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Similaire à Understanding Arthritis and Its Impact on Work
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Understanding Arthritis and Its Impact on Work
- 1. Presented by Sheryl Moriarity, CHRP Return to Work and Arthritis conditions Osteoarthritis & Rheumatoid Arthritis
- 2. Goal of this presentation To help you understand Arthritis & its affect on the ability to work, absences from work and return to work. Also to provide you with this presentation as a resource for the future.
- 3. Arthritis (“Arthro-itis”) • “Arthro” meaning joint • “itis” meaning inflammation
- 4. Joint pain is the most common denominator • Presenting as inflammation = redness, swelling, heat, pain & degrees of loss of function
- 5. Arthritis - Impact • People aged 55+ - greatest increase of cases in the future. • 6% of total hospitalizations in Canada. • 4.5 Million or 1 in 6 Canadians aged 15 years older report having arthritis • One of the most frequent reasons requiring time off work
- 6. The proportion of both men and women reporting arthritis increases with age. Women report arthritis more frequently than men. (currently 20% women, 13% men) Arthritis, often perceived as a condition of the elderly. 56% of Canadians with arthritis are under 65 years of age. Arthritis - Impact
- 7. Arthritis Can create long term and degenerative states but many people can continue to work with adaptation.
- 8. Did you know there are over 120 types of arthritis?
- 9. • Osteoarthritis • Rheumatoid arthritis • Gout and pseudo- gout • Septic arthritis • Ankylosing spondylitis • Juvenile idiopathic arthritis • Still's disease • Psoriasis (Psoriatic arthritis) • Reactive arthritis • Ehlers-Danlos Syndrome • Haemochromatosis • Hepatitis • Lyme disease • Sjogren's disease • Hashimoto's Thyroiditis • Inflammatory bowel disease • Crohn's disease and ulcerative colitis) • Henoch-Schönlein purpura • Hyperimmunoglobuli nemia D with recurrent fever • Sarcoidosis • Whipple's disease • TNF receptor associated periodic syndrome • Granulomatosis with polyangiitis (and many other vasculitis syndromes) • Familial Mediterranean fever • Systemic lupus erythematosus
- 10. Arthritis Types This presentation focuses on the 2 main disabling Arthritis conditions in the workplace Rheumatoid Arthritis & Osteoarthritis
- 12. Rheumatoid Arthritis is…… • An autoimmune disorder, when the immune system mistakenly attacks the body’s own tissues • A disease of the entire body, floats around in the blood • Affecting the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity • Discovered during blood test RF (Rheumatoid Factor) • Fast onset – 6 weeks, lifelong from there • Can cause secondary diagnosis of Osteoarthritis
- 13. Rheumatoid Arthritis Risk Factors and possible causes • Although the cause of RA remains unknown several factors may play a role in disease development: – Hyper-reactive immune system – Specific inherited genes and acquired gene defects – Hormonal factors – Environmental exposures – Previous viral or bacterial infection
- 15. Rheumatoid Arthritis Can affect other organs of the body: Skin – Eyes – Lungs – Blood Vessels Ashma, Lupus, Allergies & Psoriasis
- 18. No one-size-fits-all drug treatment Doctor will make the decision on which drug(s) to prescribe based on: •How long individual has had RA •Disease activity (symptoms, joint involvement, current status of condition) •Other health conditions such as hepatitis, heart failure or cancer. Rhematiod Arthritis Treatment
- 19. Rhematiod Arthritis Treatment • NSAIDS – Non-Steriodal Anti-Inflammatory Drugs, least potent, relieve pain but do not affect the course of the disease. Ibuprofen, Naproxen, Celebrex • DMARDS – Disease Modifying Anti-Rheumatic Drugs – most effective for slowing the progression of the disease i.e. Methotrexate, Rheumatrex, Trexall • CORTICOSTEROIDS – steroids, used to quickly reduce inflammation ie Prednisone
- 20. Barriers to RTW • Good days and very bad days • Strength • Stamina/fatigue • Lifting/carrying/bending/kneeling • Concentration/focus due to symptoms • Treatment plan
- 22. Osteoarthritis is ……… • wear and tear affecting hands, feet, knees, spine, shoulders • mechanically related • worsens with use & alleviated by rest • erosion of cartilage & bone on bone grinding • primarily occurring in older people • can be caused by trauma
- 23. Osteoarthritis Risk Factors & Possible Causes • Age • Weight • Occupation • Prior injury • Muscle weakness • Stroke, altered mechanics • Neurological conditions • Gout
- 27. How Is OA Diagnosed? A crunching sound/feeling Joint stiffness/weakness Pain No single test can diagnose osteoarthritis. Doctors use several methods/rule out other problems: medical history, physical exam, X-rays, blood tests, tests on fluid of joints
- 28. OA Treatment will depend on the…. co-morbid diagnoses current severity & length of time diagnosed/affected amount of involvement/motivation from individual affected
- 29. OA Treatment Non-pharmaceutical interventions i.e. due to side effects such as liver damage Nutrition Balancing exercise & rest Acupuncture Braces, orthotic insoles & taping Self Management programs Attitude
- 30. OA (Advanced or highly symptomatic) • Tylenol #3, Acetaminophen, NSAIDS (Aleve, Naproxen, Ibprophen, Celebrex, Aspirin/ASA) Robaxacet & Robacet • Very Severe cases - Surgery; Joint replacement (knee, hip, shoulder) ……..
- 31. Total knee replacement OA damaged knee Healthy knee
- 33. Let’s compare RA and OA …….
