Crawford Care Management


Twenty million Americans suffer from arthritis and that number is expected to double by the year 2040. Arthritis is an inflammatory disease that causes pain, stiffness, and swelling in the joints. And while arthritis is one of the most common causes of disability in persons over 75, total disability is not an inevitable result of the condition. There are ways to minimize the disabilities associated with arthritis so individuals who have the condition can grow older gracefully.

The Facts
The most common form of arthritis is osteoarthritis (OA), also known as degenerative joint disease. OA affects about 28 million Americans, 80 percent of whom are women. The disease is most prevalent in people 55 and over. In OA, the cartilage cushion in the joints breaks down, causing bones to rub together. Pain, stiffness, and sometimes the formation of bone growths, called spurs, result. OA can affect any joint, but it is most common in the hands, feet, spine, and in large, weight-bearing joints such as the hips and knees. Although OA is often attributed to general wear and tear associated with aging, it can also be caused by a number of other problems, including obesity, injury, and repeated joint stress. Many researchers believe that OA is in part hereditary and may be due to genetic abnormalities in the cells that produce cartilage.

Rheumatoid arthritis (RA) is an autoimmune disease resulting in a chronic inflammation of the membranes around peripheral joints. Often regarded as the most serious, painful, and disabling of all forms of arthritis, RA affects more than 2.1 million Americans, usually between the ages of 20 and 40, and is three times more likely to affect women than men. RA occurs most often in the same joints on both sides of the body, such as the hands, wrists, elbows, shoulders, knees, ankles, and feet. The immune system attacks the joint's lubricating tissue. The resulting inflammation can lead to widespread and severe joint damage, which may eventually restrict a patient's mobility. In severe cases, the bone itself erodes and joints may dislocate, causing the joint to freeze in one position.

Treatment Strategies
There is no known cure for most forms of arthritis and related conditions. The primary goal of treatment is to reduce joint pain and inflammation and to maximize joint mobility. Low impact, regular exercise is very important in maintaining muscle strength and joint mobility. Swimming is a wonderful activity that promotes muscle strength with minimal joint strain. Physical therapy programs, stretching, and hot showers before exercise and applying ice packs to muscles and joints after exercise minimize discomfort related to exercise. Rest is another crucial element of arthritis treatment - doctors recommend eight hours of sleep a night. Patients may also need to use a cane, splint, sling, or special footwear to rest or stabilize affected joints periodically during the day.

Pain Management
Pain management is critical in helping sufferers maintain quality of life. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as aspirin, naproxen, ibuprofen, and celecoxib are first-line drugs that can decrease pain and inflammation in swollen joints. Next are steroids, administered in low doses, taken by mouth or injected directly into affected joints for more difficult cases. For more severe types of inflammatory arthritis, doctors may prescribe more powerful disease-modifying anti-rheumatic drugs (DMARDs), such as hydroxychloroquine, sulfaslazine, ethotrexate, leflunomide, and etanercept in an attempt to prevent joint destruction and damage. Remember, almost all drugs used to treat arthritis can have side effects and may not work for all patients. Finally, behavior management techniques and even surgery are attempted when other forms of pain relief have failed.

Self-Management Strategies
While doctors and other health professionals play a key role in helping arthritis sufferers manage their conditions, self-management strategies are invaluable in maintaining optimal function.

Here are some self-management tips to help improve arthritis-sufferers' quality of life:

  • Lose weight if necessary - loss of body fat leads to an improvement in the symptoms of arthritis. Always start a weight loss program under the guidance of a physician.
  • Eat well - balanced meals, including foods rich in calcium, will help build a strong body. Be sure to:
    • Include vegetables, fruits, and grains in your diet
    • Control fat and cholesterol intake
    • Eat only moderate amounts of sugar
    • Maintain a healthy weight
    • Limit your sodium intake
    • Drink alcohol only in moderation
    • Take the recommended daily requirements of vitamins and minerals, including calcium
  • Get moving - find an activity you enjoy- swimming, hiking, stretching, or walking the dog. Exercise builds muscles, strengthens one's heart, improves balance, and increases lung capacity. Group exercise programs can provide needed support and motivation.
  • Good footwear can mean the difference between a comfortable and an uncomfortable exercise period. Spend a little extra, if necessary, on shoes that fit well and cushion your stride.
  • Assistive devices - don't hesitate to use a cane, walker, or crutches to stabilize and aid your movement. Supports such as these may also increase your confidence and help you keep limber and moving.
  • Relieve stress and pain - take steps to alleviate stress and pain through warm baths, massages, and relaxing vacations.
  • Doctor visits - participate in regular exams, review all medications you are taking, and report any joint pain.

Caregiver Strategies
Arthritis sufferers may appear to be perfectly healthy, however the pain, swelling, and fatigue they experience can be incapacitating. And pain affects everyone differently. Depression is common among those who suffer a chronic illness. Some of us manage to keep our positive attitude active at all times but, in other cases, depression and anxiety, which often accompany persistent pain, must be addressed along with the disease.

What can you, the caregiver, do? First, you can help by optimizing patient-physician interaction. Help the person you are caring for document information the doctor may be able to use in diagnosis and treatment of the disease.

  • Document all medications, over the counter drugs, supplements, or herbal remedies in use. Drug use, misuse and/or adverse interactions can result in hospitalizations that are totally avoidable.
  • Document current symptoms and previous medical history.
  • Record as much detail as possible about the pain that is being experienced.
  • Note how the severity of the pain is rated on a scale from one to ten - ask for a description of the character of the pain e.g., piercing, burning, or aching sensation.
  • Describe the location, frequency, and duration of the pain.

How else can you help?

  • Exercise can help reduce arthritis pain. Be an exercise partner. It will support the person you are caring for and it will help you stay in shape too.
  • Learn about the disease to appreciate what your loved one is going through and to make sure that you are doing all you can to provide relief. Don't be afraid to ask your physician questions. Note times when pain and inflammation increase and try to identify possible causes (unusual activity that day, forgot to take medication, overexertion, etc.)
  • Help your loved one make everyday tasks a little easier to accomplish. Help reorganize the kitchen, storing away things that are no longer used. Keep appliances that are used often right out on the counter top. Try an electric can opener, or kitchen shears instead of knives. Change doorknobs and water faucets to the levered type for easier operation. Buy food that is already chopped and frozen to alleviate the need for extended preparation. Buy toothpaste and soaps that are dispensed from a pump and are easier to use.
  • Help change negative thinking when it's present. It's easy for someone in pain to let negative thinking turn into anger, frustration, fear, or feelings of hopelessness. The negative thinking may cause the sufferer to avoid activities which can result in increased pain. Be a good sounding board and help change negative thinking into positive thinking.
  • Schedule relief - for yourself. Caregiving duties can be demanding. Keep a list of friends who can help with transportation or otherwise provide some relief. Don't neglect your own personal health and well-being.