Counseling Points - March 2008 - (Page 5)

Laser Treatment Low-level laser therapy (LLLT) was introduced as an alternative, non-invasive treatment for RA more than 10 years ago.6 LLLT generates a pure light of a single wavelength and its therapeutic effect is related to photochemical reactions in the cells. A number of studies have found that laser therapy increases hand flexibility and decreases pain and morning stiffness more than placebo laser therapy, but effects do not last beyond 20 weeks. LLLT is controversial and experts agree that this method of RA therapy needs further investigation to determine optimal laser wavelength and treatment duration.6 Results from a number of clinical trials have found that when patients with RA participate in mind-body exercises such as meditation, tai chi, yoga, and relaxation strategies, significant improvements are reported in their degree of pain and disability, overall psychological state, coping ability, and self-efficacy.8 Massage is also a useful stress management tool and improves flexibility and general well-being, decreases levels of stress hormones, and helps to alleviate depression, anxiety, and pain.9 Other stress management methods that are often utilized to promote relaxation include breathing techniques, progressive muscle relaxation, and mental imagery relaxation.9 Occupational Therapy Interventions Joint protection strategies, such as rest, splinting, orthotics, and assistive/adaptive devices have beneficial effects in managing RA symptoms.7 Adequate rest is perhaps the most fundamental principle in reducing arthritic pain and joint inflammation. General bed rest reduces the activity of systemic inflammatory arthritis, while local rest relieves pain and inflammation of single joints. However, prolonged inactivity may cause joint stiffness and decreased ROM. Therefore, an appropriate balance of rest and exercise is key to successfully managing RA. Joint safeguards, such as resting hand splints, wrist supports, finger splints, and special shoe inserts are often recommended to decrease pain, reduce swelling, and/or prevent rheumatoid joint deformity.7 Additionally, assistive devices and adaptive equipment, such as canes, walkers, and grasping implements, help to protect joints and conserve energy and are used to reduce functional deficits, diminish pain, and promote independence and selfefficiency. A variety of unique devices are available that can aid RA patients with walking, dressing, reaching, carrying, sitting, standing, cooking, climbing stairs, and driving. Use of assistive tools has been demonstrated to provide significant functional benefits. One Swedish investigation that evaluated the impact assistive devices had on maintaining physical function found that the majority of patients enrolled in the 2-year study reported no major difficulties with daily activities when using devices.7 Surgery Surgical procedures to repair damage and alleviate pain caused by RA have advanced consistently in recent years and offer many patients the chance for substantial improvement in functional status and quality of life. Indications for surgery include impending tendon rupture, marked functional limitation, severe pain related to extensive joint damage, and objective evidence of progressive damage by examination or imaging. Commonly performed types of orthopedic procedures include synovectomy or tenosynovectomy (removal of synovial tissue from joints or tendons); ligament or tendon reconstruction; carpal tunnel release (cutting ligaments to release pressure); osteotomy (cutting of bone to optimize mechanics); arthrodesis (joint fusion); arthroplasty (joint replacement); and decompression of the spinal cord and peripheral nerves.10 Complementary and Alternative Medicine Although there are numerous conventional medications available for the treatment of RA, patients also often try complementary and alternative medicines (CAM). One reason people use CAM is that conventional therapies may not work as adequately as they would like. Individuals also may have issues with side effects of drug treatments and believe that CAM therapies are safer and more “natural.” Additionally, claims of attractive benefits of CAM through widespread advertising may influence use.8 Although there are many CAM treatments available, few have been extensively studied in clinical trials making it difficult to assess whether the agents genuinely provide RA pain and inflammation relief. Some of the most commonly used CAM treatments for RA are gamma-linolenic acid (GLA), fish oil supplements, the herb valerian, ginger, curcumin (a component of the spice turmeric), and the tree resin boswellia. Before trying CAM, it is important for patients to discuss these therapies with their rheumatolo5 MARCH 2008 Stress Management Living with a chronic, debilitating illness such as RA can be intensely stressful for patients. However, evaluating the causes of anxiety and learning new ways to adapt to and manage stress through psychotherapy and other approaches may help improve psychological symptoms of the disease.

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Counseling Points - March 2008 Welcome Pharmacological and Nonpharmacological Treatment of Rheumatoid Arthritis

Counseling Points - March 2008

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