Arthritis Irelad 1 Clawilliam Square Grad Caal Quay Dubli 2 Helplie LoCall 1890 252 846 Email ifo@arthritisirelad.ie Web www.arthritisirelad.ie Livig with Osteoarthritis
PERSONAL DETAILS Arthritis Irelad, makig a BIG differece everyday Little thigs ca make a big differece to a perso with arthritis. Difficulty with the little thigs like makig a cup of tea, gettig dressed or opeig the frot door ca all add up to have a big impact o a perso s quality of life. At Arthritis Irelad we uderstad this. That is why we are Irelad s oly orgaisatio workig sigle-midedly to trasform the experiece of people livig with arthritis ad those who care for them. Every day, we work i commuities across the coutry providig commuity based educatio programmes to help people effectively maage ad cotrol this devastatig disease. We actively drive grassroots advocacy so that the voice of people with arthritis is heard ad uderstood ad we work with the medical commuity to cotrol ad cure arthritis. 36 per Other 20 per aum ( 36 + doatio) aum OAP If arthritis is affectig your life or the life of someoe you love, call us ad talk to someoe who uderstads, someoe who will liste, chat ad poit you towards the people, resources ad programme that ca make a big differece to your life. If you would like to voluteer, help raise fuds or make a doatio, call us o 01 661 8188, log o to arthritisirelad.ie or fid us o facebook!
Osteoarthritis is a disease of the joits affectig almost everyoe as they get older but youger people eve teeagers may develop it. Most people are likely to experiece some level of pai ad some degree of mobility problems. Osteoarthritis caot be cured, but a early diagosis ca help slow its progressio ad a lot ca be doe to ease the symptoms. As this booklet explais, there is a wide rage of treatmets to try ad there is a lot you ca do to make day-to-day livig easier. 1 www.arthritisirelad.ie
Cotets Itroducig OA 4 About the coditio Gettig a diagosis 9 The process of gettig diagosed Commuicatig with health professioals 11 Who you will see, what you ca do to maage your arthritis Treatmet with drugs Lookig after your joits 15 Ways of livig with arthritis Usig exercise, diet ad complemetary therapies to look after your joits Surgery Practicalities 25 Maagig at home, i work ad educatio Access to trasport ad beefits Carig for yourself 32 Cosiderig your emotios, relatioships ad self-maagemet 3 www.arthritisirelad.ie
INTRODUCING OA What is OA? Osteoarthritis is a coditio that usually develops gradually, over several years. It affects a umber of differet joits. For some people, the chages are so subtle ad develop over such a log period of time that they are hardly oticeable. But others may experiece gradually worseig problems, icludig pai ad restricted movemet, particularly i large joits such as the hip or kee. You may have to see the doctor from time to time to discuss your coditio ad your treatmet. We do ot yet kow the causes or the cure for osteoarthritis. Although there is a coectio with the ageig process, doctors ad researchers are tryig to idetify what factors i this process trigger the disease. They o loger see osteoarthritis as beig a ievitable part of ageig or a wear ad tear disease, but more a importat challege to fight. What happes? Healthy cartilage the protective layer that covers the boe ed i the joit is very smooth, strog ad flexible. It absorbs the stresses put o a joit ad protects the boes from damage. I osteoarthritis, this becomes pitted, brittle ad thi, ad, over time, ca wear out completely. Whe the cartilage deteriorates, the boe udereath thickes ad broades out. As the cartilage becomes thier, the boes of the joit rub together, causig pai, iflammatio ad the gradual build-up of boy outgrowths (osteophytes), which make it look kobbly. At the same time, the joit capsule becomes thicker ad the amout of syovial (lubricatig) fluid ca icrease, ofte causig the joit to swell. It may also become stiff ad paiful to move. 4
Causes Specific causes of osteoarthritis are hard to pi dow. Several factors ca icrease the risk of developig it. Age People usually develop osteoarthritis from their late 40s through to old age ad it is ofte udiagosed. Although it is ucommo before the age of 40, youg people ca develop it. It is ot kow exactly why older people ted to develop it, but it is probably due to bodily chages which come with old age, such as the muscles becomig weaker, puttig o weight ad the body becomig less able to heal itself. Geder Osteoarthritis is more commo ad ofte more severe i wome, especially i the kees ad hads. It ofte starts after the meopause. Obesity The effects of obesity o osteoarthritis are well documeted. Carryig extra weight puts pressure o weight-bearig joits, especially the hips, kees ad spie. It also icreases the chaces of osteoarthritis worseig oce it has developed. 5 www.arthritisirelad.ie
