Highlights
- •Functional and work disability in people with rheumatic diseases remain high despite advances in medical and pharmacological management
- •Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities.
- •Patients, primary care, and rheumatology providers need to be educated about the scope of services occupational and physical therapy provide beyond the hand impairments.
Abstract
Study design
Invited Clinical Commentary
Background
Arthritis is one of the most frequently reported causes of disability in the United
States and the prevalence is expected to increase in the coming decades. While many
rheumatic diseases involve hand impairments, most are systemic and involve more than
the musculoskeletal system. Functional and work disability are high and people would
benefit from the services of occupational and physical therapists.
Purpose of study
This paper reviews concepts of self-management, and symptoms that contribute to limitations
and restrictions to participation in daily life in people with rheumatic diseases
and suggests roles for hand therapists beyond the immediate hand impairments.
Methods
The impact of selected rheumatic diseases on functional and work disability are reviewed
along with strategies for symptom management and self-management. Upper extremity
impairments of selected rheumatic diseases are also discussed.
Results
The role for hand therapists in evaluating and addressing the complex needs of persons
with rheumatic diseases, including less common diseases, is discussed. Outcome measures
for fatigue, muscle involvement, ergonomics and computer use, and work disability
are introduced. Finally, strategies for self-management and prevention of work and
functional disability, along with symptom management for fatigue and pain are presented.
Conclusion
Hand therapists can play a vital role in chronic rheumatic disease management to improve
self-management and increase participation in meaningful activities. Patients, primary
care and rheumatology providers need to be educated about the scope of services occupational
and physical therapists provide beyond the hand impairments.
Keywords
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References
- Prevalence of arthritis and arthritis-attributable activity limitation—United States, 2016–2018.Morb Mortal Wkly Rep. 2021; 70: 1401-1407https://doi.org/10.15585/mmwr.mm7040a2
- Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040.Arthritis Rheumatol. 2016; 68: 1582-1587https://doi.org/10.1002/art.39692
- Associations of arthritis-Attributable interference with routine life activities: A modifiable source of compromised quality-of-life.ACR Open Rheumatol. 2019; 1: 412-423https://doi.org/10.1002/acr2.11050
- Effect of arthritis and other rheumatic conditions on employment.Work. 2013; 45: 417-420https://doi.org/10.3233/WOR-131629
- Prevalence and causes of work disability among working-age US adults, 2011–2013, NHIS.Disabil Health J. 2018; 11: 108-115https://doi.org/10.1016/j.dhjo.2017.04.010
- Impact of early systemic lupus erythematosus on work disability—results from the Finnish nationwide register 2000–2007.Clin Rheumatol. 2018; 37: 1413-1416https://doi.org/10.1007/s10067-018-4066-6
- Work disability in early rheumatoid arthritis.Clin Exp Rheumatol. 2003; 21: S71-S74
- Work disability in systemic sclerosis.J Rheumatol. 2009; 36: 2481-2486https://doi.org/10.3899/jrheum.081237
- Enabling performance and participation for persons with rheumatic diseases.in: Christiansen C Matuska K Ways of Living. 5th ed. American Occupational Therapy Association, Rockville, MD2020: 187-209
- Impaired hand function and performance in activities of daily living in systemic lupus erythematosus, even in patients achieving lupus low disease activity state (LLDAS).Rheumatol Adv Pract. 2021; 5: rkab029https://doi.org/10.1093/rap/rkab029
- Hand function and performance of daily activities in systemic lupus erythematosus.Arthritis Care Res. 2008; 59: 1432-1438https://doi.org/10.1002/art.24108
