Rheumatoid Arthritis #4: Rehab & Assistive Devices

Doctor's Insight.

Rheumatoid arthritis is a condition that causes morning-hand stiffness or pain in the finger joints that make it difficult to grasp things.

Normally, your immune system works to protect your body.

Rheumatoid arthritis, or RA, is a disease in which your immune system mistakenly attacks healthy cells in your body.

When RA is left untreated, the disease progresses and further destroys bones and cartilage, causing joint deformities.

It is said that 1 in every 100 people in Europe and the United States suffers from rheumatoid arthritis, and the number continues to increase each year.

In Japan, the patient's onset age peaks in the 40s, and 80% of patients are women.

Moreover, the cause of the disease is not clearly known, and anyone can be affected by RA.

In the previous episodes on rheumatoid arthritis, we focused on 2 treatment methods; drugs and surgery.

And today, we'll take a look at measures patients can take to help control the disease.

It is said that joint pain can sometimes be reduced through rehabilitation, and motions that relieve the strain on the joints.

Now, what are some examples of the things we can do in our daily lives?

Today's expert is Professor Kaneko Yuko from Keio University.

Her motto is to provide treatments that suit the patient's lifestyles.

Dr. Kaneko, thank you for joining us again today.

It's great to be back.

Today, we're going to look at measures we can take to help us live with rheumatoid arthritis.

I understand, RA is a disease we have to live with for a long time.

Yes.

Although remarkable progress has been made in the treatment of rheumatoid arthritis, currently there is still no cure, so the disease will stay with you for the rest of your life.

In order to control the progression of the disease and improve the symptoms, it's important to stay cautious and find ways to deal with the disease in your daily life.

What if the patient is in remission, and the disease does not interfere with their daily life?

Even if the disease is in remission, it is necessary to see the doctor regularly for optimal treatment, and ideally, to incorporate rehabilitation and other activities that you can do in your daily life.

What exactly should people do for rehab?

If you don't use your joints, they lose their flexibility, and it becomes more difficult to move, which creates a vicious cycle of pain.

So, it's important to stretch all your joints.

With RA, there are joints which tend to be involved.

Looking at this figure, we can see that it occurs in the wrists, the second finger joints and the base of the fingers, the hips and the knees.

These areas should be kept flexible, without overdoing it.

Here are some examples of stretches.

Let's try an elbow stretch.

Bend your elbows and touch your shoulders with your hands.

Now slowly bring your hands away.

This is also effective for stretching your wrists and elbows.

Next is a knee stretch.

From a seated position, slowly bring one foot up and hold for 5 seconds.

This will increase the flexibility in your knee and help maintain your muscles.

Repeat with the other foot.

They both look pretty easy.

Yes.

What's important is to continue doing it.

You should bend and stretch all the joints sufficiently once a day.

Are there any other exercises that you recommend?

It's also important to build muscle.

This is because joints are supported by the muscles.

If the muscles lose their strength, this can cause pain.

For instance, even after undergoing major surgery, such as the knee joint, gait training should be performed as soon as possible.

Is there any special type of resistance training exercise you recommend?

Walking or doing household chores are not special exercises, but they are excellent full-body workouts.

Also, walking in the water is a recommended exercise, because buoyancy reduces the pressure on the joints, making it an efficient way to work out without overload.

Right. Those all sound great.

Now, is there anything we should watch out for in our daily life?

Overload of the joints is a factor that accelerates deformity in the joints.

But it's not a good idea not to move your body at all.

You may be unaware of the load you put on your joints with your daily posture, and simple movements, so you can reduce the load by reexamining them.

In particular, it is important to reduce the burden on small joints such as the fingers and wrist joints, because they are prone to deformity and tendon damage.

Now, here are some ways to relieve the stress on your joints.

For instance, using a smartphone or a cell phone.

Instead of using only one hand, hold the device with both hands to reduce the strain on your wrist joints.

During this time, it's also important to use the table to support both arms.

When you stand up from a chair, don't just use the palms.

Use the palms of your hands and your entire forearms to support the weight of your body.

This will prevent the pressure from being placed only on your wrist joints.

When carrying a heavy bag, don't choose a single shoulder handbag.

Use a double shoulder backpack instead.

Now, let's take a look at some assistive devices.

Self-help or assistive devices are tools used to help people who are unable to perform certain movements.

Grasping things or twisting the wrist are movements that are especially challenging for RA patients.

Jar or bottle openers make it easier.

When you place the device onto a cap and turn, you can unscrew them with little effort.

Another device is the knob turner.

When you attach the long lever onto a knob, you can open the door without turning your wrist.

This nail clipper has a rotating blade that allows you to clip your nails without twisting your wrist.

Here is a mounted nail clipper.

You can use the palm of your hand to press down.

There is a variety of other self-help devices available.

Please try using them to help make your tasks easier on your joints.

I see.

Is there anything else people with RA can do?

Yes.

Anti-rheumatic drugs or biologics help control the progression of the disease by suppressing the immune system.

So, patients receiving these treatments are more susceptible to infections.

They should make daily efforts to help prevent infectious diseases.

Gargling, washing hands, wearing masks, getting vaccinated, and managing your health are all important.

I see.

So, am I correct to say that anti-rheumatic drugs and biologics are both commonly used in the treatment of rheumatoid arthritis?

That's correct.

So we can say that all patients need to be careful about infections.

Let's take for example, herpes zoster.

It has been reported that the risk for herpes zoster in patients with rheumatoid arthritis is two to six times higher than healthy people.

That's quite a bit.

We really want to be careful.

You mentioned that it's important to manage our health.

What exactly do you mean by that?

The basics of managing our health are: a healthy diet, moderate exercise, and adequate sleep.

It is also important to keep your body in good state of health by resting and quitting smoking if you smoke.

Smoking is said to be a cause of worsening rheumatoid arthritis or decreasing the efficacy of anti-rheumatic drugs.

Another tip is to maintain a healthy weight.

I see that there are many things we can do on our own.

Now, before we wrap up, please share your final thoughts on today's topic.

Symptoms of rheumatoid arthritis, such as pain and fatigue, are difficult for others to understand, so patients with rheumatoid arthritis tend to keep to themselves and not ask for help.

With various advances, therapeutic drugs, surgeries and self-help devices are available.

If you are having difficulties, consult your doctor to help make living with rheumatoid arthritis easier.

Although rheumatoid arthritis is a disease that we have to live with for a life time, it's encouraging you to know that there are so many options and many things that we can do.

Dr. Kaneko, thank you so much for being on our show today.

Thank you for having me.