1. Understanding Arthritis
Brought to you in collaboration with:
Arthritis Foundation Tennessee Chapter
Tennessee Department of Health
University of Tennessee Extension
rev. June 2009

2. Arthritis Defined Arthritis: “inflammation of a joint”
Rheumatism: Better term, broad, encompasses all kinds of pain and stiffness in the muscles and joints
Most common feature is PAIN
Over 120 different types of arthritis
NO CURE: Chronic. Why self-management is so important.

3. The Impact of Arthritis
The leading cause of disability among American adults
One of the most common chronic health problems in the United States
Affects people of all ages
Affects over 46 million Americans (1 of every 5 adults)

4. Impact of Arthritis (continued)
Twice as many women as men have the disease
More frequent cause of activity limitations than heart disease, cancer or diabetes
Limits activities of over 7 million Americans
Causes 39 million doctor visits, and over half-a-million hospitalizations each year
Costs the U.S. economy $128 billion a year
$81 billion in medical costs

5. Burden of Arthritis in Tennessee
1.5 million adults have arthritis
72% of people with arthritis are less than 65 years of age
Almost 26.6% of adults have been diagnosed with some form of arthritis

6. Burden of Arthritis in Tennessee
Of those diagnosed:
43% don’t know the type of arthritis they have
55% are not under a physician’s care
Source: 2005 Behavioral Risk Factor Surveillance Survey data (Centers for Disease Control and Prevention Survey)

7. Burden of Arthritis in Tennessee
More common in Whites (36%) than Blacks (33%)
More common in Women (41%) than Men (30%)
People with arthritis are more likely to be obese (30%)
People with arthritis more likely report days of poor physical health and/or mental health when compared to others

8. Symptoms of Arthritis Swelling in one or more joints
Morning stiffness lasting ≥ 30 minutes
Persistent joint pain or tenderness
Inability to move a joint in a normal way
Redness or warmth in a joint
Weight loss, fever or weakness
Joint pain that can not be explained

9. Healthy Joint Anatomy Muscles Joint capsule Tendons Synovial membrane
Bone
Synovial fluid
Cartilage
In a healthy joint, the ends of bones are encased in smooth cartilage. Together, they are protected by a joint capsule lined with a synovial membrane that produces synovial fluid. The capsule and fluid protect the cartilage, muscles, and connective tissues.

10. A Joint with Osteoarthritis
Muscles
Bone spurs
Tendons
Synovial membrane
Bone
Synovial fluid
Cartilage
fragments
in fluid
Worn away
cartilage
With osteoarthritis, the cartilage becomes worn away. Spurs grow out from the edge of the bone, and synovial fluid increases. Altogether, the joint feels stiff and sore.

11. Joints Most Often Affected
Osteoarthritis most often occurs at the ends of the fingers, thumbs, neck, lower back, knees, and hips.
Osteoarthritis most often occurs at the ends of the fingers, thumbs, neck, lower back, knees, and hips.

12. Types of Arthritis Osteoarthritis (OA) Rheumatoid Arthritis (RA)
Fibromyalgia Syndrome (FMS)
Lupus – Systematic Lupus Erythematosus (SLE)
Juvenile Rheumatoid Arthritis (JRA)

13. Osteoarthritis (OA): By Far The Most Common Form
Also called degenerative joint disease
Usually begins after age 45
Causes symptoms in 1 of every 3 individuals over age 60

14. Osteoarthritis (OA): By Far The Most Common Form
Caused by breakdown of the joint’s cartilage
Bones rub together
Joint loses shape and alignment
Bone ends thicken
Bit of cartilage or bone float in joint space
Pain, inflammation and stiffness result

15. Osteoarthritis Risk Factors
Age
Overweight
Joint Injury
Muscle weakness
Heredity

16. Rheumatoid Arthritis (RA)
Affects about 2.1 million Americans, and three time more women than men
Caused when the immune system attacks the lining of the joints
Can result in severe joint damage and deformity
May also cause fatigue, weight loss and other whole-body symptoms
Rheumatoid Arthritis is a chronic inflammatory disease of the joints. The disease occurs when the body’s immune system – which normally protects from us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, inflammation, loss of function and disability. The joints most commonly affected by rheumatoid arthritis are those of the hands, feet, wrists, knees, elbows, knees and ankles.

17. Fibromyalgia Syndrome (FMS)
Joints not affected
Muscles, ligaments and tendons affected
Sleep disturbances
Over half of people have chronic fatigue
Fibromyalgia (or fibromyalgia syndrome) is an arthritis-related condition characterized widespread muscle pain and the presence of tender points, or areas of the body that are particularly sensitive to pressure. Other symptoms may include sleep disturbances, severe fatigue, depression and anxiety, cognitive difficulties, headaches, bladder irritability and spasms, irritable bowel syndrome, jaw problems and painful menstruation.

18. Fibromyalgia Syndrome (FMS)
Cause is unknown
1990 first defined: Pain and stiffness in many parts of the body for at least 3 months and local tenderness in 11 of 18 specified places
3.7 million in the U.S. – no TN data
Good prognosis
Exercise and relaxation essential
Fibromyalgia affects more than 3.7 million Americans, the majority of whom are women between the ages of 40 and 75, but it also affects men, young women and children as well. People with other rheumatic diseases, such as rheumatoid arthritis or lupus, are at greater risk for fibromyalgia.

