Arthritis means inflammation of the joints.

Most people with arthritis will experience pain and difficulty moving around.  Arthritis affects around 9 million people in the UK – one in five of the adult population and 12,000 children.

There are over 200 kinds of rheumatic diseases or conditions – often referred to as arthritis or musculoskeletal diseases.  The word rheumatic means aches and pains in the joints, bones and muscles.

Two of the most common forms of arthritis are Osteoarthritis (OA) and Rheumatoid Arthritis (RA)

Arthritis is not just a disease of older people – it can affect people of all ages, including children (Juvenile Arthritis).

It is not clear what causes arthritis and there is no cure at present. However, if you do suffer from any of these conditions, there is plenty you can do to manage your condition and lead a full and active life.

HOW THE JOINTS WORK

A joint is where one bone moves on another. The two bones are held together by ligaments. Ligaments are like elastic bands; they keep the bones in place while muscles lengthen and shorten to make the joint move.

A coating of cartilage covering the bone surface stops the bones from rubbing directly against each other. This helps the joint to work smoothly.

The joint is surrounded by a capsule, and the space within the joint (joint cavity) contains synovial fluid. This fluid, which provides nutrients to the joint and cartilage, is produced by the synovial membrane (or synovium) which lines the joint cavity.

What goes wrong with joints varies from one kind of arthritis to another.

TYPES OF CONDITIONS

This selection gives you a brief outline of some more common kinds of arthritis which you may or may not suffer from or you may or may not know someone who is:

·         Osteoarthritis
·         Rheumatoid Arthritis
·         Secondary arthritis
·         Reactive arthritis
·         Anklosing spondylitis
·         Fibromyalgia (Arthritic related condition)
·         Gout
·         Polymyalgia rheumatica
·         Psoriatic arthritis
·         Systemic Lupus erythematosis
·         Arthritis in children (Juvenile arthritis)

We will go through the first three listed above as they are the most common that you as a person may suffer from or you as a Care Support Worker will observe from your Service Users or you as a relative who is caring for a loved one;

OSTEOARTHRITIS

Osteoarthritis is the most common form of arthritis; it usually develops gradually over time.  Several different joints can be affected, but osteoarthritis is most frequently seen in the hands, knees, hips, feet and spine.

Osteoarthritis cannot be cured, but the condition may settle down after a number of years and there is plenty you can do to relieve your symptoms.

What causes it?

There is no known cause for osteoarthritis, but it is more common among women. Osteoarthritis can develop at any age, although it occurs more frequently in older people.

Injury to a joint can also trigger osteoarthritis, even many years later.

What happens?

Osteoarthritis develops when changes in cartilage (soft tissue that protects the bone surface) occur that effect how joints work:

1.    Cartilage becomes pitted, rough and brittle
2.    Underlying bone thickens and broadens to reduce load on cartilage
3.    Bony outgrowths form at the edges of the joint, making it look knobbly
4.    Synovial membranes and joint capsule thicken, and space inside the joint narrows
5.    Stiff joint which is painful to move and sometimes inflamed

Sometimes part of the cartilage can break away from the bone leaving the bone ends exposed.  These may then rub against each other and the ligaments become strained and weakened.

This causes a lot of pain and changes the shape of the joint.

How will this affect you, your Service User or your relative?

Osteoarthritis is a condition that develops over time. Changes will be slow and subtle in some people, whereas in others, the pain and stiffness will gradually worsen until the disease finishes.

At this point, the joints will look rather knobbly, but are usually far less painful.

In some cases they become pain free. The person should be able to carry out most everyday tasks.

How is it treated?

There are a number of things a person can do to relieve the symptoms, and especially the pain.

The doctor will prescribe one (or more) of the following types of drugs:

·         Analgesics (painkillers) which relieve pain
·         Non-steroidal anti-inflammatory drugs (NSAIDs) which reduce inflammation and in turn pain
·         Steroids, which also reduce inflammation and can directly injected into a joint for fast relief
·         Surgery

The doctor may refer you to an orthopaedic surgeon if you have severe Osteoarthritis affecting weight-bearing joints, such as knees and hips.

If you do have your joints replaced they should give you no problems for 10-15 years or longer if they treat then carefully.

There is much that can be done to ease pain and keep as supple as possible, such as exercising and eating a healthy diet.

RHEUMATOID ARTHRITIS

Rheumatoid Arthritis is an inflammatory disease, mainly affecting joints and tendons.

An inflamed joint looks swollen and red, and appears warm to the touch. The disease usually starts in the wrists, hands or feet, and can spread to other joints and other parts of the body.

There is no cure for Rheumatoid Arthritis, but treatment to relieve the symptoms is effective.

What causes it?

It is not known why Rheumatoid Arthritis occurs. People of any age can develop it, but it is most common between the ages of 30 and 50 years, and among women. Certain genes may trigger the development of Rheumatoid Arthritis.

The inflammation affects:

·         the thin synovial membrane that lines the joint capsule
·         the tendon sheaths (tubes in which the tendons move)
·         the bursae (sacs of fluid that allow the muscles and tendons to move smoothly over each other)

The joints and inflamed tissues then become stiff, painful and swollen.

