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:

By recognising that you are experiencing a flare early, you can get a head start on managing it.

What can bring on a flare?

How do I manage a flare?

 

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:

 

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:

 

Fatigue

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:

Things you can do to combat fatigue:

 

Sleep

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:

 

Healthy Eating

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.

 

Supplements

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: