http://www.nationmultimedia.com/life/Losing-your-grip-30182648.html
Christian Vey
Deutsche Presse-Agentur
May 24, 2012 1:00 am
Basic therapies can help rheumatoid arthritis sufferers
The most bothersome thing about rheumatoid arthritis is that the simplest of hand movements are limited. “You can’t really grip anything tightly,” says Birgit Schmidt, spokeswoman for the Hamburg branch of the German Rheumatic League. “You constantly hurt yourself handling heavy and hard objects.”
What is more, she said, certain movements are hardly possible anymore because they are too painful. Even the twisting motion when opening the screw-on tops of bottles and jars is a challenge. Schmidt is in her mid-50s, and for the past 24 years she has had rheumatoid arthritis, a chronic inflammatory disorder that typically affects the small joints of the hands and feet.
In her case, mainly the joints of the hands and fingers are affected – or to be more precise, the lining of the membranes that surround the joints. “The inflammation is very aggressive. It attacks the surface of the cartilage in the joints and damages tendons and ligaments,” says Stefan Renhart, president of the German Society for Orthopaedic Rheumatology.
The joints become unstable and misaligned. And the inflammation causes effusion, a build-up of intra-articular fluid that manifests itself as swelling in the joints and tendon sheaths. Many people with rheumatoid arthritis often lapse into postures that relieve the pain, which aggravates the problem because muscles and joints are not moved correctly. There is then increased risk of permanent joint deformation.
Although rheumatoid arthritis cannot be cured, “a mosaic-like therapy can get the disease under control,” Renhart notes, pointing out that basic therapy should consist of several components, namely medications and ointments, ergotherapy and physiotherapy. “All of these measures are aimed at putting off surgery for as long as possible,” he says.
According to Renhart, new medications developed over the past 10 years have improved treatment of the disease. If rheumatoid arthritis is detected early, rapid and spasmodic joint deterioration can be prevented, he says. In some cases, the patient can even stop taking medications after a while.
Joint swelling is the first thing that rheumatoid arthritis sufferers notice, followed by pain and stiffness and sometimes by changes in the skin as well. :A medical specialist – an internistic or orthopaedic rheumatologist – should by all means be consulted if symptoms persist for six weeks,” Renhart advised. “It’s important to start therapy as early and thoroughly as possible.”
Rheumatologists, working together with other specialists, draw up a therapy specifically tailored for the patient. This is absolutely necessary, Renhart says, because the course of the disease varies widely. Susanne Bitzer, a Berlin-based specialist in hand ergotherapy, agrees. “Every rheumatic disease is as individual as the patient,” she said. In ergotherapy, as with medications, the particular agents and dosages must be selected individually for each patient.
She said it was important that the patient, while under medical supervision, trained precisely the muscles whose use prevented joint misalignment. But training one’s hands with foam rubber or therapeutic putty is very harmful, she warned, since it fosters joint misalignment. The basic rule, Bitzer says, is: “Movement, yes. Strain, no.”
In ergotherapy, rheumatoid arthritis sufferers also learn how to organise their daily routine in order to keep their condition from worsening. “They’ve got to change some of their automatic ways of behaving,” Bitzer remarks. “It starts by considering how to lighten their shopping bags.” She says that aids at home and at work – nonslip, enlarged handles, for example – could help to preserve joint stability and mobility as long as possible, too.
“The need for surgery has greatly diminished,” notes Richarda Boettcher, an advisory board member of the German Society for Hand Surgery. In particular, reconstructive surgery, which is performed when joint deformations have become so great that the patient is no longer able to perform everyday tasks, is becoming increasingly unnecessary, she says.
Surgery is unavoidable for some patients, however. Most surgical procedures for people with rheumatoid arthritis of the hands does not involve joint replacement. Instead, inflamed tissue is removed or the position of tendons and ligaments is corrected. Sometimes joints are surgically fused. “Then they’re less mobile, but they’re stable again,” Boettcher says.
As for Birgit Schmidt, she underwent joint fusion surgery. “I’ve had to get used to limitations,” Schmidt said, adding that she had so far managed to avoid severe deformations thanks to medications, ergotherapeutic exercises and a few tricks at home and at work.
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