Rheumatoid Arthritis


Home Page
Bathing & Grooming
Additional Energy Conservation Tips
Additional Joint Protection Tips
Assistive Devices
The Arthritis Foundation

[Introduction] [Effects of RA] [Treatment] [Energy Conservation] [Joint Protection] [Research]

[Assistive Devices] [Caution]



Rheumatoid Arthritis (RA) is a chronic disease that primarily attacks the joints and their surrounding tissues. In addition to these areas, RA also attacks major organs within the body including the heart, lungs, skin, and sensory systems. The onset of this disease is usually gradual and characterized by fatigue, morning stiffness, muscular aches, loss of appetite, and weakness. As the disease progresses, joint pain appears, with warmth, swelling, tenderness, and stiffness of the joint(s) after long periods of immobility (i.e., after sleeping). The joints typically affected by RA include those in the wrists, fingers, knees, feet, and ankles. The disease not only causes pain and inflammation within these joints, it causes joint destruction and deformities as well. If left untreated, this disease has the potential to affect almost all areas of bodily functioning, which could result in increasing levels of pain, fatigue, and disability with time (Frazier et al., 1996). It is estimated that 21 million Americans are affected with rheumatoid arthritis. Women are three times as likely to acquire it than men, and it typically begins to manifest itself in persons somewhere between 25-50 years of age (Arthritis Foundation, Center for Disease Control, 1999).

 (Picture taken from World Wide Web 7/16/01 at http://www.nih.gov/niams/healthinfo/rahandout)



Due to its attack on the immune system and the pain and fatigue that is experienced, rheumatoid arthritis can substantially limit the use of one's body. Aspects of personal care, work, leisure, home maintenance, and interpersonal relationships begin to suffer as it becomes harder and harder to participate in activities (Nordenskiold, 1994). There is currently no cure for RA, however there are many ways to help manage this disease and help to prevent its progression from occurring, or at least slow it down. In this web site, you will learn about different ways to take control of this disease by changing the way in which you complete daily activities (i.e. dressing, cooking, bathing, cleaning, and shopping).



According to Trombly (1997), fatigue and the improper use of the joints causes rheumatoid arthritis to worsen which can then cause pain, inflammation, weakness, and joint destruction. The field of occupational therapy is well known for its ability to help people with RA change the way they do their day-to-day activities in order to help prevent this pain and fatigue, and thus prevent further disease activity and joint destruction. More specifically, occupational therapists help people learn to manage their disease by teaching them simple ways to conserve their energy and protect their joints during daily activities (cooking, cleaning, shopping) in order to maximize their independence in these activities. This type of patient education is known as energy conservation and joint protection training.



Energy conservation training involves teaching people to use their energy wisely. This is important because muscle fatigue causes disease activity to increase. When the muscles become fatigued, they are unable to provide adequate support to the joints. This then puts additional strain on the joints, forcing them to work harder. When this happens, it can cause joint pain, inflammation, and destruction. Researchers have developed general energy conservation techniques that have been applied to specific activities so that they can be easily understood and utilized. Within this web site, you will find general energy conservation strategies that have been applied to the activities of dressing, bathing, cleaning, cooking, shopping, and other areas in order to help you better understand how you can prevent fatigue by changing the way you participate in these daily activities.



Joint protection involves a series of principles that help to reduce the amount of stress put on the joints. Because joint destruction is a defining feature of rheumatoid arthritis, it is essential that a person who suffers from this disease take extra care to prevent any additional, needless destruction of his or her joints. Following the principals of joint protection will help to reduce joint pain and destruction, protect the joints, and help one to stay as active as possible. As with energy conservation, general joint protection strategies have been developed by researchers and applied to specific everyday activities. Specific joint protection techniques that can be used while dressing, bathing, cooking, cleaning, shopping, and completing other activities can also be found within this web site to help you learn how to protect your joints during these essential daily activities.



Energy conservation and joint protection training has been extensively studied since it was first introduced to determine its effectiveness. Many studies such as the ones conducted by Gerber et al. (1987), Furst et al. (1987), Taal et al. (1993), Helewa et al. (1991), Nordenskiold (1994 & 1997), and Hammond (1998) have found that subjects reported feeling less pain and fatigue during their daily activities after they began to utilize energy conservation and joint protection techniques throughout their day. One of the studies mentioned above, conducted by Nordenskiold (1994), found that after a period of 7 years, people continued to experience a decrease in pain, and an increase in their ability to carry out all work, self-care, and leisure activities. Not only do these techniques help to improve the physical well being of persons who suffer from RA, but they also help to improve their psychological well being. As one's ability to participate in daily activities decreases, feelings of anxiety and depression typically result. The unpredictable course of this disorder only increases these feelings as people begin to feel that they do not have control over their own bodies. These feelings can then cause the perception of pain to increase, and efforts to engage in daily activities to decrease, resulting in a further deterioration of one's health status (Taal, Riemsma, et al., 1993). Providing those who suffer from RA with information regarding ways manage their own arthritis, and prevent or delay its progression, provides people with a sense of control over their body and therefore helps to alleviate feelings of anxiety and depression.



The last idea that will be illustrated in this web site is assistive devices. Assistive devices include anything that makes the performance of tasks and activities easier to accomplish. The use of assistive devices is a normal, everyday occurrence in the lives of most individuals. For example, forks are used to help people eat, washcloths are used to assist in bathing, and dishwashers are used to help wash dishes. Assistive devices help those with RA conserve their energy and protect their joints by helping people to complete an activity (i.e., a manual can opener), or by doing it for them (i.e., a dishwasher). An extensive study was conducted by Nordenskiold et al., (1998) to determine which types of assistive devices were most useful to persons with RA. These devices, as well as those recommended by the Arthritis foundation and other sources, are also presented within this web site.



Because this web site is intended to provide advice regarding energy conservation and joint protection to anyone who uses the Internet, the techniques described within this site can only serve as an introduction to this area of treatment. For obvious reasons, the designer of this site was unable to interview everyone who will use it and specify it to their specific needs. The activities of dressing, bathing, cleaning, cooking and shopping were chosen because they are activities that almost everyone carries out on a daily basis. Other techniques which do not relate to these activities have also been described within the site to make it more useful. However, there are many more energy conservation and joint protections tips that can be provided to meet your specific needs, and there are also many additional assistive devices that can be used as well. For example, for those who like to golf, there are many energy conservation tips that can be utilized during the game that just could not be described within this site because it is intended for such a large audience. Therefore, please consult your physician or a local occupational therapist to be provided with individualized advice regarding energy conservation, joint protection, and assistive devices that can specifically meet the needs of your lifestyle, job, and/or desired leisure activities. Remember that utilizing these techniques will not cure your disease, but rather allow you to take control of its progression so that you can stay independently active in your life for as long as possible!

**The techniques and devices mentioned are generally acceptable for the population at large. However, for some individuals, in some circumstances, these techniques and devices may not be appropriate. Therefore, this article is not intended to replace or compensate for the advice of a physician. Please contact your physician, or a local occupational therapist before using these techniques or devices to make sure that they are appropriate for you.**

[References] [Return to top of page]

Created 1/02 by Megan Belton©

Occupational Therapy student

D'Youville College