Free Rheumatoid Arthritis Research Paper Example
Rheumatoid arthritis is an autoimmune disorder that is characterized by severe, progressive inflammation of the peripheral joints, such as the small joints of the hand, the wrists, and the elbows, as well as the foot and ankle joints. Rheumatoid arthritis causes swelling, tenderness, stiffness, and pain in these joints. Over time, this chronic inflammation leads to destruction of the joint and the surrounding tissues and structures, as well as muscle weakness in the surrounding major muscle groups (Cooney et. al, 2011, p. 5). While the onset and progression of rheumatoid arthritis is generally gradual, individuals may experience flare-ups, during which symptoms rapidly become more acute, leading to increased pain and physical impairment for the sufferer (Reed, 2001, pp. 584).
Although rheumatoid arthritis is the most common disorder causing chronic joint inflammation (Cooney et. al, 2010, p.1), the cause of rheumatoid arthritis (RA), as with many autoimmune disorders, has not yet been determined. A genetic predisposition for RA has been identified, though what triggers the gene to express itself has not; environmental factors are also believed to be involved (Reed, 2001, pp. 584). The age of onset in RA is usually between 25 and 50 years old, and affects two to three times more women than men, for reasons that, like the etiology of the disorder, remain unknown (Reed, 2001, pp. 584).
Rheumatoid arthritis causes mild to significant functional impairment and occupational dysfunction depending on the joints affected, the severity of the inflammation, and the progression of the disorder and the resulting damage to the joints over time; those in the early stages of rheumatoid arthritis are affected by swelling and tenderness in the joints that limits their range of motion, impedes their ability to complete activities of daily living, and leads to muscle weakness over time due to disuse (Cooney et. al, 2011, p. 1-5). As permanent joint damage occurs, pain worsens, range of motion in the affected joints are permanently impaired, and muscle weakness worsens. Tasks that demand grasping, pinching, bending, lifting, and carrying are particularly problematic for RA sufferers, making most activities of daily living (ADLs) and instrumental activities of daily living (IADLs) such as meal preparation, eating, doing laundry, and dressing particularly challenging (Reed, 2001, pp. 584). In addition, the pain experienced by many RA sufferers can interrupt sleep, as well as prevent sufferers from engaging in social and leisure activities such as golf, knitting, playing with grandchildren, etc. Many individuals diagnosed with RA fatigue easily and, due to their constant fatigue as well as the above symptoms, change their habits and patterns over time to accommodate their increasing level of disability and thus may experience feelings of sadness, frustration, or hopelessness secondary to their diagnosis (Cooney et. al, 2011, p. 6).
There is currently no cure for RA, thus medical interventions for RA primarily consist of pharmaceutical interventions to both minimize pain (acetominophen, ibuprofen, etc.) and slow the progression of the disease (Methotrexate, etc) (Cronstein, 2005, p. 1). Occupational therapy intervention for RA is focused on maintaining range of motion in the affected joints as long as possible, strengthening weakened muscles and preventing muscle weakness, minimizing pain, and promoting clients’ independence in ADL/IADL activities and participation in preferred activities for as long as possible (Reed, 2011, pp. 584).
Treatment strategies and approaches employed by occupational therapy practitioners include client education in active/active assisted/passive range of motion exercises, as well as engaging client in hand and upper body strengthening exercises. Physical agent modalities, especially heat and cold, may be used to lessen the pain and inflammation, especially before or after stretching or exercise in the involved joints (Welch et. al, 2001). Teaching compensatory strategies such as energy conservation and joint protection principles, and how to incorporate these strategies into ADL/IADL routines is critical in keeping clients diagnosed with RA independent for as long as possible. Because RA is progressive and chronic, adaptive devices are commonly provided to patients as the damage from the disease worsens. Long-handled reachers, long-handled shoe-horns, button hooks, and built-up utensils can all be useful adaptive devices for sufferers of RA. The promotion of gentle aerobic exercise, such as walking, swimming, and cycling, to strengthen muscles and maintain physical fitness is also important, as many individuals experience health issue secondary to the sedentary lifestyle that the pain and physical dysfunction of RA often leads to (Cooney et. al., 2011, p. 8).
Although a diagnosis of RA leads to irreversible joint damage, pain, and a decrease in independence over time, with appropriate and timely intervention individuals with RA can minimize pain, maximize their function and ability to participate meaningfully in daily activities and routines. With it’s focus on prevention of deformity as well as adaptation and compensation, occupational therapy is a critical intervention for individuals diagnosed with RA and should be initiated as soon as possible.
Cooney, J. K., Law, R. J., Matschke, V., Lemmey, A.B., Moore, J. P., Ahmad, Y., Jones, J.G.,
Thom, J. (2011) Benefits of Exercise in Rheumatoid Arthritis. Journal of Aging Research
2011. doi:10.4061/2011/681640. Retrieved from
Cronstein, B. (2005). Low-Dose Methotrexate: A Mainstay in the Treatment of Rheumatoid Arthritis. Pharmalogical Reviews, 57(2), 163-172. doi: 10.1124/pr.57.2.3.
Reed, K. (2001). Quick Reference Guide to Occupational Therapy: Second Edition.
Gaithersburg, MD: Aspen Publishers.
Welch, V., Brosseau, L., Shea, B., McGowan, J., Wells, G., Tugwell, P. (2001). Thermotherapy
for treating rheumatoid arthritis. [Abstract]. Cochrane Databse System Review, 2000(4).
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11034770