I kow it s best ot to be overweight with OA, but it s difficult Joit ijury A major ijury or operatio o a joit may lead to osteoarthritis at that site later i life. Normal activity ad exercise are good for the joits ad do ot cause osteoarthritis. However, very hard, repetitive activity may ijure joits. Exercisig too soo after a ijury has had time to heal properly may also lead to osteoarthritis i that joit later o. It is always best to check with your doctor, physiotherapist or urse whe it is safe to exercise after you have sustaied a ijury. Heredity Oe commo form of osteoarthritis odal osteoarthritis rus strogly i families. This particularly affects the hads of middle-aged wome. I other commo forms of osteoarthritis, heredity plays a small part compared with obesity, ageig ad joit ijury. There are some very rare forms of osteoarthritis that start at a youg age ad ru i families ad these are liked with sigle gees that affect collage a essetial compoet of cartilage. The stadard explaatio for osteoarthritis is that it is a result of wear ad tear. Studies of people who have led very similar lives show some will have virtually perfect joits, while others have quite severe osteoarthritis. Therefore, it seems there must be a ibuilt susceptibility to, or protectio agaist, osteoarthritis. Other types of joit disease Osteoarthritis is sometimes caused by ijury ad damage from a differet kid of joit disease years before. For example, people with rheumatoid arthritis ca develop osteoarthritis i the joits that were most affected by rheumatoid iflammatio. 6
Myths Osteoarthritis does have other causes we just do t kow what they are yet. But we do kow eough to correct some myths. Although there is o evidece to support the claim that weather makes arthritis worse, may people fid that their joits ofte ted to feel worse whe the atmospheric pressure is fallig, for example, just before it rais. However, although the weather may temporarily affect symptoms, it does ot cause arthritis. My kee ad spie are more paiful whe the weather turs bad Warmer regios i the world do ot have lower icideces of arthritis tha colder regios. Osteoarthritis occurs all over the world, i all types of climate. While some types of arthritis gout for example are directly affected by diet, there is o evidece that a particular diet will elimiate the coditio. However, some people claim certai foods make their pai or iflammatio worse. It is very importat to keep your weight as close as possible to the ideal for your height ad age. Excess weight compouds the problem by puttig extra strai o damaged joits. It is also importat to eat a balaced diet to ourish muscles, cartilage ad boe. This will reduce the risk of osteoarthritis. Which joits? Osteoarthritis is variable ad ca affect differet joits i differet ways, but is most commoly foud i the kees, hips, hads ad spie. Pai ca vary i severity ad ca be so mild that may people do t eve otice it, or so severe that mobility ad quality of life is affected. 7 www.arthritisirelad.ie
The spie ad weight-bearig joits such as the kees, akles ad hips are most frequetly affected by osteoarthritis, makig mobility difficult. Osteoarthritis i the figers, thumbs ad wrists affects grip stregth ad the ability to perform everyday tasks such as opeig jars, pickig small thigs up, writig ad doig up buttos. Shoulder ad elbow joits are also susceptible to arthritis although this is much rarer. Some people may experiece a gridig feelig i the shoulder ad a reduced rage of movemet. Elbows are very sesitive to ijury so very mild arthritis here ca lead to quite a sigificat loss of mobility. Early sigs ad symptoms The early sigs of osteoarthritis are so mild that they are ofte easy to miss. The mai symptoms are stiff ad paiful joits, with the pai tedig to be worse while exercisig the joit ad at the ed of the day. Stiffess usually wears off after restig, but the joit may ot move as freely or as far as ormal ad may creak or crack whe moved. Muscle stregtheig exercises ca prevet the joit givig way. Symptoms ca vary ad you may have bad patches of a few weeks or moths followed by better periods. You may fid that it depeds o how much physical activity you do. Joits may appear swolle. I more advaced cases, there may be costat pai ad everyday tasks ad movemet may become difficult. It is importat you visit your GP ad do t igore your symptoms, as early diagosis will help prevet uecessary damage. 8
GETTING A DIAGNOSIS Your GP will be able to assess whether you have osteoarthritis or whether your symptoms are due to aother illess. Your history Your GP will begi by askig you to describe the symptoms, ad whe ad how the coditio started. Make sure you tell your doctor exactly how you feel, givig a good descriptio of pai, stiffess ad joit fuctio, how they have chaged over time ad how your work ad daily life are affected. Fially, you will be asked about ay other medical coditios you may have ad whether you are takig ay medicies. Physical examiatio Your doctor will examie your joits ad may check muscles, erves ad aspects of your geeral health, feelig for ay boy swelligs ad creakig joits. They will also look for ay restricted movemet, joit tederess ad ay thiig muscle, excess fluid or istability i the joits. 9 www.arthritisirelad.ie
You may be referred, after a time, to a physiotherapist or occupatioal therapist who ca give you special exercises to do ad advice o how to relax, overcome mobility problems, avoid joit strai ad cope with pai. If your arthritis is severe, you may be referred to a hospital specialist such as a rheumatologist or a orthopaedic surgeo. Testig for osteoarthritis There is o blood test for osteoarthritis although you may be give oe to rule out other types of arthritis. X-rays are the most useful test to cofirm osteoarthritis ad to see how much damage has occurred. These will show such thigs as cartilage loss, boe damage ad osteophytes (boy growths). X-rays do ot determie how much your arthritis will trouble you, a X-ray that shows severe chages does ot ecessarily mea that you will have a lot of pai or disability. Also, they may ot show early osteoarthritis damage. 10
COMMUNICATING WITH HEALTH PROFESSIONALS Your GP will be your mai cotact to do with matters cocerig your treatmet, ad it is importat to develop a good relatioship to esure that you are give the treatmet that is most effective for you. Do t be afraid of askig questios if somethig is ot clear. It may help you to write thigs dow or to take a fried or relative with you. Doctors are ofte rushed, but it is importat that you make the most of your cosultatios. This will help you uderstad ad feel cofidet about ay treatmet you are give. I did a lot of research ad spoke to the Arthritis Irelad Helplie before I wet to my GP, it really helped me You ad your GP must work together to help you maage your arthritis ad help you live as ormal a life as possible. Ultimately, oly you kow how you feel ad the difficulties you face. Gettig the most out of your GP appoitmet It is a good idea to make a list of about four questios to ask your GP before your appoitmet i case your mid goes blak. If you feel that you eed more time with your doctor, you ca always ask for aother appoitmet or perhaps book a double appoitmet. Your local surgery will be able to tell you about its rules. Whe you joi a practice you ca ask at receptio if a GP has a particular iterest i arthritis. 11 www.arthritisirelad.ie
Do t be afraid to discuss treatmet optios or to take o more resposibility for your ow eeds. It is worth remidig your GP of ay other coditios you have or medicatios ad supplemets you are takig. Treatmet versus prevetio While it ca be difficult to avoid, ijuries to a joit ca icrease the risk of developig osteoarthritis i the same joit, years later. However, maitaiig a ormal weight for your height ad body structure, keepig physically active ad avoidig excessive stress o the joits as you get older, ca reduce the severity ad impact of osteoarthritis. Ways to reduce stress o the joits iclude: stickig to your ideal weight pacig yourself. Istead of attedig to the chores that eed doig all at oce spread them out wearig shoes with thick, soft soles ca act as shock absorbers ad reduce jarrig usig a walkig stick ca reduce the weight ad stress o a paiful hip or kee joit. What you ca do to maage your arthritis There are may thigs you ca do to help maage your arthritis: geeral exercise keep movig. Do t be afraid to use your joits swimmig i a heated pool ca help massagig the muscles aroud the joits will help ease pai ad help keep you supple sleepig o a good mattress ca ease pai mild to moderate disease ca usually be maaged successfully with paikillers, such as paracetamol or ibuprofe (a o-steroidal ati-iflammatory drug). Make sure you follow the dosage istructios o the packet. 12 For more iformatio o gettig the best from your health professioals, see Arthritis Irelad s booklet Let s talk Arthritis or visit www.arthritisirelad.ie
A GP may prescribe a differet o-steroidal ati-iflammatory drug (if this is appropriate for you) or a stroger codeie based paikiller. I took a fried to the surgery with me, to prompt me i case I forgot to ask aythig Should your coditio deteriorate to the poit where your mobility is severely affected, you may be advised by your GP to see a rheumatologist for specialist advice o medical maagemet, or a orthopaedic surgeo to discuss the possibility of joit replacemet surgery. Treatmet with drugs The medicatio each perso is prescribed ad how ofte they take them differs depedig o their disease type ad o how they react to the drugs. Some of the most commoly used drugs for osteoarthritis are listed below. Aalgesics These are pai-relievig drugs, such as paracetamol, that do ot affect the arthritis itself, but help relieve the pai ad stiffess. They come i varyig stregths ad the stroger oes are oly available o prescriptio. Paracetamol, which is available over the couter, is the simplest ad safest paikiller, ad the best oe to try first. Side effects are uusual, although takig too great a dosage ca cause liver damage. May pai relievig drugs, icludig pai relief gels, ca be bought over the couter. Never take more tha the recommeded dose ad, if i doubt, talk to your pharmacist or doctor. 13 www.arthritisirelad.ie
Stroger, combied paikillers such as co-codamol ad co-dydramol are available o prescriptio. They cotai paracetamol ad a secod codeie-like drug. These are more likely to cause side effects, such as costipatio or dizziess. Some ati-iflammatory drugs such as ibuprofe ca be used as paikillers i low doses. Paikillers do t remove the pai completely, but they alter the ature of it, makig it more bearable No-steroidal ati-iflammatory drugs (NSAIDs) If you have mild iflammatio i your joits, your doctor may prescribe a course of o-steroidal ati-iflammatory drugs (NSAIDs). However, if there is o iflammatio, as is ofte the case with osteoarthritis, these drugs may have o advatage over paikillers. NSAIDs are more likely to cause side effects especially idigestio ad diarrhoea. They ca iterfere with the effectiveess of other drug treatmets used to treat high blood pressure ad heart disease. Ibuprofe ad diclofeac are commoly used NSAIDs but there are may others. Your doctor will advise you which is the appropriate oe to take, ad the correct dose. Creams ad gels ca ofte help, especially for kee ad had osteoarthritis. Cox-2s Cox-2 ihibitors are a type of NSAID, desiged to be safer for the stomach. However, cocers have bee raised about their side effects, icludig icreased risk of cardiovascular problems, especially for people with a history of heart disease or stroke. Some drugs withi the class have bee withdraw. If you wat to kow the latest about Cox-2s, discuss with your doctor what treatmet is most suitable for you. 14
LOOKING AFTER YOUR JOINTS Most people ca lead a full, active life with osteoarthritis by properly maagig the coditio ad makig small, commo sese alteratios to life. There are may thigs that ca be doe to help alleviate the symptoms ad prevet the disease from progressig. Regular exercise, protectig the joits from further ijury ad maitaiig a ideal weight through a healthy diet will all beefit you. Iflamed or damaged joits eed to be cared for ad protected. Keepig healthy is part of this, but you also eed to avoid straiig joits by overdoig thigs or doig them awkwardly. You may have to give more thought to the clothes ad shoes you wear, to the way you lift, grip ad carry thigs or to the way you arrage your home or place of work. A occupatioal therapist ca help with all of this. Occupatioal therapists Occupatioal therapists (OTs) ca help if you are havig difficulty with day-to-day tasks like washig, dressig, cookig ad cleaig. They ca also advise o your work eviromet. OTs are experts o what equipmet is available to help you ad where you ca buy these items. They may also be able to supply some of the more expesive items o temporary loa. Your GP or hospital cosultat ca put you i touch with a occupatioal therapist. This may be at your local hospital or they may visit you at home. 15 www.arthritisirelad.ie
EXERCISE AND REST A FINE BALANCE Exercise ca be the furthest thig from people s mids whe they live with pai o a daily basis. However, for people with arthritis, the beefits of exercise are eormous. Exercise protects joits by keepig the muscles strog ad keepig you mobile. It is also good for pai ad stress ad ca help you lose ay extra weight that puts strai o joits. The Arthritis Irelad Take Cotrol with Arthritis DVD provided me with practical ad easy to follow exercises that I ca do i my ow home Chage the way you move spread the load use both hads to lift ad hold, for example shift rather tha lift slide heavy pas alog a kitche top use larger, stroger joits rather tha pushig a door ope with your had ad wrist, use your shoulder or hip do t grip thigs too tightly choose a fatter pe, for example. Hold it as loosely as possible or expad the grip with paddig chage positios ofte shift positio or stretch every half a hour watch your posture slouchig ca add strai o muscles ad joits. Exercise wo t make your arthritis worse as log as it is the right sort. The wrog sort of exercise could put strai o your joits ad damage them further. Ask your GP 16
whether it is appropriate for you to be referred to a physiotherapist, who will help you work out a programme combiig flexibility (rage of movemet), stregtheig or aerobic exercises. Rage of movemet Rage of movemet (ROM) exercises form the backboe of every exercise programme. Everyoe should do these as they help maitai flexibility, ad are importat for good posture ad stregth. The exercises ivolve takig joits through their full rage of movemet ad the easig them a little further. ROM exercises are doe smoothly ad getly so they ca be doe eve whe i pai. Stregtheig Stregtheig exercises are especially beeficial, because they help to stregthe the muscles, which move, protect ad support your joits. May people become less active whe they develop arthritis because of the pai ad fear of causig damage. This ca lead to muscle wastage ad weaker joits. By developig strog muscles, joits become more stable ad activities such as walkig ad climbig stairs are easier. Start slowly, gradually buildig up the repetitios. As the muscles get used to doig more, they become stroger. The type of exercises you do will deped o which joits are affected ad how severe your coditio is. Always check with a doctor or physiotherapist before startig a regime. 17 www.arthritisirelad.ie
Aerobic Aerobic just meas exercise that raises your heart rate. This type of exercise burs off calories, speeds up the body s metabolism, helps maitai a strog heart ad helps muscles work more effectively. It also helps cotrol ad reduce weight, improves sleep, stregthes boes, reduces depressio ad builds up stamia. The best forms of aerobic exercise for people with arthritis are walkig, cyclig ad swimmig. Begi ay exercise by stretchig to warm up. To get ay beefit, aerobic exercise must be doe for a prologed period (20-30 miutes) two to three times a week. You are at a good level if you start to sweat ad ca still hold a coversatio at the same time. Check with a doctor before begiig ay regime. These exercises doe correctly ad cosistetly will provide some relief from the pai of arthritis, help with good posture, ad icrease your eergy ad vitality. Warm water exercise Getle exercise ca be carried out i hydrotherapy pools that will usually be heated to roud 34 degrees cetigrade. The warm water soothes the joits, relieves stiffess, ad promotes better blood circulatio. The water eables getle ad low-impact exercise, ad also offers the resistace eeded to keep muscles ad joits i shape. As with ay exercise programme, cosult your GP before you begi this type of exercise. It is very importat ot to overdo thigs. Rest your joits especially whe they are iflamed or particularly paiful. Restig paiful joits will make them more comfortable, but too much may make them stiff. You eed to strike a balace betwee rest ad activity. Check out Arthritis Irelad s Take Cotrol with Exercise DVD ad book, a tried ad tested exercise programme for people with arthritis. For more iformatio visit www.arthritisirelad.ie Because the water supports your weight, the rage of movemet i your joits should icrease ad pai decrease. Most hydrotherapy pools rage i depth ad if you caot lower yourself ito the water, there will usually be a hoist. 18
A healthy diet Your body eeds a rage of utriets, so make sure you eat a healthy, balaced diet. Iclude lots of fruit, vegetables, pasta, pulses (such as beas ad letils), fish ad white meat. Try to also cut dow o sugary ad fatty foods. There is a lot of debate about whether what you eat affects arthritis certai foods may help. Studies o essetial fatty acids (foud i oily fish) show that they ca ease joit pai ad stiffess. Try to iclude more of these i your diet ad cosider takig a supplemet. Some people claim that some foods seem to make their iflammatio or pai worse. If you ca work out which food is the trigger, talk to your doctor for advice. It is importat you do t miss out o essetial utriets. Research i this area is complicated ad much more eeds to be doe. If you are cosiderig a diet, talk it over with your doctor or dietitia first. Beware of diets that claim to cure osteoarthritis, ad ever begi a diet that ivolves stoppig medicatio without discussig it with your doctor. Supplemets For more iformatio read Arthritis Irelad s booklet Healthy Eatig ad Arthritis or visit www.arthritisirelad.ie People with arthritis ofte take a huge rage of supplemets icludig herbal remedies, homeopathic medicies, vitamis, mierals ad dietary supplemets. May people with osteoarthritis believe they do offer relief. So far there is little evidece they improve arthritis or its symptoms, though recet fidigs for omega-3 fatty acids ad glucosamie are promisig. Before you start takig supplemets: fid out as much as you ca remember that supplemets will ot cure arthritis check with your doctor or pharmacist for iteractio with prescriptio drugs tell your doctor if you are takig ay supplemets ad report ay side effects immediately 19 www.arthritisirelad.ie
keep a record of how you feel so you ca see if they are havig a effect buy brads from reputable maufacturers cosider the cost takig supplemets ca be expesive. Below are a few of the supplemets most commoly take by people with osteoarthritis. I drik lots of semi-skimmed milk ad take a supplemet to keep my boes strog Glucosamie Glucosamie is popular with people who have osteoarthritis. It is a atural substace extracted from crab, lobster or praw shells. While it does ot cure arthritis, some people believe that it does help ease pai ad stiffess. There is ot much scietific evidece to support this at this stage. If you have t see a improvemet after two moths, it probably wo t help you. There are o kow major side effects, but lesser oes iclude ausea ad idigestio. Glucosamie, which comes i capsule form, is ofte take i combiatio with chodroiti. 20
Chodroiti Chodroiti sulphate exists aturally i our bodies ad is thought to give cartilage elasticity ad to slow its breakdow. I supplemet form it is derived from the trachea of cattle or sometimes shark cartilage. Do t expect to see ay improvemet for at least two moths. If you have severe cartilage loss you probably wo t get ay beefit. There do ot seem to be ay serious side effects, but mior oes iclude ausea ad idigestio. It could icrease the chaces of bleedig if you are takig ay blood-thiig drugs. The log-term effects are ot kow. Fish oils Fish oils, like cod liver oil, ca produce a modest improvemet i joit pai ad stiffess ad have a good record of easig the symptoms of osteoarthritis. Recet research has foud that omega-3 fatty acids are effective because they reduce the activity of the ezymes resposible for cartilage damage, ad they switch off aother ezyme kow to cause much of the pai ad iflammatio of arthritis. A daily dose, ofte i capsule form, must be take for at least three to six moths. Ay beefit is lost whe you stop takig it. Care should be take ot to exceed safe levels of vitami A ad D whe takig cod liver oil. Studies still eed to be carried out o the possible log-term toxicity of takig fish oils. Complemetary therapies May people with arthritis have tried a rage of complemetary therapies i additio to the covetioal drugs prescribed by their doctor. However, what works for oe perso may well ot work for aother. There are a multitude of differet therapies. Some are thoroughly reputable ad are regulated by statutory bodies. Other therapies make highly dubious claims with little or o evidece to back them up. 21 www.arthritisirelad.ie
Complemetary therapies ca geerally be used alogside orthodox treatmet, although doctors may vary i their attitudes to them. Ay practitioer of these therapies who advises you to stop usig covetioal medicatios should be regarded with extreme cautio. I had hydrotherapy sessios which were woderful, but by the time I drove 15 miles home, I udid all the good work Complemetary therapies do ot offer a cure for arthritis. They ca, however, help alleviate some of the symptoms such as pai ad stiffess as well as dealig with some of the uwated effects of takig drugs. Complemetary therapies ca play a importat role i ecouragig positive chages i lifestyle ad outlook, such as icreased self-reliace, a positive attitude, learig relaxatio techiques ad appropriate exercises. Lifestyle chages like these may help to stabilise or improve your arthritis. Some of the most popular therapies are listed below. Acupucture may be useful for osteoarthritis. It aims to restore the atural balace of health by isertig fie eedles ito specific acupoits i the body to correct imbalaces i the flow of eergy, thereby relievig pai. The Alexader techique cocetrates o how you use your body i everyday life. By learig to stad ad move correctly, people ca alleviate coditios that are exacerbated by poor posture. Aromatherapy uses essetial oils obtaied from plats to promote health ad well-beig. The oils ca be vaporised, ihaled, used i baths or a burer, or as part of a aromatherapy massage. 22