How will this affect you, your Service User or your relative?

Rheumatoid Arthritis affects everyone differently and is therefore, hard to diagnose. There may be times when the disease is active (a flare up) and other times when it is inactive.

However badly and however long individuals experience Rheumatoid Arthritis, there are some common difficulties during a flare up:

·         Pain and loss of strength and movement in inflamed joints
·         Feeling generally unwell and tired
·         Stiffness can be bad, especially first thing in the morning, or after sitting still for a long time

Although you, your Service User or your relative may feel frustrated at times, particular during a flare-up, people should be able to carry on as normal, with some adjustments to their lifestyle.

How is it treated?

The main aim of treatment is to reduce the inflammation. A rheumatologist will regularly monitor the effect of any medications on the body. There are different kinds of drugs that will be used to treat their disease.

·         Disease modifying anti-rheumatic drugs (DMARDs) are given soon after diagnosis to slow down the disease process
·         Non-steroidal anti-inflammatory drugs may be given alongside DMARD to tackle the inflammation and painkillers
·         Anti-TNFs and biologics also reduce severe inflammation

Joint replacement surgery will only be considered if the joint is very painful or if there is a risk that they will lose overall function.

What can you do to help yourself, your Service User or your relative?

There is plenty that can be done to manage arthritis. This will become easier over time as you, your Service User or your relative learn/s how to modify difficult tasks.

Special equipment such as splints and gadgets can make it easier to carry out simple everyday tasks.

A doctor can refer anyone to an Occupational Therapist who will advise on how to make efficient use of joints without causing further damage.

A physiotherapist can help to prepare and carry out exercises to keep muscles strong and retain a good range of movement in joints.

SECONDARY ARTHRITIS

Secondary arthritis can develop after an injury to a joint – sometimes many years later.

What can you, your Service User or your relative do?

Some of the following may help to relieve pain and keep mobility at its optimum:

·         Doing exercises to strengthen muscles will reduce pain and stress on joints – a physiotherapist can help with this, especially non-weight bearing exercises i.e. swimming

·         Massaging painful joints and muscles
·         Losing weight to reduce strain on weight bearing joints
·         Attending relaxation classes
·         Trying complementary therapies such as acupuncture and aromatherapy

CARING FOR SOMEONE WITH ARTHRITIS

You may not realise it, but if you are caring for someone with arthritis you are one of six million people in the UK who look after an ill disabled person.

 You may see this as a natural extension to your role, but have you ever stopped to consider the hugely valuable job you are doing – not just for the person you care for, but for our society too?

Role of the carer

What will your role be as a carer? If you are new to the role of a carer then it may seem a bit daunting but the main thing to remember is that you are providing a helping hand.

But you are also allowing the sufferer to retain their dignity and independence.

Someone with arthritis will require help but they will also want to do things for themselves so the idea is to understand where the line is between these two and not crossing it.

Even though it may be tempting on occasions to step in and take over, it is better than you avoid doing so. The sufferer will feel resentful of your taking control and not allowing them to undertake even the smallest of tasks. This is an important issue to remember, even if the sufferer takes what appears to be a long time with a simple task.

Plus the arthritis sufferer may be lacking in confidence and self-esteem so the last thing you want to do is to reduce that even further. Your role is to encourage them to do things for themselves which will act as a boost for their confidence.

Examples of tasks

Here is a list of tasks that you will be expected to help the arthritis sufferer with. You may have to help with some or even all of these tasks.

They include:

Personal or intimate care: washing, dressing, toileting etc
Everyday care: cooking, shopping, cleaning etc.
Admin: paying bills, dealing with correspondence, finances etc.
Medical care: help with taking medication, visiting their GP, specialist etc.
Aids: help with specialist equipment or adaptations, e.g. walking stick, wheelchair, tap levers, hand rails around the home.
Benefits: advice about social security benefits and other grants.
Friend: someone who is there as a sympathetic shoulder and to provide support and advice.

This also includes acting as a motivator in regard to taking exercise, eating healthily and discussing any negative issues/emotions with you.

 There will be many a time you feel tired, stressed and frustrated but try not to let this show. The sufferer will quickly sense if you are impatient or frustrated with them which will make them feel they are being a burden to you.

Caring not controlling

One thing unites this long list of roles; they are all about helping someone with arthritis to be as independent and in control of their own lives as possible.

As a carer you may well be over worked, tired and frustrated, and the temptation to take over and make decisions for the person with arthritis, rather than with them, this can be real and damaging one for them.

Emotional impact

What a person with arthritis might feel:

Caring for someone with a serious illness can be difficult enough, but imagine what it must feel like to be cared for. Self-esteem gradually eroded by always having to ask for what you need; being dependant on others for even personal things like washing and dressing; and having to constantly grateful, a service user’s self esteem may be eroded

All this and the pain and discomfort of the arthritis.

Practical support

As well as offering emotional support to the person you’re caring for, you need to consider the day-to-day practical support that could make a big difference to the service user.

Don’t think you have to do this alone – there is help and advice available.

