rheumatoid arthritis management program · rheumatoid arthritis (ra) is an autoimmune disease.the...

Rheumatoid ArthritisManagement Program

Rheumatoid Arthritis Management Program •

Rheumatoid arthritis is a form of arthritis that primarily affects the joints,but can also affect other parts of the body. Rheumatoid arthritis cansignificantly impact work, family and social life, and activities of dailyliving.

Is there anything you can do?

Yes! You can manage rheumatoid arthritis and itsimpact!

The Rheumatoid Arthritis Management Program will give you information andtools, such as a pain diary, to help you manage rheumatoid arthritis more effectively.This resource guide will help you get started. The guide is organized into units to helpyou find the information you need quickly. Other resources are listed in the units tohelp you find even more information when you are ready.

Here is an overview of the guide:

Unit 1: Understanding Rheumatoid ArthritisLearn the symptoms of rheumatoid arthritis and how it is diagnosed.

Unit 2: Treating Rheumatoid ArthritisLearn about self-care measures, and medical and surgical treatments.

Unit 3: Medicines for Rheumatoid ArthritisLearn about medicines commonly used in treating rheumatoid arthritis, and how you can use your medicines moresafely.

Unit 4: Pain ManagementLearn about managing rheumatoid arthritis pain and identify the key elements of a pain diary.

Unit 5: Living with Rheumatoid ArthritisLearn about healthy habits that can help you manage rheumatoid arthritis and improve quality of life.

Unit 6: Your Healthcare TeamLearn about your role on your healthcare team, identify other team members and learn tips for getting the most fromyour medical appointments.

Welcome to the Rheumatoid Arthritis Management Program!


Understanding Rheumatoid ArthritisRheumatoid arthritis (RA) is an autoimmune disease. The body’simmune system normally protects the body, but in autoimmunediseases, the immune system attacks the body.

RA is also known as a systemic disease. This is because the diseasecan cause problems throughout the body, although the primary target isthe body’s joints.

What are joints?Joints provide flexibility and stability for the body. They also providesupport and protection.

A tough membrane sac called the joint capsule holds the bones and otherparts together in the joint. The joint capsule is lined with a thin membranecalled the synovium (sin-O-vee-um). The synovium produces a fluid calledsynovial fluid, which lubricates the joint and provides nutrients and oxygento the cartilage. Cartilage is a hard, slippery coating on the end of eachbone. Cartilage is composed of substances that absorb pressure thatoccurs between bones during movement.

What happens in rheumatoid arthritis?The immune system protects the body from invaders, such as bacteriaand viruses that can cause infection and disease. The immune systemidentifies these invaders by detecting certain chemicals that are part of theinvader. Sometimes the immune system mistakes a part of the body as aninvader and begins to attack it. With rheumatoid arthritis, the immunesystem attacks the joint tissues. Other parts of the body can also beaffected.

White blood cells are an important part of the immune system. In RA,these cells cause the synovial membrane in a joint to become inflamed.This causes the membrane to thicken, which makes the joint swell andfeel puffy to the touch.

As RA progresses, the cartilage and bone in the joint are damaged.Muscles, tendons and ligaments around the joint are eventually affected.This causes additional problems with the joint’s ability to function normally.It is important to begin treatment for RA as early as possible becausedamage to the bone can begin within the first two years of the disease.

The course of the disease varies for different people. Some people with RA have periods of worsening symptoms (flares)followed by periods in which they feel better (remissions). Others experience symptoms most of the time.

The exact cause of RA is unknown. Scientists are currently studying the possible roles of certain genes, viruses andother environmental factors and hormonal factors. It is probable that rheumatoid arthritis occurs due to an interaction ofseveral factors.

Unit 1: Learning Goals

• Understand how rheumatoidarthritis affects the joints

• Identify symptoms of rheumatoidarthritis

• Understand how rheumatoidarthritis is diagnosed

• Identify resources for additionalinformation about rheumatoidarthritis


Who gets rheumatoid arthritis?Rheumatoid arthritis affects women two to three times more often thanmen. The disease can occur at any age, from very young to very old, butmost commonly begins between the ages of 20 and 50. People of allracial and ethnic groups develop RA.

What are the symptoms of rheumatoid arthritis?The most common symptom of rheumatoid arthritis is tender, warm, swollen joints. The wrist and finger joints closest tothe hand are affected most often. Other joints may be affected in some people. Joints are affected symmetrically, whichmeans the same joint is affected on both sides of the body.

Other symptoms of RA include the following:

• Pain and stiffness lasting more than 30 minutes after awakening in the morning or after a long rest• A general sense of not feeling well, with occasional fevers• Fatigue

How is rheumatoid arthritis diagnosed?No single test will diagnose rheumatoid arthritis. Instead, diagnosis is based on the history of symptoms, a medicalexamination, and laboratory tests.