- Scleroderma: Therapy.7th ed. Rehabilitation of the hand and upper extremity. 2020. Elsevier Inc, 2020: 1308-1322
- A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis.Clin Exp Rheumatol. 2014; 32: S68-S74
- Effect of psoriatic arthritis on the strength, proprioception, skill, coordination, and functional condition of the hand.Int J Rheum Dis. 2022; 25: 47-55https://doi.org/10.1111/1756-185X.14241
- Patients with polymyositis or dermatomyositis have reduced grip force and health-related quality of life in comparison with reference values: an observational study.Rheumatology. 2011; 50: 578-585https://doi.org/10.1093/rheumatology/keq356
- 2018 Accreditation Council for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide (effective July 31, 2020).Am J Occup Ther. 2018; 727212410005https://doi.org/10.5014/ajot.2018.72S217
- Self-management education: history, definition, outcomes, and mechanisms.Ann Behav Med. 2003; 26: 1-7
- 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis.Ann Rheum Dis. 2021; 80: 1278-1285https://doi.org/10.1136/annrheumdis-2021-220249
- Self-management support needs of patients with chronic illness: do needs for support differ according to the course of illness?.Patient Educ Couns. 2013; 93: 626-632https://doi.org/10.1016/j.pec.2013.08.021
- Has the severity of rheumatoid arthritis at presentation diminished over time?.J Rheumatol. 2014; 41: 1590-1599https://doi.org/10.3899/jrheum.131136
- Social participation in early and established rheumatoid arthritis patients.Disabil Rehabil. 2016; 38: 1172-1179https://doi.org/10.3109/09638288.2015.1076071
- Impact of rheumatoid arthritis on career progression, productivity, and employability: the PRET study.Joint Bone Spine. 2016; 83: 47-52https://doi.org/10.1016/j.jbspin.2015.05.001
- Nonpharmacological treatment in established rheumatoid arthritis.Best Pract Res Clin Rheumatol. 2019; 33101482https://doi.org/10.1016/j.berh.2019.101482
- Patient preferences for psychological support in inflammatory arthritis: a multicentre survey.Ann Rheum Dis. 2016; 75: 142-147https://doi.org/10.1136/annrheumdis-2014-205636
- A systematic review into the effectiveness of hand exercise therapy in the treatment of rheumatoid arthritis.Clin Rheumatol. 2014; 33: 1539-1548https://doi.org/10.1007/s10067-014-2691-2
- The effectiveness of home hand exercise programmes in rheumatoid arthritis: a systematic review.Br Med Bull. 2016; 119: 49-62https://doi.org/10.1093/bmb/ldw024
- Splints and Orthosis for treating rheumatoid arthritis.Cochrane Database Syst Rev. 2001; (IssueArt)CD004018https://doi.org/10.1002/14651858.CD004018
- The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial.Rheumatol. 2008; 47: 1548-1553https://doi.org/10.1093/rheumatology/ken292
- Efficacy of wrist working splints in patients with rheumatoid arthritis: a randomized controlled study.Arthritis Car Res. 2008; 59: 1698-1704https://doi.org/10.1002/art.24078
- Non-pharmacological interventions for fatigue in rheumatoid arthritis.Cochrane Database Syst Rev. 2013; https://doi.org/10.1002/14651858.CD008322.pub2
- EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis.Ann Rheum Dis. 2018; 77: 797-807https://doi.org/10.1136/annrheumdis-2017-212662
- Conservative therapeutic interventions for osteoarthritic finger joints: A systematic review.J Hand Ther. 2019; 32: 153-164https://doi.org/10.1016/j.jht.2018.01.001
- The effectiveness of joint-protection programs on pain, hand function, and grip strength levels in patients with hand arthritis: a systematic review and meta-analysis.J Hand Ther. 2019; 32: 194-211https://doi.org/10.1016/j.jht.2018.09.012
- Systematic review of design and effects of splints and exercise programs in hand osteoarthritis.Arthritis Care Res. 2011; 63: 834-848https://doi.org/10.1002/acr.20427
- Efficacy of nonsurgical interventions for trapeziometacarpal (thumb base) osteoarthritis: a systematic review.Arthritis Care Res. 2020; 72: 1719-1735https://doi.org/10.1002/acr.24084
