Stay Safe From Arthritis Pain

Stay Safe With These Fall-prevention Guidelines

The American Geriatrics Society and the British Geriatric Society have issued updated guidelines for preventing falls in older people. It is the first such update in over 10 years.

“There is always evidence that is coming out and in area like falling, we are learning more about it every day,” says Mary Tinetti, MD, a professor of medicine at Yale University School of Medicine, New Have, Ct., and a co-chair of the panel that came up with the guidelines. “We want to make sure the guidelines are as timely and accurate as possible.”

While the guidelines, which appear in the January 2011 issue of the Journal of the American Geriatrics Society, target older patients, they apply to patients of any age with rheumatic disease involving gait.

“It relates to all of our patients who have lower extremity disorders,” says Nortin M. Hadler, MD, attending rheumatologist at UNC Hospitals and professor of medicine and microbiology/immunology at University of North Carolina at Chapel Hill.

“Gait is quite remarkable. It’s a highly integrated biological function that requires heel strike and push off of toes, knees that are supple and hips with reasonable range of motion,” says Dr. Hadler. “All of these things we take for granted, but if anyone has any impairment, they don’t take it for granted.” Dr. Hadler notes that patients with rheumatic disease also fall “less well” because they are less able to brace themselves when they do fall.

The new guidelines call for a complete risk assessment for patients who simply report difficulties with gait or balance in addition to those who have a history of falling. The assessment should include evaluation for muscle weakness, balance problems, orthostatic hypotension (a fall in blood pressure when a person stands up from a sitting or lying down position), as well as an examination of the feet and footwear, and an evaluation of both daily living skills and the use of adaptive equipment and mobility aids. Health care professionals should also ask patients about the fear of falling.

“Falls are a very serious problem and they often have a complex set of causes that can be a challenge to sort out. One of those things is that we are fearful,” says Sharon Brangman, MD, president of the American Geriatric Society. “Patients can be so fearful that it limits mobility, which sets up a vicious cycle: We are fearful, so we restrict our activities, and our muscles get weaker and so we are more likely to fall.” 

The guidelines were developed by a panel including members from previous panels, as well as experts in areas such as geriatrics, physical therapy, orthopedics, emergency medicine, occupational therapy, nursing and pharmacy. To come up with the new guidelines panelists reviewed the medical literature on fall prevention published between May 2001 and July 2009.

“The main thing is that these guidelines were developed by a panel of experts who scoured the literature and scientific information to find guidelines based in science,” says Dr. Brangman. “We knew things anecdotally, but these guidelines have evidence behind them.”

Within the new guidelines are recommendations for intervention that include:

•     an exercise component that combines balance and strength training, such as tai chi or physical therapy.

•     cataract surgery when needed (but only in conjunction with other interventions).

•     medication reduction or withdrawal, especially drugs that affect the central nervous system, such as sleep medications and antidepressants.

•     appropriate management of heart rate and rhythm abnormalities, and orthostatic hypotension.

•     a daily 800 IU vitamin D supplement.

“The new guidelines are not all doctor-oriented,” says Dr. Brangman. “They have practical pieces that people can carry out on own: finding safer shoes, removing clutter in your home, clearing off stairs and installing handrails in bathrooms and on steps.”

But the interventions must be followed. “It really made a difference in how carefully all the interventions were carried out,” says Dr. Tinetti. “It’s important not just to say that something needed to be done, but to do it.”

More Information : http://www.arthritis.org/living-with-arthritis/pain-management/joint-protection/fall-prevention-guidelines.php

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Massage and Arthritis

Massage and Arthritis

Regular massage of muscles and joints, whether by a licensed therapist at a spa or by self-massage at home, can lead to a significant reduction in pain for people with arthritis, according to Tiffany Field, PhD, director of the Touch Research Institute at the University of Miami School of Medicine, who’s conducted a number of studies on the benefits of massage, including on people with arthritis. In Field’s research and other recent studies on the effects of massage for arthritis symptoms, regular use of the simple therapy led to improvements in pain, stiffness, range of motion, hand grip strength and overall function of the joints.

While most research on massage examines its effects on the general population, not specifically people with arthritis, recently more studies are underway to study the effectiveness of massage for people with arthritis. For example, one 2006 study conducted at the University of Medicine and Dentistry of New Jersey examined 68 adults with knee osteoarthritis receiving two Swedish massages per week for eight weeks, compared to a group who received no massage. The massage group reported significant improvements in knee pain, stiffness, function, range of motion and walking, the researchers found.

Best Types of Massage for Arthritis

If you’re interested in trying one of the many types of massage as a way to ease your arthritis symptoms, it’s important to consult your rheumatologist or primary-care physician first to ensure that massage is safe for you. Some techniques may involve strong pressure to sensitive tissues and joints, or moving limbs into various positions that may be difficult for someone with damaged joints from a disease like rheumatoid arthritis or ankylosing spondylitis.

Use caution when considering massage if you have:

    Damaged or eroded joints from arthritis
    Flare of inflammation, fever or a skin rash
    Severe osteoporosis (brittle bones)
    High blood pressure
    Varicose veins

“It’s always a good idea to get the thumbs up or down from a doctor if you are having even the slightest worry about using massage for your condition,” says Chunco. “It’s also very important to tell the therapist if you are experiencing pain or if you are uncomfortable with the work that she is doing. A good therapist will want feedback on what you are feeling during the session.”

Be sure to have a conversation with your massage therapist beforehand about your arthritis, and what parts of your body are most affected by the disease, advises Field.

“Therapists should be very cognizant and careful, as they all have a list of contraindications for massage in their brains already,” she says. “They can usually tell if you have an area of inflammation” but it’s wise to discuss it first, she says. In addition, if you have any concerns about the therapist using scented oils or lotions that might cause a rash, speak up – these lubricants are commonly used but are probably not necessary.

Your goals for massage may vary. You may be interested in relieving anxiety and stress caused by dealing with arthritis, or you may be seeking relief for pain and stiffness in a specific area of your body. Talk openly with your massage therapist about your goals for the session so she can adjust the technique accordingly. There is no set way to perform a massage; she should be flexible to your needs.

Most importantly, massage should make your arthritis pain and stiffness feel better, not worse, says Veena Ranganath, MD, a rheumatologist at the University of California, Los Angeles Department of Medicine. “I do tell my patients that if it hurts, don’t do it,” says Dr. Ranganath. Your doctor also can refer you to a massage therapist, which may not only lead you to a qualified professional, but also help you qualify for reimbursement if your insurance policy covers massage treatments.

Massage is not medicine. It’s a complement to your doctor-prescribed arthritis treatment. You should enjoy experiencing a massage, and it should not increase your pain or anxiety. Communication with your doctor and massage therapist beforehand can ensure that massage is right for you and help you achieve beneficial results.

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