Rheumatiod Arthritis: Coping With Chronic Health Disorders
Coping With Chronic Health Disorders – Rheumatoid Arthritis: A Case Study Arthritis affects over 10 million people in the UK alone. There are over 200 types with the main types being osteoarthritis and rheumatoid. Osteoarthritis, the most common form suffered by 8. 5 million In the K, is a wasting of connective tissue between bones.
Rheumatoid arthritis (RA), although less common, Is more severe and accounts for less than 10% of arthritis sufferers In the UK (INS [J, 2012). It Is a painful condition causing swelling, damaging bone and cartilage around joints.
Its progression and verity vary greatly between individuals but it can cause serious disability, having a huge impact on ability to carry out tasks in everyday life. For this reason I have chosen to do a case study on the impact on one individual with rheumatoid arthritis. Patient H (referred to H) is female, 70 years of age and has had RA for approximately 17 years.
This case study gives an overview of RA and her experience in coping with the disease. A Joint is a part of the body where two bones meet. The most common are synopsis Joints, the structure of which allows free movement.
In synopsis Joints the ones are covered by cartilage with a slippery surface to reduce friction. The Joint Is surrounded by the reticular capsule; a fibrous capsule holding the bones together whilst allowing movement.
Within this a space between the bones, the synopsis cavity contains synopsis fluid. It Is produced by the synopsis membrane and Is also present in bursar around the joint which allow muscle and tissue to glide (Stouter, 2010). The effect on the synopsis membranes is a primary feature of RA. Rheumatoid arthritis is an autoimmune disease.
The body produces antibodies which attack its own tissue, namely the synopsis membranes of Joints, cartilage, and bursar. The primary symptom is inflammation of the synopsis membrane, which overproduces synopsis fluid as well as releases other chemicals causing more inflammation.
The membrane then produces an additional granular tissue (pants) which bonds to, and can erode cartilage (fig 1) allowing fibrous tissue to Join the bone ends together, ossifying and leading to Manifestation (Tractor & Grosbeaks, 2000). RA tends to affect both sides of the body and Is more likely to affects small and middle sized joints.
Initial symptoms ay Include Joint swelling, pain, morning Joint stiffness, fatigue, poor sleep, weight loss and flu-like symptoms. It affects individuals differently and the disease may present itself in flare-ups’ or as persistent symptoms making early diagnosis difficult (Bowwow’s, 2003). In 1995 H demonstrated pain, swelling and stiffness and was told by her GAP ‘it is all in the mind’. Pain was being poorly controlled and flare-ups, sometimes lasting 24 hours, had a debilitating effect.
H struggled to get out of bed and, although mentally strong, H recalls the emotional frustration and anxiety of the situation.
The ornithologist’s formal diagnosis came almost two years later. Diagnosis initiates a care pathway of medical treatment, advice and support allowing the patient some physical relief and the opportunity to learn to cope with the disease. Already by this point H had needed to make adjustments to compensate for restricted movement In her arms, hands and feet making everyday tasks much harder. Today, although better treated, the disease progression means she soul needs pain killers prior to many tasks such as driving and cooking.
SE of a bath seat, patted ankles on taps Ana special cutlery are Just some AT ten none alas H uses o physically cope around the house. Her hands have got progressively more deformed (fig 2) and nodules form on her hands and feet. She worries how her hands look and has had surgery removing lumps from her feet, which will grow back, and dropping things makes tasks difficult causing embarrassment. It is the impact on functionality that causes most distress. For H the physical aspect of RA her focus, so she deems medical treatments her greatest support.
Treatment was started with cortisone injections three monthly to suppress immune response, reducing swelling.
This provided much relief for four seeks, after which flare-ups continued as strong as before. Oral medication, metamorphose, was started bringing with it horrific gastrointestinal side effects, as well as the need for two weekly blood tests. Due to side effects and liver toxicity it was stopped after three months. Following this another medication was started, 10 tablets per day of lifetime, bringing relief particularly with morning pain and stiffness. H was informed of a new medication Enabler in 2007.