During the physical exam, the doctor will check the bothersome joints and test muscle strength and reflexes. The doctorwill want to know the degree to which the symptoms affect daily life.

The most common laboratory test performed when RA is suspected checks for rheumatoid factor. Rheumatoid factor is aspecial protein in the blood of many people with RA. Unfortunately, this test is not conclusive for the disease because noteveryone with RA has rheumatoid factor, and people with diseases other than RA can have rheumatoid factor.

Other blood tests are used to check for inflammation. These include a white blood cell count, an erythrocyte (e-REE-thro-site) sedimentation rate (often called a sed rate) and a C-reactive protein test. A blood test for anemia is often performedas well. Anemia is a condition in which production of red blood cells decreases.

X-rays are not useful in the earliest stages of the disease because bone damage is not evident. However, X-rays can beused to monitor the progression of rheumatoid arthritis through the years.

How can I learn more about rheumatoid arthritis?The resources below will help you learn more about rheumatoid arthritis:

• National Institute of Arthritis and Musculoskeletal and Skin Diseases: http://www.niams.nih.gov/index.htm• U.S. National Library of Medicine: http://www.nlm.nih.gov/medlineplus/rheumatoidarthritis.html• Arthritis Foundation: http://www.arthritis.org/• American College of Rheumatology: http://www.rheumatology.org/• American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/

Talk with your doctor if you do not find satisfactory answers to your questions. Ask your doctor to explain any informationyou do not understand. Record any questions as they arise. Carry your list of questions to your next appointment so youwill remember to ask them.


Treating Rheumatoid ArthritisThe goals of treatment for rheumatoid arthritis (RA) are to:

• Relieve pain• Reduce inflammation• Slow or stop joint damage• Improve ability to function• Improve sense of well-being

The details of the treatment plan vary for each person. However,treatment typically involves a combination of lifestyle measures,medicines and other medical treatments.

What lifestyle measures are used for treating rheumatoid arthritis?Lifestyle measures are an important element in treating RA. These measures include properexercise, nutrition and joint care.

Proper exercise must be balanced with rest. Rest helps fight fatigue and also reducesinflammation and pain. Exercise improves flexibility and muscle strength, which helpsprotect the joint and improves the ability to function. Other benefits of a balanced exerciseprogram include:

• Reducing stress and improving mood, which helps you cope more effectively with RA• Maintaining a normal weight

A healthy diet is also important to maintaining a normal weight. Maintaining a normal weight reduces theamount of stress placed on a joint. A well-balanced diet also provides the nutrients your body needs for overall goodhealth. This helps your joints and muscles function as well as possible.

It is important to protect your joints. Modifying the work area or using assistive devices can help protect your joints.Shoes with shock-absorbing soles or orthopedic shoes help reduce stress on the feet, knees, hips and back. Flat heelsare also important. High heels change the angle that weight is placed on the knees and hips, causing more stress onthese joints.

What are assistive devices?Some assistive devices help support and protect joints. Others help you perform activities of daily living more easily.

Splints and braces help align joints and properly distribute pressure. They are most commonly used when rheumatoidarthritis affects the hands, wrists, knees, ankles or feet. Splints and braces are used during activity and also whileresting.

Canes, crutches or walkers may be beneficial when rheumatoid arthritis affects mobility. These devices reduce the risk forfalls and injuries due to falls. People who are at high risk for falling may also choose to use specially designed hipprotectors to help guard against hip fractures.

Splints and braces must be fitted. Use of an improperly fitting splint or brace can cause more harm than good. Generaldevices such as canes and walkers must be selected and adjusted based on height. If a device is not adjusted to theperson using it, discomfort, fatigue and possibly falls can occur.

The list of assistive devices for activities of daily living is long and varied. Eating utensils with modified handles, jaropeners, key turners, shoe inserts, bathroom equipment, such as raised toilet seats and handrails, footstools andbookstands are a few examples of the devices available.

Physical therapists and occupational therapists can help you identify devices that may be most useful for you. They canalso provide training for using a device to help ensure you get the most benefit from the device.


• Identify self-care measures fortreating rheumatoid arthritis

• Identify types of surgery used totreat rheumatoid arthritis

• Understand precautions for usingcomplementary and alternativetreatments

Maintaininga normal weight

reduces theamount of

stress placed on a joint.


What medicines are used to treat rheumatoid arthritis?Many medicines are used in the treatment of rheumatoid arthritis. Somemedicines are used to treat the disease process. The American Collegeof Rheumatology recommends that people begin using one of thesemedicines as soon as possible after the diagnosis of RA is made. Othermedicines are used to treat symptoms that often occur with RA, such aspain and inflammation. You can learn more about medicines used intreating rheumatoid arthritis in Unit 3.

