Chapter 11: Osteoarthritis & Rheumatoid Arthritis

Chapter 11: Osteoarthritis & Rheumatoid Arthritis

Welcome to my 2nd educational post. Today we’ll tackle arthritis!

What is arthritis?

Arthritis means “joint inflammation” (Deshaies, 2018). There are two types of arthritis that I will review today: osteoarthritis (OA) and rheumatoid arthritis (RA).

What is osteoarthritis (OA)?

OA is a joint condition in which the cartilage between joints wears away, causing stiffness and pain (Deshaies, 2018). As the cartilage wears away, the bones within the joint begin to rub together.  This causes inflammation (swelling) and crepitus (noise of bones crunching or popping). Unlike rheumatoid arthritis (explained later), OA typically attacks individual joints such as a joint within the fingers (distal and proximal interphalangeal joints), knees, and hips.

What does OA “look like”?

OA presents with multiple symptoms including joint pain, stiffness, tenderness, limited range of motion (movement), inflammation, and crepitus (Deshaies, 2018). The symptoms typically present themselves after activity and will subside with rest or at night. An individual with OA may also experience morning stiffness or stiffness after prolonged sedentary activity (this is called “gelling”).

Nodules may also appear on either or both of the last two joints of the finger (distal interphalangeal (DIP) or proximal interphalangeal (PIP) joints). Nodules that appear at the DIP joint are called Herberden’s nodules. Nodules that appear at the PIP joint are called Bouchard’s nodules. A mnemonic to remember which is which is listed below:

HD = high definition = Herberden’s DIP

BP = blood pressure = Bouchard’s PIP

What is rheumatoid arthritis (RA)?

RA is a chronic, systemic inflammatory autoimmune condition (Deshaies, 2018). Let’s break that down. “Chronic” means long-term and “systemic” means within the whole body’s system; therefore, RA is a long-term whole-body inflammatory condition. Unlike OA, RA effects joints bilaterally (on both sides) rather than unilaterally (on one side). RA symptoms can occur acutely, chronically, or intermittently (with periods of exacerbations and remissions).

What does RA “look like”?

RA presents with the following symptoms, which are very similar to OA: inflammation, redness, prolonged morning stiffness (>1 hour), joint pain, generalized weakness, and/or low grade fever (Deshaies, 2018). Bouchard’s and Herberden’s nodules may also be present (do you remember which is which?!). Other deformities that may occur include ulnar drift (hand positioned more towards the pinky side of the hand), Boutenneire or Swan Neck deformity (google them!), and countless other wrist, elbow, and upper and lower body joint deformities.

How do OTs help individuals with OA & RA?*

Because there is no cure to either form of arthritis described here, treatment goals include relieving symptoms, improving function, limiting disability, and avoiding drug toxicity (via nonpharmacological treatments!).

OT treatment may include establishing a home exercise program to strengthen muscles in order to protect joints from further damage and to decrease stiffness. Low impact exercises are often recommended, such as walking, biking, or swimming.

Clients will also be educated regarding joint protection principles and ergonomics. This means that clients will be taught safer, more protective ways to prevent further damage to arthritic joints. Such principles may include avoiding positions of deformity. This could mean using adaptive devices to help open jars, lifting a coffee mug with two hands instead of one to decrease joint strain, and avoiding prolonged periods of the same joint position. Ergonomic recommendations could include the use of an adjustable desk to offer both sitting and standing options, keeping items close to the body when carrying heavy (or light) loads, or distributing a load across two joints instead of one. An example of this would be wearing a backpack instead of using a shoulder bag or purse to carry your items. Joint protection is key!

Clients will also be educated regarding adaptive equipment to promote joint protection. Adaptive devices may include electric can openers, utensils with built-up handles, dressing/bathing devices (refer to Chapter 10: Parkinson’s Disease for a list of such devices), doorknob levers, and/or extended key holders, among many other possible adaptive devices.

Education will continue with fatigue management/energy conservation strategies. These are best described using a checkbook analogy. Imagine all the energy you have reserved for one day as your entire checkbook. You must balance your checkbook in order to maintain the energy that you have earned through a full night’s slumber. To balance your checkbook, you may do some activities in the morning hours, followed by a period of rest, followed by a few more activities, followed by rest. You mustn’t expend all your energy in a small amount of time or your daily checkbook will quickly show zero. Energy conservation can be achieved by strategically scheduling your day to balance high exertion activities (i.e. cutting the grass or grocery shopping) with low exertion activities (i.e. reading the newspaper, managing your finances, or calling a friend). Alternating between high and low exertion activities is one way to balance your checkbook. Additionally, high exertion activities could be spread out over the course of a week, rather than a day. Perhaps Monday could become grass cutting day and Wednesday could be grocery shopping day. Energy conservation is important for individuals with OA/RA in order to prevent overstraining of joints or overexerting joints in awkward and/or strenuous positions. As mentioned previously, joint protection is key!

Depending on the severity of symptoms and related complications, orthoses may also be fabricated for individuals with OA/RA. Orthoses are “splints” made of hard material (kind of similar to the material you would see for a cast after a broken wrist) to protect joints, prevent further damage, and allow certain joints to rest. Entry-level OTs know how to make basic orthoses and, as long as materials are available, be able to make such orthoses for clients who might benefit from them.

There are countless other ways that OTs can help manage symptoms for OA/RA. This post provided a brief overview of what OA/RA is and how OTs help clients who have been diagnosed with arthritis. I hope you’ve been informed through this post and I hope to educate myself and you more in upcoming posts!

*Note: These examples of OT involvement are strictly my own. Information on this post was provided through the reference referred to below.

Reference: 

Deshaies, L. (2018). Arthritis. In H. Pendleton & W. Schultz-Krohn (Eds.), Pedretti’s occupational therapy practice skills for physical dysfunction (8th ed., pp. 945-971). St. Louis, MO: Elsevier.

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