19. Lupus
Rheumatic disease that affects the skin and body tissues – autoimmune disease
Possibly organs such as the kidneys, lungs or heart
Affects women more than men
Primarily a young woman’s disease
Affects more African Americans than Caucasians
Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Lupus is also a disease of flares (the symptoms worsen and you feel ill) and remissions (the symptoms improve and you feel better). Lupus can range from mild to life-threatening and should always be treated by a doctor.

20. Chronic Pain Cycle
Arthritis may cause you pain because of inflammation or bone rubbing against bone “Disease”. In response to this pain, and to protect the area that hurts, your body unconsciously tends to tighten up in that area, or compensate by using other muscles “Tense Muscles”. When these muscles are tightened for a long period of time, they create even more pain. As your pain mounts, you become stressed and more tense, wondering if the pain will ever get better “Stress and Anxiety” . Your stress could keep you from performing your everyday activities which leads to “frustration/anger/fear/worry” then “depression” and “fatigue”. Your pain is now worse, completing the vicious cycle.

21. Arthritis Medications
Medications are important to your management of pain.
When taken properly, medications can reduce pain and increase joint mobility.
Medications will not cure arthritis, but they can keep your symptoms under control and make life more comfortable.
Medication is major catalyst in breaking the Pain Cycle. When used properly, medications can reduce pain which in turn reduces tension and stress. When stress and tension in the body is decreased, the chance of developing frustration, depression and fatigue is also lessened.

22. Importance of a Healthy Weight
Maintaining a healthy weight is an important key to managing arthritic pain.
The less stress (weight) you put on your joints, the less pain you will experience.
Increased Muscle Mass=Increased Bone Density=Decreased Body Fat=Healthier Joints=Happier You!

23. Importance of Healthy Weight
Keys to achieving a healthy weight
Move more and eat less!
Strive to eat a minimum of 5 servings of fruits and vegetables (2 cups vegetables and 1 ½ cups of fruit) each day.
Reduce portion sizes (Healthy Plate Method).
Aim to exercise (walk, bike, swim, garden) for minutes each day.
Fruit and vegetable serving recommendations are based upon a caloric intake of 1600 calories a day. Recommend that participants eat a minimum of 2 cups of vegetables and 1 ½ cups of fruit each day.
Exercise also plays an important role in breaking down the Pain Cycle. Endurance exercises are an excellent treatment for tense muscles, stress and tension, for working our difficult emotions, stress, and fatigue. Exercise also improves sleep patterns.

24. Arthritis Management Programs
Arthritis Self-Help Program
Arthritis Foundation Exercise Program
Arthritis Foundation Tai Chi Program

25. Arthritis Self-Help Program
The Self-Help program is an in-depth program that gives newly and previously diagnosed individuals with arthritis the knowledge and skills needed to better manage their disease.
Led by UT Extension Educators certified by the Arthritis Foundation.
The Arthritis Foundation Self-Help Program is a group education program designed to complement the care provided by your health-care team and allow you to share experiences with others

26. Arthritis Self-Help Program
The Arthritis Foundation Self-Help Program is designed to:
Identify and teach you the latest pain management techniques
Help you develop your own individualized exercise program
Help you learn to manage fatigue and stress more effectively

27. Arthritis Self-Help Program
The Arthritis Foundation Self-Help Program is designed to:
Discuss the purposes and effective use of medications
Help you learn new ways to communicate with family and friends
Teach you how to form a partnership with your healthcare team.

28. Arthritis Self-Help Program
Participants will learn how to:
Reduce arthritic pain and stress
Cope with fatigue
Manage pain
Use medications wisely
Benefit from exercise

29. Arthritis Foundation Exercise Program
The Arthritis Foundation Exercise Program is a 60-minute class held twice a week.
It is designed to improve endurance and joint motion.
The low-impact program offers 2 types of classes – Basic and Advanced.

30. Arthritis Foundation Exercise Program
Program benefits include:
Joint stiffness relief
Decreased arthritic pain
Decreased depression
Increased energy
Increased flexibility
Better, more relaxed sleep
Increased functional ability

31. Arthritis Foundation Tai Chi Program
Led by Extension Educators certified by the Arthritis Foundation Tai Chi Instructor program
The Arthritis Foundation Tai Chi Program is a 60-minute class held twice a week
Appropriate for individuals with mild to moderate arthritis
Arthritis Foundation Tai Chi Program® is designed to improve the quality of life for people with arthritis using Sun style Tai Chi, one of the four major recognized styles of Tai Chi. This style includes agile steps and exercises that may improve mobility, breathing and relaxation. The movements don't require deep bending or squatting, which makes it easier and more comfortable to learn.
The program itself consists of 12 movements — 6 basic and 6 advanced — a warm up and a cool down. Once becoming familiar with the 12 movements, the program is designed to provide continual challenge by reversing the direction of the movements.

32. Arthritis Foundation Tai Chi Program
Program benefits include:
Decreased pain and stiffness in joints
Improved daily physical functioning
Improved balance leading to decrease in falling
Improved abdominal muscle strength
Increased confidence in one’s ability to exercise

33. Monitoring Your Progress Exercise

34. Rating of Perceived Pain Scale

35. Monitoring Your Progress Self-Help

36. Discussion
Questions