The Alexader techique really helps my posture ad relieves pai Chiropractors use their hads to adjust the joits of your spie, aimig to improve mobility ad relieve pai. Massage ca loose stiff muscles, improve muscle toe, icrease the flow of blood ad lymph, ad ease tesio. A good massage leaves you feelig relaxed ad cared for. Osteopaths maually adjust the aligmet of the body ad apply pressure to the soft tissues of the body to correct structural ad mechaical faults ad allow the body to heal itself. Tai chi is a o-combative martial art desiged to calm the mid ad promote self-healig through sequeces of slow, graceful movemets. Fidig a good therapist Ask other people with osteoarthritis if they ca recommed a therapist, but remember that what works for someoe else may ot suit you. The Associatio of Complemetary Health Therapists ca also help you fid a qualified therapist, www.irishtherapists.ie. Ask how much treatmet will cost, ad how may sessios you will eed to feel a beefit. Ask if the therapist is a member of a professioal body, what kid of traiig they have had ad how log they have bee practicig. Ask if they have isurace i case somethig goes wrog. They must take a full medical history. Tell your therapist about ay drugs you are takig, ad your doctor about the therapy. Do t stop takig prescribed drugs without talkig to your doctor first. For more iformatio see Arthritis Irelad s booklet Drugs ad Complemetary Therapies or visit www.arthritisirelad.ie 23 www.arthritisirelad.ie
Surgery While some people with arthritis will ever eed to have surgery, others fid it is very successful i relievig pai caused by arthritis, improvig mobility ad reducig stiffess. Surgery is usually oly cosidered after all other suitable treatmet optios have bee explored ad whe the joit is badly damaged by arthritis. Surgery ca be mior to assess damage doe or to smooth joits ad repair cartilage (kow as a arthroscopy), or it ca be more itrusive to replace or to fuse a joit. I still have a bit of pai sice my op, but it does t limit me like it used to There is a risk the operatio wo t work, or will lead to further physical complicatios. Recovery may take some time ad a lot of effort o your part. However, may people decide that the positive effects o their lifestyle will outweigh ay risks. Havig surgery could brig about a dramatic improvemet i your pai levels ad quality of life. Surgery ca also prevet joits deterioratig further ad prevet disability. I spite of great progress with artificial joits, may people with osteoarthritis who have had surgery still live with difficulties ad pai because of their coditio. For more iformatio see Arthritis Irelad s booklet Surgery ad Arthritis or visit www.arthritisirelad.ie 24
PRACTICALITIES Livig with osteoarthritis may ot be easy, but there are plety of sources of help ad there is plety you ca do to help yourself. At home There are may ways you ca set thigs up at home to make sure that daily livig is as streamlied ad stress-free as possible. Do t let your pride get i the way of usig equipmet that may really help you I the kitche, for istace, this might iclude: rearragig cupboards ad drawers so the thigs you use the most are earby lightweight pas, mugs or a kettle equipmet with easy-to-use buttos a electric ti opeer, a cap gripper, or kives ad peelers with padded hadles a stool to sit o while you are preparig food, or a trolley for movig heavy items 25 www.arthritisirelad.ie
devices for turig taps more easily eveig-up your worktops, or raisig the ove ad fridge, so they are at the right height for you ad you ca slide thigs aroud. Arthritis Irelad s Easy to Use Programme provides iformatio ad advice o practical, easy to use products ad services that ca make it easier for you to live day to day with your arthritis. Visit www.arthritisirelad.ie for further details o these products. Help with costs You may be able to get help with equipmet or adaptatios to your home. The Housig Adaptatio Grat for People with a Disability, the Mobility Aids Grat Scheme ad the Housig Aid for Older People Scheme are admiistered by your local authority. For further iformatio o these schemes ad to see whether you are eligible for help cotact the Housig Departmet of your local authority. There is o hard ad fast rule o what you will get: followig assessmet you will be told what you are etitled to receive ad you may have to cotribute towards the cost. You may also have to wait a log time for a assessmet or to get equipmet. If your eeds chage, cotact your local authority so they ca move you up the waitig list. Work Oly you ca decide how much you wat to tell people at work about your arthritis. It may ot affect your work at all - other tha time off for hospital appoitmets or surgery - but hidig it ad strugglig o if you have difficulties could make your arthritis worse. For more iformatio ad support o workig with arthritis check out Arthritis Irelad s dedicated website www.fitforwork.ie The best policy is to be positive, hoest ad clear about your eeds, ad help people uderstad what arthritis meas for you. 26