When is surgery performed with rheumatoid arthritis?Surgery is usually considered a last measure for relieving pain andimproving function in people with rheumatoid arthritis.

Surgery may be considered when:

• Pain prevents daily activities or sleep• Medicines are no longer effective in controlling pain• Mobility is restricted such that the risk for falls and injury is significantly increased

Several factors influence the decision to use surgery. These include:

• The level of disability and the degree to which it interferes with daily living• The intensity of pain• The patient’s weight• The patient’s general health• The patient’s age

The type of surgery performed depends on what the surgery is intended to accomplish. The following surgical proceduresare the ones used most often for people with RA.

Arthroscopy uses miniature instruments inserted through tiny incisions (cuts). An arthroscope is a miniature telescopethat is inserted into the joint. After the joint is filled with fluid, the surgeon is able to see the inside of the joint and performtasks, such as removing particles from the joint (debridement) or cleaning the joint (lavage or irrigation). Other problemscan also be corrected with arthroscopy.

SynovectomyA synovectomy is the surgical removal of the synovium, the tissue that lines the joint. Removing the diseased tissue canslow the damage to the joint and reduce pain. However, the synovium can grow back over time. For this reason, asynovectomy is seldom performed except as part of reconstructive surgery on the joint.

Joint ReplacementArthroplasty is the medical term for joint replacement. Part of a joint may be replaced, or the total joint may be replacedwhen pain is severe and unrelieved or normal functioning is impossible. Hip replacement and knee replacement are themost common procedures. Other joints may also be replaced, including shoulders, elbows, wrists, and fingers. Somejoints, such as those in the spine, cannot be replaced. Some people are not good candidates for arthroplasty. Theseinclude people who have severe osteoporosis or who are obese. Other medical conditions, such as neurological (brainand nerve) disorders, are also taken into consideration.

Tendon ReconstructionTendons are tissues that attach muscle to bone. Rheumatoid arthritis can damage these tissues, which keeps a jointfrom functioning properly. Tendon reconstruction surgery restores function by attaching a new tendon to the damagedone. This procedure is most commonly used to restore hand function.

Doctors who perform surgery on the bones and joints are called orthopedic surgeons. You can get more informationabout surgery for rheumatoid arthritis from the American Academy of Orthopaedic Surgeons. The web address is:http://orthoinfo.aaos.org/


Do complementary and alternative medicine treatments help?The National Center for Complementary and Alternative Medicine(NCCAM) defines complementary and alternative medicine (CAM) as “agroup of diverse medical and health care systems, practices, andproducts that are not presently considered to be part of conventionalmedicine.”

Complementary therapies are used along with conventional medicine. Alternative therapiesare used instead of conventional medicine. The treatments classified as complementary oralternative therapy continue to change as research determines the safety and effective-ness of each treatment.

Researchers are studying the possible role of CAM therapies for rheumatoid arthritis.However, no clear statements can be made regarding benefit from CAM therapies atthis point.

If you are considering a CAM therapy, learn all you can about the product or service.Health information is abundant, especially in this day of the Internet. It is important thatyou evaluate information carefully before deciding to use a particular product or service.Always consider the following when evaluating information:

• Who is providing the information? Information provided by government agencies —such as the National Institutes of Health — and universities are generally trustworthysources.

• Is there any reason to believe the information is biased? More thorough research ofthe topic should be conducted when the primary intent of information is to sell aproduct.

• Is the information up-to-date? Look for a publication date. When looking at websites,remember, “date modified” and “last updated” do not necessarily refer to theinformation. Contact the site’s sponsor to determine when the information was lastrevised if this is not explicitly stated.

Once you have information you believe is trustworthy, talk with your doctor. Your doctorcan help you decide if the therapy may be worth the time and expense.

Be wary ofproducts orservices claiming…

Quick or miracle cures

Limited availability

Use of a secretformula

Use of informationsuppressed by thegovernment or medicalgroups

Effectiveness for awide range ofproblems

Did You Know?The exact cause of RA is unknown. Scientists are currently studying the possible roles of

certain genes, viruses and other environmental factors and hormonal factors.

If you areconsidering a CAM therapy,

learn all you canabout the product or

service.


Medicines for Rheumatoid ArthritisMany medicines are used in the treatment of rheumatoid arthritis (RA).Some medicines are used to treat the disease process. Others are usedto treat symptoms that often occur with RA, such as pain and inflamma-tion.

Disease-modifying anti-rheumatic drugsThe American College of Rheumatology recommends that people begin using a disease-modifying anti-rheumatic drug(DMARD) as early as possible after rheumatoid arthritis is diagnosed. DMARDs slow and sometimes stop theprogression of RA. There are a variety of DMARDs available. Someone may need to try several DMARDs or acombination of DMARDs before finding the best therapy. Different precautions are required for different DMARDs. It isimportant for you to talk with your doctor about the medicines you use. It usually takes a few weeks or months for aDMARD to produce improvement in symptoms. During this time, other medicines may be used to help control symptoms.

Biologic response modifiersBiologic response modifiers (BRMs) stop the progression of rheumatoid arthritis. These medicines are typically usedwhen DMARD therapy is not effective. The BRMs block the action of immune system proteins called cytokines (SI-toe-kines) that trigger inflammation. Currently all BRM medicines must be given via intravenous infusion or injected under theskin. Special monitoring by a doctor is required when a biologic response modifier is used.

CorticosteroidsCorticosteroids (COR-tee-co-STER-oids), often called steroids, are medicines thatrelieve pain by reducing inflammation. Steroids are usually taken by mouth. Insome cases, a doctor will inject a steroid directly into a joint. Steroid injections maybe used during severe RA flares and are limited to 2 or 3 treatments per year.

Other medicinesOther medicines may be used to relieve the pain of rheumatoid arthritis. Theseinclude the following:

• NSAIDs (nonsteroidal anti-inflammatory drugs) relieve moderate to severe painand reduce inflammation. Some NSAIDs are available only by prescription(Naprosyn,® Motrin® 800 mg). Many others are available over-the-counter (aspirin,ibuprofen, naproxen sodium, Aleve,® Motrin,® Advil®). There are risks associatedwith using NSAIDs. The risk is greater for people age 65 and older. The risk is also greater for people with a history ofstomach problems, ulcers, gastrointestinal bleeding, heart disease or congestive heart failure. NSAIDs cannot be usedwith certain other medicines because NSAIDs affect the way the body uses or eliminates these medicines. Talk withyour doctor or pharmacist before using a NSAID.

• COX-2 inhibitors (Celebrex®) are a new type of nonsteroidal anti-inflammatory drug that cause fewer gastrointestinalproblems than the traditional NSAIDs. COX-2 inhibitors are available by prescription only. There are risks associatedwith their use and people who use a COX-2 medicine should be monitored for serious side effects. Talk with your doctorabout the risks and benefits of using a COX-2 inhibitor.

• Topical pain-relieving creams, rubs or sprays are applied directly to the skin. Some contain salicylates (sa-LIS-ill-ates)and skin irritants. Salicylates alter the ability of nerve endings in the skin to detect pain. Skin irritants cause sensationssuch as hot or cold that distract from the pain. Many of these products (Icy Hot,® Arthritis Hot®) are available over-the-counter. Products containing capsaicin (cap-SAY-sin) (Zostrix®) may relieve inflammation in addition to providing painrelief.


• Recognize medicines that may beused in treating rheumatoidarthritis

• Identify things you can do toensure you are using yourmedicines safely

• Identify important facts youshould know for each medicineyou use

Overall health condition

Severity of the disease

Length of time themedicine will be needed

Potential side effects ofthe medicine

Factors thatinfluencemedicine choice


• Tramadol (Ultram®) is a prescription medicine that relieves pain. It issimilar to narcotic pain medicines but it is not as addictive. Thismedicine is sometimes used in combination with acetaminophen(Ultracet®).

• Opioids are also known as narcotic pain medicines. These medicinesare used to manage severe pain when other treatments do not providesufficient relief. Narcotic pain medicines are only available by prescrip-tion. Examples include oxycodone (Percodan,® Percocet,® Oxycontin®)and hydrocodone (Vicodin,® Lortab®). These medicines can be addictiveand their use is monitored closely and may be restricted.

How can I ensure I am using my medicines safely?Knowing all you can about your medicines will help you use them more safely.Begin by understanding the names of your medicine.

All medicines have two names. The brand or trade name belongs to a singlemanufacturer of the medicine. The generic name refers to the active ingredientin the product. All companies use the same generic name if they manufacturethat medicine, and then give their unique brand name to the product.

Learn the generic name, especially if there is more than one brand nameproduct with that medicine. This allows you to more easily recognize and avoidmedicines that may have caused problems in the past.

It is easy to confuse medicine containers. Always read the label beforetaking the medicine. This means you should never take a medicine in thedark! If you do not want to disturb someone by turning on a bright light,use a small flashlight to read the medicine label.

