Inflammatory Joint Diseases
Rheumatoid arthritis is a chronic inflammatory disease involving many joints simultaneously (polyarthritis), and most commonly involving the small joints of the hands and feet, in a symmetrical fashion (ie: both wrists, both ankles). The affected joints become painful, swollen, stiff and in some cases deformed. The effects of disability are generally more severe than in osteoarthritis. Its onset is most often in a younger age group than those affected by osteoarthritis - even in childhood - but it may start in the older person. Many complications (in adults and children) may be found in severe arthritis which involve various parts of the body, including the heart, small blood vessels, the lungs, kidneys, eyes and spleen.
In juvenile chronic arthritis (Still's disease), the disease tends to affect the larger joints and growth can be impaired. Prognosis (outcome) is more favourable than in rheumatoid arthritis. For the majority of children the disease will "burn out" by the age of 16 or 18. Response to surgery such as hip or knee replacement is usually successful.
Other diseases which manifest principally as a chronic polyarthritis are psoriatic arthritis, reactive arthritis (Reiter's Syndrome), and ankylosing spondylitis.
Psoriatic arthritis is similar to rheumatoid arthritis, the main difference being that it is usually associated with the skin condition psoriasis, and usually leads to less overall joint disablement. Rarely it can give rise to a particularly severe form of arthritis with severe joint destruction and resulting gross disablement when care needs will be at least as great as those described for severe rheumatoid arthritis.
Reactive arthritis is a polyarthritis found in association with certain infections in other parts of the body. These are often in the gut or the urogenital system.
Ankylosing spondylitis mainly involves the joints of the spine, is commoner in men, and often leads to a stiff and rigid spine. Symptoms may become worse with time, spreading from the low back to mid back and then the neck. Unless other joints than the spine are involved care needs and mobility considerations will be similar to those in people with the painful back
Care Needs
(i) In rheumatoid arthritis there is characteristically a prolonged period of joint stiffness in the morning on arising from bed, and after sitting in a chair for some time. During these periods of joint stiffness the affected person has to "limber-up" slowly and so may need help with dressing, rising from bed/chair, and washing. Bathing or showering in the morning may assist in the "limbering-up" process, and help would be required for this. The duration of morning stiffness often exceeds an hour in those with active inflammation of several joints. Even in remission, between the flare-ups, damaged joints may be painful and stiff in the mornings causing difficulties in taking medication, bathing and dressing
(ii) Damage to the joint structure may result in weakness of ligaments, tendons and surrounding muscles, causing the hands and wrists to be weak with markedly impaired grip and loss of dexterity. Involvement of the finger joints may also seriously impair grip and manual dexterity, preventing the person from handling utensils, and making it difficult to cut food. In the early stages there may only be slight impairment of manual dexterity but help may be needed in the preparation of meals. If the shoulders and neck are affected this, too, may lead to difficulties with washing, dressing, cutting up food, and eating. Putting on and taking off outdoor clothing, splints (when used) and collars may also pose problems.
(iii) Except in those with highly active disease, there should be little need for attention at night for such activities as toileting and turning in bed. During flare-ups, however, when splints and collars are used at night, removal of these to attend to toilet needs may be difficult. Help may also be required, in these circumstances, for taking pain relief medication.
(iv) Due to disuse atrophy (ie wasting of muscles) because of painful lower limb joints, falls can be a problem, generally in the older person.
(v) In ankylosing spondylitis, because of back stiffness, assistance may be needed with lower garments when dressing and in getting in and out of the bath.
Mobility Considerations
(i) Walking may well be impaired in those with active inflammation of joints in lower limbs. When the feet are affected, this may cause severe pain on walking. If knees and hips are involved, standing and sitting can be difficult and painful, and walking more severely limited.
Duration of Needs
(i) The needs of persons with highly active joint inflammation may lessen dramatically when spontaneous remissions occur or in response to drugs. These drug treatments are associated with an improvement in the extent and severity of arthritis. When this occurs it will be likely to do so within about one year's treatment. Patients are most responsive to treatment in the initial stages of rheumatoid arthritis (ie. 2 to 5 years following onset).
(ii) There will be older patients with a longstanding history of rheumatoid arthritis in whom the disease may be "burnt-out", leaving many of the smaller joints of the hands deformed with poor hand function or resulting in fixed deformities of lower limb joints with impairment of walking ability. In these people the needs will depend upon the overall disablement in the individual case but are unlikely to change throughout the remainder of the person's life. (iii) In the majority of people with rheumatoid arthritis, the disease smoulders on, involving further joints, and slowly increasing levels of disability and associated needs.
For more information, please see our rheumatoid arthritis and ankylosing spondylitis pages.