Acknowledgements Arthritis SA would like to acknowledge the booklets and fact sheets published by Arthritis Australia as the source material for this screen cast and the work of Ben Corso from the Physio clinic for his work on OA hip and knee.
Common forms of Arthritis The impact on walking .
Arthritis In Australia
What is Arthritis ? Arthritis is a name for a group of conditions affecting the joints. These conditions can cause damage to the joints. Arthritis can affect any joint in the body. Each joint may be affected differently.
Over 120 Different Types
Arthritis in Australia Rheumatoid Osteoarthritis Gout Arthritis 2.1 million 192,000 407,900 Source :AIHW 2016
Common Elements • No Cure Chronic life long conditions • Variable symptoms Variable =Good days and bad days • Pain and stiffness e.g. after sitting for long periods • May affect other body systems e.g. heart , lungs, eyes
Common Principles for all people with Arthritis Movement is good Studies have shown similar benefits for pain and arthritis irrespective of type – strength, aerobic, tai chi, aquatic, home ex Exercise can be as effective as drugs for both pain and function Zhang et al 2010, Henriksen et al 2016 Exercise is effective whether done as an individually delivered treatment or in a small group
Common Principles for All Attitude matters ‘ Believing that exercise is achievable, safe, and likely to benefit health-related outcomes is motivational for older people
Osteoarthritis Contributing Factors High Body Mass index High-level, high-impact sport or occupations Repetitive occupational factors Being female Congenital joint abnormalities Ethnicity
Joint Anatomy
Joint Anatomy
What does that mean in everyday life? Common symptoms: • Pain • Grinding or cracking noises • Stiffness in the morning or after inactivity • Weakness • Loss of full movement in the joint e.g. can’t fully bend toes ,ankles Common complaints: • Difficulty standing/walking long periods • Difficulty up and down stairs • Trouble getting in/out of car • Sitting in low chairs and getting up • Difficulty with fine motor skills in every day activities ( i.e. opening jars) • Problems cutting food
What management strategies are recommended? Manage pain Pacing and Healthy joint lifestyle protection Healthy attitude
Pain can be a negative cycle
Positive ways out of the pain cycle
Practical issues-OA Pain : can increase pressures through the arthritic joint x3 body weight goes through knees when walking on level ground x4 body weight goes through knees with stair walking/ up hills More force goes through the knee cap when walking DOWN stairs/slopes D’ Lima et al 2012 Consider your route and any slopes involved Encourage individuals to seek appropriate medical or allied health support if pain persists
Practical issues-OA Time off : After an arthritis flare, or surgery there is often loss of muscle bulk and strength Muscles act as natural cushioning and shock absorption Without them , more force goes through the joint Without them pain is often worse and abilities are reduced Consider if individuals have missed sessions if they need a shorter easier walk to get back into the habit. Encourage individuals to seek appropriate medical or allied health support . A pre-walk stretching program or graded return to exercise program may help.
Practical issues-OA Overdoing it : Pacing means taking a break BEFORE you need it for the person and the tissues of their joint to recover In a group, individuals may find it hard to self pace Over time the capacity of individuals may change Take the lead, let people know its ok to rest. Plan routes with seats and benches or looped routes.
Rheumatoid Arthritis Autoimmune condition that affects joint linings, causing painful swelling. Symptoms vary between individuals. Problems can include: • Inflammation • Pain • Swelling of joint/s • Bone erosion & joint deformity if the disease is uncontrolled • Can affect organs e.g. heart ,lungs ,eyes • Changes soft tissue around joints • Can cause ongoing fatigue
What does that mean in everyday life? Common symptoms: • Pain • Hot feeling in joints • Stiffness much worse in the morning • Loss of joint movement • Loss of strength in joints Common complaints: • Deformity of joints ( more common in the past) • Low energy levels ( fatigue) • Inflamed tendons • Other organ issues ( heart, lungs, eyes) • Difficulty early in the day
What interventions are recommended? Medication Flares & Manage triggers pain Healthy Healthy attitude lifestyle
Practical issues-RA Fatigue : Can be both mental and physical and affect ability to perform ALL daily tasks i.e showering, dressing, socialising May still impact even if the disease is well controlled with medications or in in remission. Accept abilities can vary Understand attendance may be erratic Build in short and long route options to your session to maximize opportunities for participation
Practical issues-RA Flare ups : auto immune conditions are naturally variable that may be precipitated by a certain event or come out of no where. Learning how to manage flare ups is a skill both physically and emotionally. Set up contingency plans! Encourage people to tell you if they have had a flare so you can adjust as needed Learn how to look for patterns related to flare ups
Practical issues-RA Sensitivity : many auto immune conditions affect ability of individual to deal with changes in temperature/climate Sensitivity to sunlight may be related to the disease and the medication used to treat it. Blood vessels can be affected creating cold sensitivity Basic sun and skin care vital Check people are well prepared in cold conditions Consider your hot and cold weather policy as it relates to some individuals Think about shaded and sheltered walks and rest spots
GOUT Gout is a common and painful condition that affects the joints. Small crystals form in and around the joint, causing inflammation, pain and swelling. These crystals are made of one of the body's normal waste products, uric acid
Practical issues-Gout Footwear : whilst it may affect any joint it commonly affects the toes/feet. A Podiatrist should be seen as a core member of the health care team and can assist with selecting shoes, orthotics, foot care and exercises Advise individuals about suitable footwear before they start Check your route with footwear in mind Consider how the weather may change the route
Arthritis What else should I consider? For many, arthritis is an invisible illness Affects of medications Falls risk Impact on daily Life
Arthritis What else should I consider? Individuals with inflammatory arthritis are at risk of bone loss due to the disease and to the use of medications such as steroids taken to treat the disease.
What else should I consider? Falls Falls : any arthritic condition can reduce the signals sent from the joints to the brain, reducing reaction time and increasing the likelihood of a fall. Falls can have serious consequences particularly for those also living with osteoporosis/ osteopenia. Falls should always be noted even if there is no immediate injury. Individuals should always be encouraged to tell their GP of falls and seek advice . There are many programs to improve balance and help people at risk of falls.
What else should I consider? Managing Arthritis in Daily Life Changing or modifying the following can help people participate: • the environment • the way activities are performed • habits • peoples expectations • individual expectations Remember Keep Moving !
Sources of Support Empowered www.empowered.org.au Psoriatic Arthritis ,Rheumatoid Arthritis and Ankylosing Spondylitis My Joint Pain www.myjointpain.org.au Osteoarthritis Comfy Feet Go a Long Way http://www.sahealth.sa.gov.au Falls Prevention Factsheets SA Health
Questions Do you have a question that was not answered on this screen cast? Did the presentation raise a new question? Arthritis SA will be available to discuss these at the interactive conference call on Wed 8 th March
To contact Arthritis SA 08 8379 5711 1800 011 041 info@arthritissa.org.au www.arthritissa.org.au
Thank you ASA
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