Drug information sheets provide information to help you use your medicinesafely and effectively. An information sheet is provided whenever you fill anew prescription. This information can also be found at the U.S. NationalLibrary of Medicine and National Institutes of Health website. The addressis: http://www.nlm.nih.gov/medlineplus/druginformation.html

Read the drug information sheet before you begin taking the medicine!Look at the generic name of the medicine. Have you had problems withthis medicine in the past? Read the list of things your doctor should know.Do you have any of these conditions that you have not reported to yourdoctor? If you answer yes to either of these questions, talk with yourdoctor or pharmacist before you take the medicine!

All medicines have side effects. Learn what side effects you mightexperience by reading the drug information sheet. Some side effectsshould be reported to your doctor immediately. Others may be reported during your next scheduled appointment withyour doctor. The side effects you experience and the impact they have on your ability to function will influence yourdoctor’s decision about whether you should continue to use the medicine. Always tell your doctor about symptoms youexperience while taking a medicine.

Trade Generic

Tylenol® acetaminophen

Advil® ibuprofen

Motrin® ibuprofen

Orudis® ketoprofen

Examples of Medicine Names*

Know These Facts…

Why is the medicine used?

How do I take the medicine?

What do I do if I miss a dose?

What drugs or foods may interactwith the medicine?

What side effects may occur?

What special precautions should Ifollow?

How do I store the medicine?

*NOTE: Brand names included as examples only, and their inclusion does not mean that these products are endorsed by theauthor. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.


Pain ManagementPain is a common symptom with rheumatoid arthritis. Fortunately, thereare many self-care measures you can use to relieve pain.

The first step in relieving your pain is to understand your pain and how itaffects your life. Knowing what affects the pain will help you control itmore effectively. This knowledge can be gained most easily with a paindiary.

What is a pain diary?A pain diary is a record of your experience with pain. A pain diary will help you and yourdoctor understand your pain and its impact on your life. The diary can also help youdetermine if your treatment plan is working as intended.

To keep a pain diary, record the following information:

• When the pain started• What you were doing when the pain started• A description of the pain (dull, ache, sharp, stabbing, burning, throbbing, etc.)• The severity of the pain, where “1” is very mild and “10” is very severe• Treatment for the pain. List the name and amount of medicines you used (e.g. Tylenol,® 250 mg) and

other treatments, such as ice, heat, deep breathing, relaxation, etc.• How well the treatment worked. Indicate if the pain was completely relieved, improved or did not change.• How the pain affected your life. Indicate the degree to which you had to miss or limit work, social or family activity or

household tasks because of the pain.

It is important that the information in your pain diary be as accurate and complete as possible. Record information in yourdiary on the same day you experience the pain. It is easy to forget or confuse information if you wait several days beforewriting it down.

A blank diary form is included on page 12. As you search for additional information about rheumatoid arthritis, you maydiscover another form that you would prefer to use. You may even prefer to design your own! Regardless of the form youuse, be sure you record all of the information your doctor may request. Share your diary with your doctor during yourscheduled medical appointments.

What are some self-help measures I can use to relieve pain?Thinking about pain can affect pain severity. Distracting activities keep you from focusing on the pain, which can makethe pain less intense. Pursuing hobbies and participating in fun activities that require your attention can help relieve yourpain.

Pain is a type of stress. Your body responds to pain in the same way it responds to other forms of stress. Muscles tighten.Heart rate increases. Breathing becomes fast and shallow. These reactions can worsen pain, leading to a vicious cycle.

Relaxation techniques can reverse these effects and lessen your pain. One easy relaxation tool is focusing on slow, deepbreathing. Progressive muscle relaxation and imagery are other techniques you may wish to learn. Ask your doctor forthe names of health professionals in your area who can help you master these techniques. You can also learn moreabout relaxation to manage pain at the Arthritis Foundation. The web address is: http://www.arthritis.org.


• Identify information to record in apain diary

• Identify self-care measures forrelieving pain

Start your pain diary.

Go to page 12or create your own!

Use the resources below to learn more about sleep:

• U.S. Food and Drug Administration: http://www.fda.gov/fdac/features/2002/602_sleep.html• National Institute of Neurological Disorders and Stroke:

http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm• National Institute on Aging: http://nihseniorhealth.gov/sleepandaging/toc.html

Can ice or heat relieve pain with rheumatoid arthritis?When a joint is inflamed, applying cold (like an ice or cold pack) for 20 to 30 minutes can help relieve pain. A package offrozen vegetables makes a handy substitute if you do not have an ice pack. Ice or cold packs should never be applieddirectly to the skin. Wrap ice or a cold pack in a cloth before using it next to the skin.

Hot soaks, warm towels and heating pads can help relieve pain and stiffness. Limit heat use to 20-minute sessions anduse mild heat to prevent burns. Never use heating pads while sleeping.

