint disease” or “wear and tear” arthritis, osteoarthritis most frequently affects the hands, hips, and knees, according to the Centers for Disease Control and Prevention (CDC). Osteoarthritis causes cartilage and bones within a joint to breakdown, with changes usually developing slowly before worsening over time. The condition can cause pain, stiffness, and swelling, and can result in disability. Nurses should be cognizant of signs and symptoms such as pain/aching, stiffness, decreased range of motion, and swelling.2
Rheumatoid arthritis is classified as an autoimmune and inflammatory disease that results in painful swelling and inflammation due to causes that remain unknown, according to the CDC. Commonly found within the joints of the hands, wrists, and knees, rheumatoid arthritis causes the lining of the affected joint to become inflamed, which can cause damage to joint tissue and subsequent long-lasting or chronic pain, lack of balance, and even deformity.3 Other tissues throughout the body can also be impacted, and damage can occur to organs such as the lungs, heart, and eyes. Signs and symptoms are varied and include pain or aching in more than one joint, stiffness in more than one joint, tenderness and swelling in more than one joint, complementing symptoms to both sides of the body, weight loss, fever, fatigue, and weakness.3 If not treated appropriately, physical and social consequences can impact quality of life and lead to premature death due to premature heart disease and obesity.3
Gout, or gouty arthritis, is another common form of the condition that typically appears in one joint at a time, usually in the big toe. Characterized as very painful when “flares” occur, periods of remission (that can last years) are known to occur only to be followed by repeated bouts that can create increasingly painful periods of flaring. Most likely to impact men and obese adults, gout is caused by hyperuricemia, a result of too much uric acid in the body. Certain health conditions, such as congestive heart failure, hypertension, insulin resistance, metabolic syndrome, diabetes, and poor kidney function, can increase one’s chances of developing gout, as can using certain medications, such as diuretics, and drinking alcohol and liquids high in fructose. A diet that’s high in red meat, organ meat, and some kinds of seafood (anchovies, sardines, mussels, scallops, trout, and tuna) can also increase risk. Symptoms, aside from pain that tends to be described as “intense,” include swelling, redness, and heat in the affected area, which less commonly can be the ankle or the knee. Flare-ups can begin suddenly and last for weeks, and there is no known cure. However, effective treatment and management strategies (including self-management) do exist and will be discussed further in this article.
Then there are those patients who are experiencing pain all over their body, or fibromyalgia, which, not surprisingly, is accompanied by sleep difficulty and fatigue, as well as emotional and mental distress. Fibromyalgia may also lead patients to be more sensitive to pain than those who don’t have fibromyalgia, a phenomenon known as “abnormal pain perception processing,” according to the CDC. Fibromyalgia affects about 4 million U.S. adults, and the cause is also not known, but it can be effectively treated and managed.
Treatment Strategies
According to the CDC, appropriate fibromyalgia care includes a combination of treatments, including prescription and over-the-counter drugs; aerobic exercise and muscle strengthening; patient education; stress-management techniques; good sleep habits; and cognitive behavioral therapy, which can be utilized to treat underlying depression. Aside from medical treatment, patients can manage their fibromyalgia with self-management strategies including being more physically active. Nurses should recommend that patients engage in exercise for at least 150 minutes per week and consider participating in physical activity programs that are proven to reducing pain and disability.4
Suggested treatment for osteoarthritis includes a combination of therapies that could also include physical activity and muscle strengthening, supportive devices such as crutches or canes, and surgery.2 (if other treatment options have not been effective). In addition to medical treatment, CDC officials suggest that patients living with osteoarthritis can reduce pain and disability while pursuing activities that are important to them and improve their quality of life.5 Guidelines include joint-friendly physical activities (for example, walking, biking, and swimming) that are low-impact and place less stress on the body while reducing injury risk.5 Being physically active can also delay the onset of arthritis-related disability and help people with arthritis manage other chronic conditions such as diabetes, heart disease, and obesity, according to the CDC.
Although rheumatoid arthritis affects many aspects of daily living treatment commonly includes medications that slow the disease and prevent joint deformity (disease-modifying antirheumatic drugs) as well as biological, according to the CDC. Self-management goals compare to those of fibromyalgia3 and include smoking cessation, as tobacco worsens disease symptoms and can lead to other medical problems.
The focus of gout treatment is based on managing the pain of a flare-up through NSAIDs and the anti-inflammatory drug colchicine, according to the CDC. Avoiding future flares often means making dietary changes, losing weight, limiting alcohol, eating less red meat and stopping medications associated with hyperuricemia.
Doctors may also recommend preventive therapy to lower uric acid levels in the blood with drugs such as allopurinol, febuxostat, and pegloticase.6
The Massage Therapy Modality
According to a report by the Arthritis Foundation, regular massaging of the muscles and joints affected by arthritis can lead to significant reduction in pain.8
Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, has reportedly conducted numerous studies on the benefits of massage for people living with arthritis, and that research shows that regular use of the simple therapy led to improvements in pain, stiffness, range of motion, hand-grip strength and overall function of one’s joints.
A 2010 study published in the International Journal of Neuroscience claims that stimulating pressure receptors, with moderate pressure leads to reduced symptoms. “The critical thing is using moderate pressure,” Field said in a prepared statement. “Light pressure, just touching the surface of the skin or brushing it superficially, is not getting at those pressure receptors. Light pressure can be stimulating, not relaxing.” However, caution should be used when considering massage if the patient has damaged or eroded joints due to arthritis; flare of inflammation, fever, or skin rash; severe osteoporosis; high blood pressure; and/or varicose veins.
References
- What Is Arthritis? Arthritis Foundation. Accessed online: www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php
- Osteoarthritis. CDC. Accessed online: www.cdc.gov/arthritis/basics/osteoarthritis.htm
- Rheumatoid Arthritis. CDC. Accessed online: www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html
- Fibromyalgia. CDC. Accessed online: www.cdc.gov/arthritis/basics/fibromyalgia.htm
- Managing Arthritis: Strive for Five. CDC. Accessed online: www.cdc.gov/arthritis/basics/management.htm
- Gout. CDC. Accessed online: www.cdc.gov/arthritis/basics/gout.html
- Bernstein S. Benefits of Massage. Arthritis Foundation. Accessed online: www.arthritis.org/living-with-arthritis/treatments/natural/other-therapies/massage/massage-benefits.php