Due to the annual cost, EEK per person, the hospital funded only six most affected patients. This was setting, putting a price on her pain. One year later treatment was commenced consisting of a self-administered injection each week. This took time to get used to but H describes this as the ‘single biggest [positive] impact throughout’. H takes part in a RA research group giving her thoughts and time to help others. It aims to give a life insight through the eyes of people with RA.
One question asked Would you take 10 pills every day for your condition? She responded ‘l would take 100 if it gets me out of bed in the morning! Seeing their importance, H became accustomed frequent capital visits and blood tests relatively quickly. Alongside medical treatment are offers of advice and support in the form of patient groups. H initially attended but it was not for her. She described it as depressing due to people’s negative outlook of their situation, however does understand the group’s value for others. H tries to maintain normality of life but appreciates the emotional and mental impact of RA first hand.
Approximately 15% of adults give up work within 1 year of diagnosis, 40% within 5 years (Stouter, 2010).
H continued to work 2 days per week until she retired. Both knees were seizing and painful, she was using a walking stick, needed assistance using the bath and could not use the stairs at work. She was overdosing on perpetrator and spending lunchtimes asleep in the car, yet did not want to take time off due to her principles. The one occasion she could not get up for work, a colleague said she would collect her, H cried. She was incredibly emotional about her whole life situation.
One day she told her daughter she was ‘going to the GAP to ask for a gun’.
She is proud, would not describe herself as disabled but having ‘a condition aging some aspects of life harder’. She does not want sympathy and will ask for help when she needs it, she Just wants understanding. Without family and social support H believes she would cope ‘because she’d have to’, but would find it harder still. The nature of RA is that severity and progression not only vary between individuals, individual severity and impact on functionality vary over time. H finds sometimes coping is far easier and impact on life is minimal, in contrast some periods she cannot drive, cannot leave, or even maneuver around, the house.
Research NAS snow Atonally addle TTY Is linearly lanker to oppression (Douglas, et al. , 2004). He’s view on life is positive but through the hard times she emotionally at her lowest, feeling isolated and ‘snappy, which puts additional strain on life and relationships. A chronic condition like RA affects every aspect of life. DRP Stouter (2010) discusses the five spheres of life’; body, emotions, mind, behavior and lifestyle/ events/relationships and their interaction together.
By understanding this interaction individuals can better equip themselves to cope with the disease.
This approach seems sensible to H but she did not need to have it planned out for her. Ever increasing amounts of literature are available on therapies and techniques alongside medical treatment as people learn from and share past experiences. H initially found information and has established her coping style over time. She is not likely to change that now.
She has good quality of life and is thankful for the health she has, at the same time she is aware that her condition will continue to worsen and that may change things. H is advised to make lifestyle changes; improve diet, reduce alcohol consumption, use exercises.
She has made a conscious choice to enjoy life and not put herself under too much pressure. She has given up smoking, but will continue to cope in her own ways. RA is a systemic disease affecting not only the musculoskeletal system but also can affect blood, lungs, liver, kidneys, skin and eyes (Stouter, 2010), therefore can lead to more complications.
The potential Joint damage and systemic effect means specialist referral is important at the earliest opportunity. In 2009 NICE guidelines for RA management were amended to state referral is squired in suspected RA or unknown causes of synopsis. National Institute of Clinical Excellence, 2013). H suffered a heart attack in 2013 and recalled being told that RA increased her risk. It has been a reminder to slow down but also that RA impacts on so much more than her Joints and will continue to worsen.
One of He’s biggest worries is that as health worsens, the impact on her family will increase and they are her life. Many useful approaches to coping with RA could be discussed in detail including pain management techniques, ways to combat tiredness, pain/ exercise diaries and importance of these is recognizes by the INS in their care pathways.
Talking to H has shown that the most important thing when coping with RA or any chronic condition is communication and access to information. For H, knowledge and her understanding of what to expect gave her the power to use that information as she sees fit and develop ways of coping to suit her. What is important to one may not be as important to another but the key is choice.
Some may say the choices H makes are not the best for her health, but they are hers to make. There are any ‘healthy people not as happy and positive as H.