In general, ice is used after activity that could worsen pain. Heat is used before an activity and to relax and loosentissues and stimulate blood flow to the area. Talk with your doctor or physical therapist for more information about usingice and heat.

When should pain medicines be used?There are many medicines that may provide relief from pain. You can learn more about thesemedicines in Unit 3.

In general, pain medicines are recommended when other measures do not provide sufficientrelief. The medicines are then used in addition to the other pain relief measures.

If you use pain medicines, do not let the pain become too severe before taking the medicine.The medicine may not provide relief as well if the pain is too severe.

Talk with your doctor about which medicine you should use and how to use them in the most effectivemanner.

Where can I find more information about managing pain?The resources below will help you learn more about managing pain with rheumatoid arthritis:

• American Pain Foundation: http://www.painfoundation.org/• Arthritis Foundation: http://www.arthritis.org/conditions/Pain_Center/default.asp

Talk with your doctor if you do not find satisfactory answers to your questions. Ask your doctor to explain any informationyou do not understand.


Will rest relieve pain?Yes. Rest helps reduce inflammation in the joints, which helps relievepain. Rest also helps relieve fatigue, which helps you cope moreeffectively.

A 15 to 20 minute nap if you feel tired and achy may help relieve pain. Ifyou discover that napping interferes with your sleep at night, use theperiod to practice relaxation instead of sleeping.

See page 8to learn more

about painmedicines.

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Living with Rheumatoid ArthritisYour lifestyle plays an important role when you live with rheumatoidarthritis (RA). Healthy habits will help you manage the disease moreeffectively and improve your quality of life.

A healthy lifestyle includes using medicines as directed to alter thecourse of the disease and control symptoms. Exercise, good nutritionand stress management are other key elements for living well withrheumatoid arthritis.

What are the benefits of exercise in rheumatoid arthritis?It can be scary to think about exercising when you know you have a problem with one or more joints. After all, you do notwant to cause more problems, right? But exercise has many benefits for people with rheumatoid arthritis.

Stiffness is a common symptom with RA. Stiffness may occur when you stay in one position for a prolonged time.Frequently changing position can help you avoid stiffness due to lack of movement. Stiffness alsooccurs when a joint’s range of motion is decreased. An exercise program that includes properstretching can help you maintain range of motion and flexibility.

Other benefits of an exercise program include:

• Decreased pain• Reduced stress and improved mood • Improved general health• Weight maintenance

Exercising regularly is one of the best things you can do for yourself! Exercise can bedone at home where it is convenient and inexpensive. Participating in group exerciseprograms can provide the benefits of exercise and the fun of socializing with others.

What exercises should I do?The best exercise program for you depends on your overall condition. Talk with your doctor before you begin a newexercise program or change your current exercise program.

In general, a well-rounded exercise program will include three types of exercise:

• Stretching exercises improve joint function and flexibility.• Strengthening exercises improve muscle strength. Strong muscles protect joints from stress.• Aerobic exercises are also called endurance or cardiovascular exercises. These exercises improve heart and lung

function and overall stamina, which promote healthier joints.

Always include a warm-up period before beginning your exercises. Warm-up activities increase blood flow to muscles.This provides the oxygen and nutrients the muscles need to work properly and reduces the risk of injury. Stretchingexercises are not a good warm-up activity. Stretching exercises should be done after a general warm-up activity thatincreases blood flow and warms the muscles. Ask your healthcare provider about the best warm-up activities for yourexercise program.

A cool-down period after exercising allows the body to gradually return to its resting state. This helps you avoid problems,such as dizziness, that can occur if exercise is stopped suddenly. Good cool-down activities include slowing the pace ofthe main activity you are doing for five to 10 minutes.

Talk with your doctor, physical therapist or occupational therapist about designing an exercise program tailored to yourspecific needs. Learn to do recommended exercises correctly. Exercising incorrectly can cause injury.


• Identify the benefits of exercisewith rheumatoid arthritis

• Understand the importance of ahealthy diet with rheumatoidarthritis

• Understand the importance ofstress management withrheumatoid arthritis

Talk with yourdoctor before you

begin a newexercise program

or change yourcurrent exercise

program.


How can I “stick with” an exercise program more easily?Begin by setting realistic goals. Start slowly. Improvements from exerciseoccur gradually. As they do, set new goals.

Make exercise part of your daily routine. Some exercises may need tobe done every day. Other exercises may require a day of rest betweensessions. Talk with your doctor, physical therapist or occupationaltherapist about an exercise schedule. Regardless of which exercises youmay do on a given day, it is easier to maintain an exercise program ifyou perform some part of it every day.

