Taking care of RA
A diagnosis of any medical condition can be difficult. It’s important to understand that, while there is no cure for arthritis, there is a lot you can do to manage your disease. Treatment in the past number of years has greatly improved, allowing many people to function at normal or near-normal levels. When you are diagnosed with RA, you are bound to have questions about what the future holds for you. One of the most unpredictable things about RA is that symptoms can come and go.
What is a flare?
A flare is a severe episode of inflammation. It occurs when you have painful or swollen joints that won’t settle down, or your pain is increased. You may find it very hard to move, especially when you wake up. You may also feel generally unwell and very fatigued. Flare-ups can last a couple of days but they can also stretch to a month or so.
Over time, you may be able to notice the warning signs of a flare, although this does not always happen. One of the most frustrating things about RA is that it is unpredictable – a flare can happen at any time.
How do I know if I am in a flare?
Signs to watch for:
- Your morning stiffness lasts longer than usual
- You’re more tired than normal
- Your blood tests report high levels of inflammation
- Symptoms become more severe lasting more than two days
- Increased swelling, stiffness and pain in your joints and muscle groups
- Disturbed sleep
- Difficulty managing your routine and daily activities
By recognising that you are experiencing a flare early, you can get a head start on managing it.
What can bring on a flare?
- Another illness, such as an infection
- Medication – Are you taking your medication correctly? Perhaps you may need more or different medication
- Overdoing it
- Overusing a joint
How do I manage a flare?
- The first thing you can do in managing a flare is to realise that you are having one. By recognising that you are having a flare you can get an early start on managing it.
- Keep a diary of your symptoms – this will help your healthcare team to see if there are any triggers.
- Take painkillers if needed.
- Try to control stress levels.
- Hot packs, heating pads, paraffin wax baths (for hands), warm tub baths, showers or warm water pools can all help the joints feel better. Ice packs or running cool water on the joints a few times a day can help reduce pain and swelling.
- Do gentle range of motion exercises.
- Use breathing techniques.
- Try to get a good night’s sleep.
- Use an electric blanket if you find it helps morning stiffness.
- Don’t be afraid to ask for help.
- Strike a balance between rest and activity.
- Plan and prioritise your daily activities – you will be less likely to get carried away and overdo things.
- Break bigger tasks into smaller, more manageable ones.
- Speak to your healthcare team.
When should I contact my healthcare professional?
This is a very individual decision and, over time, you will get a better understanding of your RA and what is normal for you. While everybody is different, if you are experiencing a flare that is not settling down and the pain is severe enough to interfere with everyday life, it is advised that you contact your medical team. If in any doubt, call your rheumatology nurse, GP or rheumatologist. They will be able to offer you advice based on your own medical case.
How can I cope with pain?
Pain from arthritis can be felt for a variety of reasons. Inflammation in the joint causes heat, redness, swelling and loss of movement, and can often cause pain. Damaged joints can be painful as well. Pain is a very personal experience. It can range from a dull ache to short stabs, and, for some, it comes and goes. There is a lot you can do to develop the tools, skills and resources to help you break the pain cycle and help you to self-manage your arthritis. Some useful things to help manage pain include:
- Gentle exercises
- Gentle massage
- Splinting (supporting) an inflamed joint for a short period of time to allow it rest
- Striking or achieving a balance between rest and activity. Try to focus on something other than the pain – such as phoning a friend, watching TV, listening to a relaxation tape
- Relaxation – ease tension. Take time out to read, take a bath, listen to music or other activities you find relaxing
- Using a TENS machine (This is a battery-operated unit that sends small electrical currents through pads placed on the skin over painful areas. These currents may help to relieve or control pain)
- Try to be patient. It may take a little while for things to settle down.
Take care of your joints
It’s important to start looking after your joints as soon as you know that you have RA. Be clever about how you use your joints.
Tips on how to use your body more effectively:
- Make the job as easy as possible – use gadgets or products that take the effort out of the task e.g. dishwasher/frozen vegetables/electric toothbrush.
- Spread the load – use both hands to lift and hold instead of one.
- Use less effort to do the job (use the microwave instead of the oven).
- Don’t grip things too tightly – this puts extra pressure on your joints.