Smarter ways of workig will help protect your joits ad coserve eergy. They ca iclude: Orgaise your work rearrage the work area, use computer equipmet correctly, take regular breaks, relax, pace yourself ad vary tasks. Be flexible perhaps workig a shorter day or fewer hours, or beig based at home some of the time if that fits i with your job. I ve got a good, comfortable chair ad my desk is set up correctly, which makes such a differece Take regular movemet breaks for example, walkig to the photocopier or water foutai. No-oe eeds to kow you are doig this for a movemet break. Pace yourself do t overdo it. Take your aual leave ad try to spread it out over your caledar year. You may eed to use leave for rest at times. Pace yourself i what you eed to do after a workig day. You may eed to cut back o household chores ad prioritise time for rest/ light exercise/ social outigs. Take your break times always ad try to leave the buildig for a short period of light exercise if possible. For more iformatio see Arthritis Irelad s booklet Workig with arthritis, back pai & related coditios: a guide for employees or visit www.fitforwork.ie 27 www.arthritisirelad.ie
Trasport People with osteoarthritis ofte fid gettig out ad about difficult. May rely o cars either drivig themselves or gettig lifts or public trasport to get aroud. There are a few thigs you ca try to make drivig easier. A automatic gearbox ad power steerig will reduce strai. Mior adjustmets, such as a padded steerig wheel, a headrest, extra side-mirrors or a wide-agled mirror may make drivig easier. There are various meas tested supports available through the HSE icludig grats for adaptig a vehicle, the Disabled Perso s Parkig Card ad tax relief for ecessary adaptatios to vehicles. The Irish Wheelchair Associatio (tel: 045 893 094 or www.iwa.ie) ad the Disabled Drivers Associatio (tel: 094 936 4054 or www.ddai.ie) provide advice ad iformatio o all aspects of motorig. If you would like to lear to drive or have lost cofidece i your drivig skills, the Motorig Advice ad Tuitio Service i the Irish Wheelchair Associatio ca provide assistace to you. If you are relyig o public trasport you ca apply for the Free Travel Pass, which allows you to travel for free o all public trasports ad selected private services. 28
Beefits The Citizes Iformatio Board offer a comprehesive booklet that outlies all etitlemets for people with a disability, icludig rights relatig to work, educatio ad traiig. You ca get this booklet, Etitlemets for People with Disabilities, by visitig your local office or cotactig them o LoCall 1890 777 121 or www.citizesiformatio.ie. You may be able to apply for state beefits to help with the extra costs of havig arthritis or if you are uable to work. Some of the mai disability-related paymets are: Social Isurace Paymets Illess Beefit: Illess Beefit was previously called Disability Beefit. This is a short-term paymet made to people who are uable to work due to illess. It ca be paid i the log-term. To qualify you must be aged uder 66 ad uable to work because of illess. Your PRSI cotributios or credits must be up to date. Ivalidity Pesio: Ivalidity Pesio is payable for as log as you are uable to work. At the age of 65, the persoal rate of paymet icreases to the same rate as State Pesio (Trasitio). At age 66 you trasfer to the State Pesio (Cotributory). Other beefits: Livig Aloe Icrease is payable regardless of age if you live aloe. You may also qualify for free travel ad the Household Beefits Package which icludes allowaces towards household bills. 29 www.arthritisirelad.ie
Rehabilitative work: You may be allowed to do rehabilitative or therapeutic work (maximum 20 hours a week) ad retai your Ivalidity Pesio. You must get prior writte approval from the Departmet of Social Protectio before you start work. The Treatmet Beefit Scheme: A scheme ru by the Departmet of Social Protectio that provides detal, optical ad aural services to people with the required umber of PRSI cotributios. Meas-Tested Paymets Disability Allowace: This is a log-term meastested paymet made to people with a disability. The disability must be expected to last at least a year. You may be etitled to Disability Allowace if you are aged betwee 16 ad 66, satisfy both a meas test ad a habitual residece test, ad have a specified disability which results i your beig substatially restricted i udertakig suitable employmet. Your meas ad that of your spouse or parter are take ito accout. Your parets meas are ot cosidered. You may qualify for a Livig Aloe Icrease ad the Household Beefits Package which icludes allowaces towards household bills. If you are awarded Disability Allowace, you get a Free Travel Pass automatically. This allows you to travel for free ad your spouse or parter to travel free i your compay. If you are medically assessed as beig uable to travel aloe you may be etitled to a Compaio Free Travel Pass. Health Service Medical Cards: Most medical cards are grated o the basis of a meas test ad/or medical eed. Each case is decided o its merits but you may qualify if your icome is ot much above the guidelie figure ad your medical costs are exceptioally high. It may be possible for oe or more members of a family (who would ot otherwise qualify) to get a medical card i their ow right if they have high medical expeses or eeds. GP Visit Cards: The purpose of the card is to help people who are ot eligible for medical cards with the 30