What precautions should I take with exercise?It is important to balance exercise with rest. More rest is needed when your RA is active. The amount of rest varies foreach person. For most people, shorter rest breaks more frequently are more beneficial than prolonged rest periods. Askyour doctor, physical therapist or occupational therapist for guidelines on balancing rest and exercise. You should also askabout exercising when a joint is sore or swollen, and when to use medicines to relieve pain and inflammation.

Listen to your body. Some exercises will cause discomfort. However, pain is an indication that something is wrong. Stopan exercise if it is causing pain. Do not stop your exercise program! Instead, talk with your healthcare team if an exercisecontinues to cause pain. You may be doing an exercise incorrectly or your condition may have changed such that youneed other exercises.

Is body weight important for people with rheumatoid arthritis?Yes. Every pound of body weight transmits 3 to 4 pounds of pressure to the joints. Extra pounds carried on the bodyplace more pressure on your joints! Reducing excess weight reduces the stress on the joints.

Just as being overweight is unhealthy, so is being underweight. Being underweight increases your risk for problems suchas anemia and osteoporosis (thinning of the bones). Mood may also be affected, which can make it more difficult to copewith RA.

Maintaining a healthy diet will help you maintain a normal bodyweight. A healthy diet will also provide the nutrients your body needsto function properly.

What is BMI?BMI stands for body mass index. This is a measure of body fat basedon height and weight in adults. You can find more information aboutBMI at the National Heart, Lung and Blood Institute. A BMI calculatoris also provided for your convenience. The address is:http://nhlbisupport.com/bmi/bmicalc.htm

If you do not have Internet access, you can calculate your BMI usingthe steps below.

1. Multiply your weight in pounds by 703.

2. Multiply your height in inches by your height in inches.

3. Divide the first number by the second number.

Talk with your doctor to determine the steps you should take if yourBMI is 25 or higher.

BMI Categories

Underweight <18.5

Normal weight 18.5 – 24.9

Overweight 25 – 29.9

Obesity 30 or greater

Example of BMI Calculation

1. 125 lbs x 703 = 87,8752. 67 ins x 67 ins = 4,4893. 87,875 ÷ 4,489 = 19.6

BMI = 19.6 - Normal weight


What is the Food Pyramid?A healthy diet includes a variety of nutrient-rich foods everyday. The Food Pyramid illustrates the elements of a healthydiet. The Food Pyramid is part of the Dietary Guidelines forAmericans. The guidelines were developed by the U.S.Department of Health and Human Services (HHS) and theU.S. Department of Agriculture (USDA) to help people makesmart choices about food and activity.

Dietary needs vary based on your goals. Health conditionsand activity levels also affect dietary needs. Talk with yourdoctor or a dietician to determine the best way to meet yournutritional needs. You can also get more information by visitingthe U.S. Department of Agriculture website at:http://www.mypyramid.gov/

Is it safe for people with rheumatoid arthritis to drink alcohol?People who take certain medicines, such as methotrexate, must be careful about drinking alcohol. The combined effect ofthe alcohol and medicine can cause serious problems. Ask your doctor or pharmacist if it is safe for you to drink alcohol.

Are “natural” or “herbal” weight-loss products safe and effective for people with rheumatoid arthritis?Products labeled as “natural” or “herbal” are not regulated by the Food and Drug Administration and are not usuallytested to determine safety or effectiveness. Always talk with your doctor before using a supplement or herbal remedy.Some supplements and herbal remedies can cause problems if used with other medicines or by people with certainhealth conditions.

You can learn more about supplements by visiting the U.S. Food and Drug Administration website. The address is:http://www.cfsan.fda.gov/~dms/supplmnt.html

Is stress management important with rheumatoid arthritis?Yes! Stress can make it more difficult to cope with pain and otherproblems that rheumatoid arthritis might cause. Stressful experiencesmay even trigger flares in the disease. Managing stress can help youmanage RA more effectively.

To manage stress, begin by identifying things that are stressful. Thinkabout what makes them stressful. Can anything be changed? If so,start changing it. If not, changing your view about it may be helpful.Exercises, such as deep breathing and muscle relaxation, may alsobe helpful.

Talk with your doctor if you continue to feel overwhelmed by stress.You can also use the resources below to learn more about stress andmanaging it:

• U.S. National Library of Medicine:http://www.nlm.nih.gov/medlineplus/stress.html

• Arthritis Foundation: http://www.arthritis.org

Stress Management Tips

“Let go” of things beyond your control.

Break large problems into smallerpieces. This makes a situation seemmore manageable and reduces stress.

Look for the challenge instead ofdwelling on the undesired aspects of asituation. Accepting a challenge makesthe situation more positive and lessstressful.

Find the humor. Laughter reducesstress in you and in those around you.

A well-balanced diet provides the nutrients your body needs for overall good health.This helps your joints and muscles function as well as possible.