- Avoid sitting in one position for a prolonged time as this may increase stiffness.
- Be aware of your posture – if you slouch, the weight of your body falls forward, putting added strain on muscles and joints.
- Use your strongest joints for any activity rather than using your smallest i.e. use the palm of your hand to push instead of the tips of the fingers.
One of the biggest challenges for people with RA is fatigue and learning to manage it. Most people feel tired after a hard day, but the fatigue that comes with RA is different. Fatigue is a feeling of extreme tiredness and exhaustion. You may experience feelings of heaviness, have tired muscles, increased pain and have no energy.
This can affect your mood and motivation also. You may feel so exhausted you feel unable to carry out normal, everyday activities and have difficulty concentrating but this can be helped by pacing and light exercise.
Fatigue tends to be worse during a flare-up, but can vary from a stubborn, ongoing tiredness to a sudden drop in energy that leaves you completely wiped out. It may mean you are too tired for even simple tasks. That can be extremely frustrating.
Like pain, fatigue can vary a lot and may have a number of causes:
- Your disease is active and you are experiencing a lot of inflammation, which release chemicals that consume energy
- Some medications used in the treatment of RA can cause fatigue
- Your medication may not be right for you
- Pain can increase your fatigue
- A poor diet or missing meals
- Anaemia – not having enough iron in the body
- Overdoing things or being under-active
- Too much or too little sleep
- Poor fitness
Things you can do to combat fatigue:
- Follow a healthy balanced diet and make sure your energy intake is good. Food is your body’s fuel and you need it to keep going.
- Prioritise – plan ahead, schedule time for rest breaks. Cut out unnecessary exertions and efforts.
- Learn to say no – you don’t have to say yes to everything. By saying no, you can choose to focus on the things you enjoy.
- Pace yourself avoid doing too much or too little and try to conserve energy. Do the same amount of activity each day, building up the activity level slowly if necessary. You do not have to give up any activites that you are currently doing.
- Balance heavy and lighter activities throughout the day and week.
- Learn the balance between exercise and rest. Knowing when you need to rest is important. Overdoing activity or under doing activity may bring on a flare.
- Keep active – when you are exhausted it is tempting to cut down on exercise, but muscles in poor condition will tire sooner than stronger ones. Light regular aerobic exercise can help to reduce fatigue.
- Get a good night’s sleep – only you know how much sleep your body needs. If you need to nap, get into bed, set an alarm and aim for 20 or 60 minute nap durations. This is the best for a normal sleep cycle. Napping for longer can leave you feeling more wiped out.
- Speak to your healthcare team – they might check to see if something else is causing your tiredness and can help you learn how to manage your fatigue.
- Be open about your emotions – talk openly about your feelings and relationships with someone who understands such as friend, family member or the Arthritis Ireland helpline.
- Ensure you are taking your medication correctly.
Getting a good night’s sleep plays an important role when living with RA. Sleep allows your body to get the rest it needs. When you sleep, your body secretes hormones that repair the wear and tear you’ve done throughout the day.
People living with RA are more likely to have broken sleep than others. Getting a good night’s sleep is sometimes easier said than done. If you’re not sleeping properly, it’s important to find out why. Poor quality sleep can make pain and fatigue worse. It’s important to talk to your healthcare team if you’re not sleeping properly. The cause could be something related to your medication, such as taking steroids late at night which can keep you wide awake. Or it could be the pain itself, causing you to wake. The amount of sleep we need varies from person to person. Some people need eight hours while others need only a few hours.
A poor night’s sleep can make managing your arthritis more difficult. Here are some tips to improve your sleep routine:
- Relax before bed – take some time to wind down.
- Have a routine – go to bed and get up at the same time each day.
- Have a relaxation phase before going to bed, avoid going to bed stressed or straight after activity. Take a warm bath or shower/ do a relaxation exercise or listen to music.
- Take a warm bath or shower before bed – this may help to ease pain.
- Make sure the bedroom is a haven of peace and ease. Remove clutter or any reminders of stress.
- Minimise noise and light by using ear-plugs and eyemasks.
- Reduce your fluid and caffeine intake; and avoid alcohol before bed.
