Rheumatoid Arthritis

Rheumatoid arthritis is potentially the most serious of the three chief diseases. However, many victims have only mildly annoying trouble. The disease characteristically occurs in attacks of joint pain and swelling, weakness, fatigue, and stiffness, especially in the morning. The attacks may last for weeks, months, or years, but usually the intensity of the disease fluctuates. The disease varies in severity from time to time, seldom completely disappearing, though a few people have recovered completely. A very small percentage of patients have severe, steadily-worsening arthritis that finally results in crippling and deformity. Rheumatoid arthritis is indeed a capricious disease.

The best treatment of rheumatoid arthritis includes a variety of different methods and techniques. When applied in a comprehensive daily program it is very effective. Dependence on any one drug or other single means of treatment is doomed to failure. Rest is a cardinal principle of management and is usually prescribed as a number of hours per day. Details of rest are outlined by the physician or physical therapist. Rheumatoid arthritis is a disease of the whole person, and rest must include the mind and the body as well as the inflamed joints. The bed should be firm; pillows under the knees or back should be avoided. The feet should be supported by a footboard. The bed is easier to get in and out of if blocks six to eight inches in height are placed under the casters. Plaster of Paris splints are used for severely inflamed joints to assure proper rest.

Rest is alternated with exercises and activity. Prescription of the proper balance is the physician's responsibility. Specific exercises are prescribed, among which are muscle strengthening exercises. Joint deformity can be prevented by daily putting the joints, actively or passively, through a full range of motion. The paradox of alternately using exercises and rest puzzles many patients. The arthritic requires both. However, if pain lasts for more than 15 to 20 minutes after exercise, it has been too much.

Rest is necessary to reduce joint inflammation but exercise is required also to retain muscle and joint function and prevent insidious and gradual onset of deformity. Many patients believe they "must keep moving" for fear of "stiffening up." This is not the case; proper balance of rest and exercise is the keynote.

Warm or hot tub baths once or twice daily are helpful. Hot towels wrung out of hot water, applied to the joints and then wrapped in plastic sheets, provide muscle relaxation. Infrared lamps are useful when applied at an 18-inch distance. A towel may be put over the joint being treated. This does not interfere with penetration of the rays, but does avoid skin burn.

Other methods of treatment and aids to the patient include hot paraffin to hands and feet; special splints for specific joints; contrast baths, hot and cold; surgical procedures for certain joints; elevation of the chair the patient sits in, and a special elevated toilet seat. Joint care entails positioning in bed, postural exercises, diet for reduction of body weight, and prescription of certain kinds of work to exercise the joints and muscles.

Education about the characteristic and expected behavior of the disease is very important in order to help the patient anticipate in a general way what his future is to be and to learn how to deal with his problem in a positive and predictable way. A patient who has experienced pain and disability for years will understandably grasp at any straw that promises relief. He should be warned against quackery and the use of expensive and ineffective drugs or appliances.  The family members of the patient with rheumatoid arthritis are his most important allies. They should be trained in home care and instructed in special techniques of treatment. They should understand the nature of the disease, and participate in the over- all treatment program.