How Occupational Therapy Can Help With Rheumatoid Arthritis

Living with rheumatoid arthritis (RA) can be a challenge, to say the least. The painful condition can cause deformities and the loss of dexterity, making everyday tasks difficult to perform. The reason: RA is an autoimmune disorder that causes your immune system to attack the lining of your joints. The inflammation triggered by RA can damage other parts of your body, including your heart, eyes, skin, and more. According to the Arthritis Foundation, about 1.3 million Americans have RA, the majority of them women.

The disease has no known cure, but medications can help reduce its impact and improve symptoms. Even with medication, though, the joint pain caused by this disease can make something as simple as carrying a bag of groceries, showering, buttoning your shirt, or putting on socks a challenge. In these cases, occupational therapy (OT) can help. Here’s how.

“Occupational therapy is a form of therapy focused on facilitating a patient’s ability to perform and engage in daily activities,” says Ruth Chan, D.O., a rheumatologist at The Ohio State University Wexner Medical Center in Columbus, OH. “OT is one of the cornerstones of treatment in rheumatoid arthritis.”

Some of the major areas of intervention that OT offers include:

• Joint protection that involves learning techniques of doing things that won’t further damage your affected joints. (Physical therapy for RA has a similar goal.)

• Modifications to ease RA-associated stiffness and make your everyday tasks less burdensome.

• Fatigue interventions to help you conserve the energy you need throughout the day.

• Assistive technologies that allow you to work more comfortably.

“Our tagline for occupational therapy is ‘skills for the job of living,’” says occupational therapist Jessica Daigle, rehab manager at Northwell Health in Long Island, New York. “Our main role is to make sure people we work with are independent.”

Anyone with RA can benefit from occupational therapy, says Dr. Chan, though it’s particularly warranted when the disease progresses.

“Any signs of decline of function, strength, or mobility would be a time to consider a referral for occupational therapy,” she says.

During your first session, your occupational therapist will talk to you about the areas of concern that you have and the ways in which the disease limits your activities.

“It’s a semi-structured interview including questions like: ‘What’s a day in your life like? Where are you having difficulty?’” says Bellevue, WA-based occupational therapist Cheryl Crow, a volunteer for the American Occupational Therapy Association and founder of the online education company Arthritis Life. “The OT will distinguish between tasks the patient is performing successfully and unsuccessfully, and they will attempt to assess what is impeding performance: fatigue, pain, social barriers, environmental barriers, or other factors.”

Subsequent occupational therapy sessions will teach you how to make adjustments to the tasks that you do every day so that you can do them more efficiently and without further damaging the joints affected by your RA.

“We look for little common-sense things that we are trained to see,” says Daigle. “We are experts in teaching people how to do things in a different way so that they can do it independently.”

One example: Say you have RA in the joints in your hands and fingers, which is quite common. Carrying heavy shopping bags by the handle at your side puts an unhealthy amount of strain on those joints. The solution: Hold the bag over your forearm or elbow and close to your body instead, which takes the weight off your hand, says Daigle.

“This is called proximal support, meaning you carry things close to your body so that you’re using your larger joints in order to protect those very delicate smaller joints in the hands and wrists,” explains Daigle.

Keep in mind that occupational therapy is very individualized. Your needs may be very different from those of someone else with RA, so your program will be uniquely yours.

Do you have trouble typing because of the way that RA affects the joints in your hands? Your occupational therapist may recommend assistive technologies such as speech-to-text software, which allows you talk into a microphone while your computer types your spoken words onto the screen. Your occupational therapy also will assess your desk set-up and determine whether you might benefit from an ergonomic keyboard, computer mouse, and/or chair.

“These are some typical interventions used to help people with inflammatory arthritis maintain employment and work more comfortably,” says Crow.

Manual aids aren’t limited to helping you with your work life. Daigle points to things like devices that help you put your socks on or open stubborn jars. You may benefit from a reacher, which helps you pick things up when you have trouble with range of motion.

“We prescribe adaptive equipment, but we also teach people how to do things in a way that’s going to protect their joints and help them be independent,” says Daigle.

For some people, making the step toward using assistive devices can be difficult. Deciding that you need an aid like a wheelchair or walker may be hard to contemplate, notes Daigle.

“We help them identify when it’s time to transition to something like that, as well as help them come to terms with it,” she says. “Most people see that as accepting a disability, and they don’t want to do that. We try to reframe things to show them that it’s making them more independent, rather than less independent.”

Fatigue is one of the most common symptoms in RA. The Arthritis Foundation says that as many as four out of five people with the disease feel rundown, while more than half experience high levels of fatigue. How can OT help?

Crow says therapists focus on teaching people with RA how to conserve energy and simplify. “For example, we may come up with a schedule that includes taking a 10-minute break after every 50 minutes of work, to help sustain energy,” Crow says. “Fatigue interventions can also include therapeutic activities and exercises designed to decrease stiffness and improve endurance and strength.”

To figure out what you need the most, your occupational therapist will go through your day with you and identify trouble spots. You may find it difficult to empty your dishwasher, for example. In that case, Daigle says it may help to stack several plates and slide them across the counter instead of carrying them. Or you could place your dishes onto a rolling cart or table, and then wheel that closer to your cabinets. This gets rid of the need to walk back and forth with each dish you have to put away.

Many of the tips that OTs provide are common sense, but people often get stuck in their own way of doing things and resist change, says Daigle. She works with them so they see—and feel—the benefits of more efficient activities.

She also teaches them how these more efficient ways of doing things can be protective of your joints, particularly your hands. “We use our hands all day every day, so you have to be careful not to overdo it,” Daigle explains. “We want to find ways to use your hands less, not more.”

The symptoms and severity of rheumatoid arthritis can vary significantly from one person to the next. If your medication is keeping your flares under control and you are able to go about your daily life without noticeable pain, then occupational therapy may not be something you currently need.

Still, almost everyone can benefit from this form of therapy, whether it’s to improve strength or simply maintaining what you have. How long you receive OT for will also depend on your symptoms. Like the program itself, this is highly individualized. You may need only a session or two to help you with a specific need, like how to effectively use a splint to support the joints in your hands. But if your needs are more complex, you could expect up to 20 sessions, possibly more.

And because RA typically gets worse over time, your needs tomorrow may be different than today. In other words, you may need more occupational therapy in the future. “As new needs or decline in function arises the patient can always be referred to OT again,” says Dr. Chan.