Your Healthcare TeamManaging rheumatoid arthritis (RA) is a team effort. Who is the captainof the team? You are!

You know yourself better than anyone else. Only you can describe yoursymptoms and the effect they have on your life.

As the captain of your healthcare team, you have a responsibility tobecome knowledgeable about RA and its treatment. This will enable youto make more informed decisions about your care.

You also have a responsibility to communicate with the other members of your team. Share your concerns. Only youknow what your concerns are. Once they become aware of the situation, your healthcare team members can help youaddress your concerns more effectively.

Have you not been following medical instructions? Perhaps you have done something to increase pain that you wouldrather not admit. Be honest, even if it makes you feel embarrassed or uncomfortable. In these situations, it may help to letyour healthcare provider know of your embarrassment or discomfort. Most likely, your healthcare provider hasencountered others with similar situations and can help you feel more relaxed in discussing the problem.

Discuss any objections you may have to recommended treatments. Your doctor or another team member may be able toidentify more acceptable treatments. Tell your doctor if financial or other concerns are keeping you from followingtreatment instructions. Your team may be able to help you overcome the problems you are having.

What is a rheumatologist?Most people with rheumatoid arthritis should be seen by a rheumatologist initially and periodically over time.Rheumatologists are doctors who specialize in the diagnosis and treatment of diseases that affect the joints, musclesand bones.

In most cases, a rheumatologist will manage your use of disease-modifying anti-rheumatic drugs (DMARDs) or otherspecialized drugs for RA. Your rheumatologist may also help you coordinate services among other healthcare profes-sionals who may work with you.

Who are other members of my healthcare team?Your healthcare team may include several of the following health professionals:

• Primary care physicians (PCPs) provide general healthcare and may refer patients to specialists as needed.• Orthopedists are physicians who specialize in surgery and other treatment for diseases that affect the bones and joints.• Physical therapists assist patients to regain function, improve mobility and relieve pain due to muscle or joint problems.• Occupational therapists help patients regain, maintain or improve their ability to perform activities of daily living.

Use the resources below to learn more about health professionals who may be part of your team:

• American Medical Association, Allied Health Careers: http://www.ama-assn.org/ama/pub/category/14598.html• U.S. National Library of Medicine: http://www.nlm.nih.gov/medlineplus/directories.html


• Identify your role on yourhealthcare team

• Identify members of yourhealthcare team

• Learn tips for making yourmedical appointments moreproductive


How can I get the most from my medical appointments?Your medical appointment is the time your doctor or therapist hasdevoted to focusing on you. Be prepared. Bring your Pain Diary andanything else your healthcare provider has requested that you bring toyour appointment. (See page 12 for more information about a PainDiary.)

Ask questions. Write down questions you want to ask before your appointment so you will not forget to ask them. Ask themost important questions first to be sure there is plenty of time for them to be answered. During the appointment, askquestions about anything you do not understand. You may even want to ask for an illustration to help you understandmore clearly.

In some cases you may want to have someone accompany you to the medical appointment.A family member or friend can help you remember what is discussed. If you find you havemore discomfort at the end of the appointment, your companion can help you returnhome safely.

Get directions in writing. If your doctor or therapist does not write down the informationfor you, ask for time to write it down. Have the person check that you have writteninstructions correctly.

As you learn more about rheumatoid arthritis, you may have questions or want yourdoctor’s opinion on information you have found. Be specific. Handing your doctor longarticles to discuss during your appointment may lead to disappointment and frustration.Instead, highlight the sentences that cause you the most concern. Mark the pages so thehighlighted sentences can be found quickly. This will help your doctor answeryour questions efficiently without taking too much time from other needs.

When should I call my doctor?Many medical concerns can be handled over the telephone. Some doctorsprovide instructions for when to call the office. Follow your doctor’s instruc-tions. Be prepared when you call.

If you are calling about an emergency, state this at the beginning of your call.Delay calling about less urgent matters until mid-morning or later. This avoidsthe period when the office staff is extra busy preparing for the day. Call asearly as possible if you need to cancel an appointment for that day.

Remember, every day your doctor receives many calls in addition to patientvisits. To help with this busy schedule, receptionists and nurses are trained tohandle some calls. If you feel you still need to speak directly with your doctorafter talking with a member of the office staff, politely request that your call bereturned when it is convenient.

Organize your thoughts.Write a one-sentencedescription of the problemand the reason for the call.

Have a pad and pencil readyto write any instructions youare given.

Have the telephone numberfor your pharmacy handy.

Preparing to Call

Don’t forgetto bring your pain

diary to yourappointment. See

page 12 to getstarted.


Your Notes

rheumatoid arthritis management program · rheumatoid arthritis (ra) is an autoimmune disease.the...

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