- Avoid using gadgets in the bedroom or before going to sleep – for example, TV, phone, computer.
- Use a good quality pillow to support you neck and shoulders.
- Don’t toss and turn – if you are unable to sleep after 20 or 30 minutes, get up but avoid doing anything that stimulates the brain such as watching TV.
- Exercise regularly but not in the three hours prior to bedtime. This can help with getting a good night’s sleep.
- Ensure muscles are as relaxed as can be – deep breathing and other relaxation techniques may help with this.
Your body needs a range of nutrients, so make sure you eat a healthy, balanced diet. Include lots of fruit, vegetables, pasta, pulses (such as beans and lentils), fish and white meat. Cut down on sugary and fatty foods. Eating well will also help you lose excess weight, which can put extra strain on your joints. Every kilogram of excess weight a person carries puts four extra kilograms of pressure on the joint. Healthy weight loss is one of the major benefits of healthy eating for people with arthritis.
The most important link between your diet and arthritis is your weight. Being overweight puts an extra burden on weight-bearing joints (back hips, knees, ankles and feet). Maintaining an appropriate weight will help you more than any food supplements. If you are overweight and have arthritis, consider a balanced diet as a way to help you achieve and maintain a healthy weight.
For others, healthy eating may give you the energy to complete your daily activities. Proper nutrition is vital to controlling body weight and managing arthritis symptoms. As someone living with arthritis, you are, unfortunately, at a higher risk for developing other conditions such as obesity, diabetes and heart disease. Maintaining a healthy diet will help reduce this risk.
If you are thinking about dieting, talk it over with your doctor or dietician first. Beware of diets that claim to cure arthritis, and never begin a diet that involves stopping medication without discussing it with your doctor first.
There is a lot of debate about whether what you eat affects RA. Certain foods may help. Studies on essential fatty acids (found naturally in oily fish) show that they can ease joint pain and stiffness – though it might take several months. Include more of these foods in what you eat, and consider taking a supplement.
Some people notice that certain foods make their arthritis flare up, but this is unusual. If you notice this, and can work out which food is the trigger, it makes sense to avoid it. Try removing it from your diet for about 3-4 weeks and then reintroducing it. If you do have food intolerance you’ll notice a flare-up in your arthritis within a few days.
Make sure you don’t miss out on essential nutrients. Get medical advice if you are unsure, and don’t assume that what works for someone else will work for you.
Alcohol and RA
There is some evidence that small amounts of alcohol provides some protection against RA but it is not recommended to have alcohol as part of a healthy diet.
If you do drink, spread your drinking over the week and stick to the recommended limits i.e 17 standard drinks a week for men and 11 standard drinks a week for women. Alcohol in moderation does not seem to interfere with RA.
However, there are some medications that can interact with alcohol and so it is important to discuss this with your nurse or doctor. Loss of bone density has been reported in people who consume large amounts of alcohol.
Smoking and RA
Cigarette smoking, whether you have RA or not, has no positive effects on any aspect of your health. People living with RA are strongly discouraged from smoking as it makes symptoms worse. Studies have shown that smoking is associated with poor long-term outcomes. Research has also shown that smoking increases the risk of heart of disease, putting people living with RA at a higher level of risk.
For more information, see Arthritis Ireland’s booklet “Healthy Eating and Arthritis”.
If you are a smoker, one of the best things that you can do for your overall health is to quit. If you need help or advice about quitting, contact the National Smokers Quit
Line on 1850 201 203 or visit www.quit.ie. Many local hospitals also run clinics to help you quit.
People with RA often take supplements, including herbal remedies, homeopathic medicines, vitamins, minerals and dietary supplements.
If you decide to try these therapies or supplements, you should take note of whether or not they seem to help you. Base your decision to continue taking them on whether you notice any improvement.
Before you start taking supplements:
- Find out as much as you can about the ones you’re considering.
- Remember that supplements will not cure arthritis.
- Check with you doctor or pharmacist to see if it’s ok to take along with your prescription drugs.
- Tell your doctor if you are taking any supplements and report any side effects immediately.
- Keep a record of how you feel so you can see if they are having an effect.
- Buy brands from reputable manufacturers.
- Consider the cost – taking supplements can be expensive.