costs of visitig a doctor. The card covers you for GP visits but othig else. The icome guidelies for the GP visit card are 50% higher tha the medical card icome guidelies. Drugs Paymet Scheme: With a Drugs Paymet Scheme (DPS) card, a idividual or family i Irelad oly has to pay a maximum amout mothly for approved prescribed drugs, medicies ad certai appliaces. As of Jauary 2017, the maximum amout a family must pay is 144. Everyoe i Irelad who does t have a medical card should apply for the DPS card. Hospital Charges: Everyoe residet i Irelad is etitled to be treated free of charge i a public bed i a public hospital. Some people may have to pay maiteace charges. Out-patiet services, whe you are referred by your GP, are also provided free of charge. Tax relief: You may get tax relief o certai health expeses, which you have icurred ad for which you have ot bee reimbursed. The tax relief is at the stadard rate of tax of 20%. So, if you spet 1,000 you would get a refud of 200. This claim should be made o a Med 1 form, available from your local tax office or olie at www.reveue.ie. Claimig beefits ca be complicated ad time-cosumig, so it s worth gettig expert help ad advice from: a social worker from your local Health Office. a housig welfare officer from your local authority your citizes iformatio service: LoCall 1890 777 121 your local social welfare office the Leaflet Request Lie i the Departmet of Social & Protectio: LoCall 1890 20 23 25 olie at www.hse.ie. There are may ways i which you ca lear to maage your osteoarthritis effectively ad there is a lot of help available. You ca lear to cotrol your arthritis rather tha let it cotrol you. If you have ay questios about livig with osteoarthritis, cotact Arthritis Irelad s Helplie o LoCall 1890 252846 Moday to Friday from 10am to 4pm. 31 www.arthritisirelad.ie
CARING FOR YOURSELF Your emotios Everyoe s experiece of arthritis is differet. Not all people experiece the same symptoms, level of pai or fatigue or the same feeligs. Do t be surprised if you feel frustrated oe day ad perhaps agry the ext. The ivisibility of pai is most frustratig It is good to let your emotios out. Bottlig them up ca make thigs worse. Pai ca usually be cotrolled; stiffess ad iflammatio relieved, ad there are ways to overcome the loss of stregth, grip ad mobility. Some people fid that their lives do ot chage that much ad that they ca more or less carry o as ormal. Some people become stroger ad more For more iformatio see Arthritis Irelad s booklet Copig with Emotios or visit www.arthritisirelad.ie determied as a result of havig to adapt their lives to fit i with their arthritis everyoe is differet. Your ow reactios to arthritis will differ from week to week, but it is perfectly atural to feel out of sorts sometimes. Your relatioships Sharig iformatio about your coditio with family ad frieds ca really help them to uderstad what you re goig through. They may really wat to help, but ot kow how. You may be worried about lettig them dow or about depedig o them too much. Talkig ad listeig is the 32
key. Explai how your arthritis affects you ad be as clear as you ca about how you are feelig. Relatioships may come uder a bit of strai. If you have a parter, talk to them about how you feel, both physically ad emotioally ad ecourage them to ask questios. Nothig is more aoyig tha whe someoe says: But you look so well If you are feelig stiff or havig trouble movig aroud, it is hard to be spotaeous; eve a hug ca be difficult if you are i pai. There will be times whe you are just too tired or paiful to get close to your other half, but there are alteratives. Try differet positios or supportig your body with pillows ad cushios to make love-makig more comfortable. A warm bath or shower beforehad will help to loose your joits. You could eve try persuadig your parter to give you a getle massage. Do t be embarrassed to raise the issue with your healthcare team. 33 www.arthritisirelad.ie
Livig well From time to time, your arthritis will get o top of you. Ager, frustratio, ucertaity, depressio ad fear are all very uderstadable ad very commo. Several thigs may help: If I go out socialisig, I accept I might feel a bit off colour the ext day try to build a good relatioship with your health professioal fid out as much as you ca about your arthritis. It will make you feel less worried about the future accept your limitatios. Remid yourself about what you ca do ad ejoy, rather tha the thigs you ca t try to make space for your social life iclude exercise i your day. It will build your stregth, help you to keep flexible ad boost your mood talk to somebody who uderstads how you are feelig. This could be someoe close to you or someoe else with arthritis. 34
SUPPORT FROM ARTHRITIS IRELAND You ca lear more of the skills that will help you deal with Arthritis o oe of Arthritis Irelad s self-maagemet programmes. Livig Well with Arthritis, our most popular course, focuses o what you ca do for yourself, how to get the most from you health professioals, hadlig pai, fatigue ad depressio, relaxig ad keepig active. It is a great chace to meet ad share tips with other people who kow what you are goig through. Lookig for somebody to speak to about livig with arthritis? Why ot give the Arthritis Irelad Helplie a call. All our voluteers are livig with arthritis ad as such have a strog uderstadig of what it is like to live with a lifelog coditio like arthritis. They would be happy to hear from you if you are i eed of a listeig ear. Call 1890 252 846. 35 www.arthritisirelad.ie