- 34. Attribute Rheumatoid Arthritis (RA) Osteoarthritis (OA) Disease Of the blood, Autoimmune – can cause OA Degenerative, trauma induced, doesn’t cause RA Treatment Early and aggressive pharmaceutical TX, higher to lower amounts can slow/stop progression of disease, surgery in some cases to correct deformity. Exercise, strengthening, non- pharmaceutical - can slow progression of disease, surgery in some cases. Pain RX. Activity of Disease Can go into/out of remission with or without TX for years Can progress without symptoms for many years Physical capabilities Physical capabilities may decrease rapidly Physical capabilities will slowly decrease with time & age RTW Sustainability Job modifications with disease progression, can limit heavy labour/repetitive job tasks quickly. Job modifications with disease progression, can limit heavy labour / repetitive job tasks slowly with time.
- 35. Attribute Rheumatoid Arthritis (RA) Osteoarthritis Age at which condition starts It may begin at anytime 15 year old + Majority of cases appear later in life 40 -50 year old + Speed of onset Relatively rapid, over weeks to months Slow, over years Pattern of joints affected Small/large joints usually bi-laterally, hands, feet, knees, shoulders Starts - one set of joints and moves usually fingers, thumbs, hips & knees Duration of morning stiffness Lasts longer than 1 hour Lasts less than 1 hour, returns at end of day or after periods of activity Joint symptoms Painful, swollen and stiff Ache and may be tenders but have little or no swelling Symptoms affecting the whole body Frequent fatigue & general feeling of being ill are present In general symptoms are felt in affected joints only
- 37. Arthritis Can require time off work May not require permanent time off
- 38. Arthritis – RTW Statistics 44 % report working with job limitations 33 % require job modifications 55 years+ will account for high proportion of reduced participation in the workforce in the future
- 39. Sustainable RTW will rely on Flexibility Varying, reducing, supporting Adaptation Devices providing assistance to perform tasks
- 40. RTW considerations • New onset cases (with today's disease modifying treatment ) have higher chance of staying at work than in the past. • 10 years + RA diagnosis may be permanently unable to do heavy work • The pattern of remissions and exacerbations all affect the length and reoccurrence of disability
- 41. RTW considerations • Ability to complete tasks and meet deadlines • Nature of job and physical requirements • Employers Drug policies • Bona fide and/or safety sensitive positions • RA affects normal ADL’s such as standing, walking, washing, dressing, preparing food, and performing household chores – pacing is important
- 42. Limitation examples • Opening door knobs, jars • Gripping, fine finger manipulation • Shifting gears • Heavy lifting • Prolonged sitting, standing, walking, kneeling, bending, twisting • Range of motion (ROM) • Many repetitive tasks
- 44. RTW sustainability Individuals with work autonomy, flexibility and a supportive employer are more likely to remain working longer than those without.
- 45. MD Guidelines RTW averages • Sedentary 0–7 days • Medium - Light 0-14 days • Heavy to Very Heavy 0-indefinite • Timeframe of absence is heavily dependent on body part affected, advanced symptoms in knees and hips seem to totally disable more individuals from Heavy to Very Heavy positions than shoulders and wrists.
- 46. Can you share a story or information of your own? Do you have any questions?
- 47. Thank you! For being here today!
Notes de l'éditeur
- Weight is the most changeable risk factor Occupatons with activities that require frequent bending or carrying heavy loads, significant repetitive activities Prior Injury – trauma, sports related injuries Muscle weakness
- Viewing the difference between a normal joint and one with Osteoarthritis
- Viewing the difference between a normal spine and one with Osteoarthritis
- Osteoarthritis of the hip
- A crunching feeling or the sound of bone rubbing on bone Joint stiffness: After getting out of bed or sitting for a long time, swelling or tenderness in 1 or more joints Pain that can be elevated by rest and brought on by activity of the joint or prolonged physical activity
- & aimed at controlling pain & inflammation while maintaining mobility
- Exercise program: address loss of motion & strength Nutrition - maintaining a balanced diet – weight Loss Exercise & strengthening programs - stamina Acupuncture Braces, orthotic insoles & taping Balancing exercise & rest - pacing Self Management programs – education, motivation, proven methods Attitude – Counseling – Change - What I could do and what I can’t do now
- There are hundreds of types of arthritis that require time off work but they all do not always require permanent time off. Some can create chronic and degenerative states but many people can continue to work for years.
- Varying or reducing prolonged physical or very sedentary work Flexibility to stop activity with the onset of pain, fatigue, or increased swelling/pain. Avoidance of prolonged stooping, lifting, kneeling and standing Alter work duties and or body repositioning or changing tasks ½ hour, hourly or when needed Avoiding heavy lifting or high grip force, tight gripping or pinching. Used adaptive/assistive devices Lower mobility may necessary
- Modern medicine and the success of DMARDS
- Ability to complete tasks and meet deadlines becomes more difficult with disease advancement - flexibility Nature of job and requirements determine how much it will affect job performance – altering job duties A physically demanding job involving lifting, carrying, walking, or a lot of standing would likely be impacted more than a desk job – altering job duties A Heavy job may become difficult or impossible to continue at some point – changing job tasks A review of drug policies may be necessary for performance or ability to drive and/or operate machinery – ie Tylenol #3, narcotic pain medication
- Construction now requires levers on doors rather than door knobs
- Those individuals with work autonomy, flexibility and a supportive employer are more likely to remain working longer than those without. Adaptive changes along the way are crucial for RTW longevity too.