Equipment

There is a huge range of equipment and adaptations that can help people with arthritis stay more independent, and make their life easier as a result:

·         Specially-designed equipment such as raised toilet seat
·         Standard items which are available everywhere but which take the effort out of everyday tasks – such as electric tin openers
·         Adapted equipment, such as rubber knob turners
·         Adapted environments – for example, electric sockets place at waist height

Physical tasks

If physical tasks such as lifting a person with arthritis you care for becomes a problem, you will need to seek advice to get a risk assessment done or ask an occupational therapist about a hoist, grab rails beside the bed and toilet and other aids such as a motorized bath seat

Balance of responsibilities

Caring for someone with arthritis is a delicate balance between attending to their needs whilst ensuring that they are able to retain a certain amount of independence.

The positives include knowing that you are making a difference to someone’s life. This also means helping someone to manage their condition and enabling them to lead as normal a life as possible.

But there are also a few negatives which include physical and mental stress, isolation and money worries.
How to help an arthritis sufferer

There are several ways you can approach this role but remember that at all times; the aim is to enable the person to remain as independent as possible.

There are four ways of doing this which include:

Understanding about arthritis
Two way communication
Helping with treatment
Support and advice
This means finding out as much as you can about arthritis so that you have an understanding of the effects of this condition on the person’s physical and mental wellbeing.

Understanding about arthritis

 Accept that the sufferer will have good and bad days. This is often due to ‘flare up’s: periods of intense activity when the arthritis symptoms are at their worst followed by remission (when the symptoms have died down).

The sufferer will become very tired, emotional and frustrated which they will express as a series of angry outbursts. This is often due to painful, stiff and swollen joints, and a lack of sleep. This is where sympathy and understanding are vitally important.

Two way communication

Talk to the person about their condition and any concerns they may have.

Encourage them to express their feelings rather than bottling these up.

Make an arrangement whereby you will offer help when they ask but will respect their right to say no to your offer of help. This will enable the person to maintain control and a sense of independence. It helps to establish early on in the relationship clear guidelines for when help is needed and when it is not.

The sufferer may find it easier to talk to someone who is ‘neutral’ rather than a close family member.
Helping with treatment

Be patient and sensitive to their needs. Someone with arthritis will take longer to perform tasks which include even the easiest of things. They may require help with personal or intimate care such as washing, dressing or using the bathroom.

Provide additional support with their treatment. The sufferer will have been given a diet and exercise plan so encourage them to stick to this. Exercise with them and suggest healthy meals which will stimulate their appetite.

Understand about the type of medication the person is taking. Learn all you can about the various arthritis drugs which includes the risks as well as the side effects.

Support and advice

Offer support and advice wherever necessary. Encourage the sufferer socialise with others and to undertake activities which they feel are beyond them. The aim is to boost the person’s confidence and show them that they are capable of more than they realise.

If the sufferer is worried about financial issues then discuss these with him/her. Mention about the various social security benefits which they may be entitled to. Also mention about car parking permits such as a disabled badge which will enable them get out and about.

Looking after yourself as a carer

It is important that you do not neglect your own needs whilst looking after someone else. This can be a stressful and demanding role which if you are not carefully, can affect your own health and general wellbeing.

It is rewarding role and one that many people get a huge amount of satisfaction from. But, you need to take time out for yourself on occasions.

There are networks that can help but don’t forget your family and friends. Do not cut yourself off from others but socialise with your friends and undertake some form of activity. Exercise can help or try a new hobby.

Accept that there will be times when you feel frustrated or tired. This is an entirely normal reaction and means that you are basically, human. Allow yourself to feel like this and try and do something to take your mind off this.

Go for a walk or a swim. Have a day out with your family or go to the cinema with friends.

You may find it helpful to talk to other carers. There are support groups which cater for this and enable you to share any concerns with others.

If money is an issue then you may be able to claim Carer’s Allowance. This is normally payable to a person who is looking after someone in receipt of Disability Living Allowance or Attendance Allowance. Speak to someone at your local benefits office or contact the DWP.

You may be able to obtain help with your caring role from your local social services department. They will carry out a carer’s assessment which will look at your role before deciding upon the amount of help you need.

You may also be able to get some respite care for yourself or your relative to ensure you are in optimum health to continue to care for your loved one.

To reiterate: aim for a balance between your role as a carer and the needs of you and your family. This is never an easy thing to do but it is important that you do so to avoid stress and burnout.

Arthritis Care

A support group for people with arthritis.

Telephone: 0121 475 2959 / 0121 382 6143

http://www.arthritiscare.org.uk/Home

National Rheumatoid Arthritis Society

The National Rheumatoid Arthritis Society provides support and information for people with rheumatoid arthritis and juvenile idiopathic arthritis, and their families, friends and carers.

National Rheumatoid Arthritis Society
Unit B4 Westacott Business Centre
Westacott Way
Littlewick Green
Maidenhead
Berkshire
SL6 3RT
Telephone: 0845 458 3969
Helpline: 0800 298 7650 (UK only)

http://www.nras.org.uk/

More information can be found on:

http://www.arthritisresearchuk.org/

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