Rheumatoid Arthritis and the Effect

Rheumatoid Arthritis and the Effect on Daily Living Introduction to Rheumatoid Arthritis According to the University of Virginia Health System, rheumatoid arthritis is "a chronic disease that causes inflammation of the joints." (nd) Inflammation can be of the severity that it affects the function of the hands as well as other body parts. In the hand specifically, "rheumatoid arthritis may cause deformities in the joints of the fingers, making it difficult to move the fingers.

Lumps, known as rheumatoid nodules, may form over small joints in the hands and the wrists." (University of Virginia Health System, nd) the precise cause of rheumatoid arthritis is not known but it is know that rheumatoid arthritis is an "autoimmune disorder, which means that the body's immune system attacks its own healthy cells and tissues." (University of Virginia Health System, nd) Inflammation is the body's response and because this inflammation occurs in and around the joints, this "may lead to a destruction of the skeletal system." (University of Virginia Health System, nd) Other organs such as the heart and lungs may also be affected by rheumatoid arthritis.

Of those who have rheumatoid arthritis, seventy-percent are women. Rheumatoid arthritis most commonly affects the hands, wrists, feet, ankles, knees, shoulders and elbows. Symptoms of rheumatoid arthritis include: (1) pain; (2) stiffness; (3) swelling over the joints; (4) decreased movement; (5) pain that is worse with movement of the joints; (6) bumps noted over the small joints; (7) difficulty in performing activities of daily living (ADL); and (8) a decrease in the ability to grasp or pinch.

(University of Virginia Health System, nd) the individual who has four or more of the following is likely to be diagnosed with rheumatoid arthritis: (1) morning stiffness that last longer than one hour for at least six weeks; (2) three or more joints that are inflamed for at least six weeks; (3) presence of arthritis in hand, wrist or finger joints for at least six weeks; (4) blood test that reveal rheumatoid factors; or (4) x-rays that show characteristic changes in the joints. (University of Virginia Health System, nd) II.

Importance of Exercise for Individuals with Rheumatoid Arthritis The importance of exercise for the individual with rheumatoid arthritis cannot be stressed enough.

According to the University of Illinois of Chicago Department of Disability and Human Development "although people with RA may be hesitant to exercise due to the pain they experience with their joints, current evidence suggests that a significant amount of the disability related to the condition occurs from a lack of fitness." (2007) the work of Nieman (2000) relates that the individual's hesitation to exercise due to pain results in inactivity and this results in "deteriorated Muscle strength and diminished endurance, weakens joints, and contributes to a cycle that accelerate the negative effects of arthritis." (Nieman, 2000; as cited in NCPAD, 2007) This view is supported as well in the work of Van den Ende et al.

(1996) who stated that due to pain in the joints the individual is hesitant to exercise. The work of Hakkinen et al. (1999) states implications that "lack of physical activity and decreased bone loading have a harmful effect on bone structure in those with RA." (as cited in NCPAD, 2007) III. RA & ADL The work of Sadamoto, Ogawa, Ogura and Saito (2006) entitled: Impact of Mood on the Course of Disease Activity in Patients with Rheumatoid Arthritis" reports a study of the influence of mood on the course of disease activity in RA.

The study was conducted with 101 patient participants with RA by means of a questionnaire containing 43 items concerning activities of daily living (ADL) as well as pain scores, socio-economic status, working status, and future prospects. Patients moods were analyzed using the Lorish face scale (FS). Results of the study state that there was found to be a: "…strong correlation between the FS scores and disease activity. Namely, patients with worse FS scores tended to manifest a higher disease activity than those with better FS scores.

Patients with better mood "showed lower disease activity after one year of observation as compared with those with worse mood. As well as several reports relating diseases and mood, mental status has also been reported to affect immuno-regulatory systems. Chronic depression or chronic stress conditions lead to immuno-suppressive status and imbalance in corticotrophin-releasing hormone, which induces cancer and hyperthyroidism.

It has been reported that depressive states induce suppression of mitogenic reaction in lymphocytes, decreases the number and activity of natural killer cells and decreases the production of interferon." Sadamoto, Ogawa, Ogura and Saito, 2006) the work of Gray (nd) entitled: "What Feature of Rheumatoid Arthritis are Hard to Cope with Psychologically and What Strategies Might be Helpful in Coping?" identifies the features of RA which are hard to psychologically cope with and explores the relationships between those features and negative psychological outcomes.

The following figure shows the percentages of the disease symptoms and how the ability of those with RA are affected in coping. Figure 1 How Severely Individuals with RA are Affected Source: Gray (nd) Gray states that: "...regardless of the degree of severity, different patients will be more or less disabled by their disease depending on their expectations and tasks they wish to partake in.

Any small change in the hand or wrist could be catastrophic for a pianist for example, but may not bother someone else who does not require the same levels of precision in hand movements." (nd) Therefore, it is critical when considering the psychological coping of the different variations of the severity of RA that one be "clear about difference between restriction, resulting disability and consequent handicap." (Gray, nd) Dickens et al.

(2002) conducted a meta-analysis, which shows that in 13%-19%Q of RA depression is existent, which is approximately three times the normal population range. ADL in RA is affected by joint pain (Heiburg and Kvein, 2002) the study of Minnock et al. (2003) conducted a survey of a group of women with RA using the Arthritis Impact Measurement Scales 2 (AIMS2) and state findings that the primary factor associated with a reduction in ADL was pain.

Functional impairment is also a result of RA and Heiburg and Kvein state findings that 45% of the participants state that hand and finger functioning was most affected in their ADL while 33% state that walking and bending was the most affected ADL. Crosby (1991) reports that 80% of RA patients report fatigue as the primary affect on.