- Comparative effectiveness of orthoses for thumb osteoarthritis: a systematic review and network meta-analysis.Arch Phys Med Rehabil. 2021; 102: 502-509https://doi.org/10.1016/j.apmr.2020.06.012
- 2018 update of the EULAR recommendations for the management of hand osteoarthritis.Ann Rheum Dis. 2019; 78: 16-24https://doi.org/10.1136/annrheumdis-2018-213826
- The functional and psychological impact of hand osteoarthritis.Chronic illness. 2010; 6: 101-110https://doi.org/10.1177/1742395309345614
- Coping styles and disability in patients with hand osteoarthritis.Rheumatology. 2016; 55: 411-418https://doi.org/10.1093/rheumatology/kev295
- Impact of thumb carpometacarpal joint osteoarthritis: a pragmatic qualitative study.Arthritis Care Res. 2021; 73: 336-346https://doi.org/10.1002/acr.24124
- What do you expect? You're just getting older”: a comparison of perceived osteoarthritis-related and aging-related health experiences in middle-and older-age adults.Arthritis Care Res. 2006; 55: 905-912https://doi.org/10.1002/art.22338
- Just get on with it”: qualitative insights of coming to terms with a deteriorating body for older women with osteoarthritis.PloS One. 2015; 10e0120507https://doi.org/10.1371/journal.pone.0120507
- Hand impairment and activity limitations in four chronic diseases.J Hand Ther. 2013; 26: 232-237https://doi.org/10.1016/j.jht.2013.03.002
- Physical or occupational therapy use in systemic sclerosis: a scleroderma patient-centered intervention network cohort study.J Rheumatol. 2019; 46: 1605-1613https://doi.org/10.3899/jrheum.181130
- Psychosocial aspects of scleroderma.Rheum Dis Clin North Am. 2015; 41: 519-528https://doi.org/10.1016/j.rdc.2015.04.010
- Rehabilitation interventions in systemic sclerosis: a systematic review and future directions.Arthritis Care Res. 2022; 74: 59-69https://doi.org/10.1002/acr.24737
- Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.Arthritis Rheum. 2012; 64: 2677-2686https://doi.org/10.1002/art.34473
- Fatigue in systemic lupus erythematosus: impact on occupational participation and reported management strategies.Br J Occup Ther. 2014; 77: 373-380https://doi.org/10.4276/030802214X14044755581862
- Experiences and perspectives of adults living with systemic lupus erythematosus: thematic synthesis of qualitative studies.Arthritis Care Res. 2013; 65: 1752-1765https://doi.org/10.1002/acr.22032
- Burden of lupus on work: issues in the employment of individuals with lupus.Work. 2016; 55: 429-439https://doi.org/10.3233/WOR-162398
- Fatigue and activity management education for individuals with systemic lupus erythematosus.Occup Ther Int. 2017; 2017https://doi.org/10.1155/2017/4530104
- The impact of upper limb exercise on function, daily activities and quality of life in systemic lupus erythematosus: a pilot randomised controlled trial.RMD Open. 2020 Jan 1; 6e001141https://doi.org/10.1136/rmdopen-2019-001141
- Effectiveness of occupational therapy interventions for adults with systemic lupus erythematosus: a systematic review.Am J Occup Ther. 2019; 73 (-21)7304205020p1https://doi.org/10.5014/ajot.2019.030619
- Non-pharmacologic therapies for systemic lupus erythematosus.Lupus. 2019; 28: 703-712https://doi.org/10.1177/0961203319841435
- Effectiveness of nonpharmacologic interventions for decreasing fatigue in adults with systemic lupus erythematosus: a systematic review.Arthritis Care Res. 2016; 68: 141-148https://doi.org/10.1002/acr.22675
- The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015; 41: 545-568https://doi.org/10.1016/j.rdc.2015.07.001
- Prevalence and severity of fatigue in psoriasis and psoriatic arthritis.Postepy Dermatol Alergo. 2020; 37: 46https://doi.org/10.5114/ada.2019.83629
- Fatigue in psoriatic arthritis–a cross-sectional study of 246 patients from 13 countries.Joint Bone Spine. 2016; 83: 439-443https://doi.org/10.1016/j.jbspin.2015.07.017
- 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis.Arthritis Rheumatol. 2019; 71: 5-32https://doi.org/10.1002/art.40726
- Diagnosis and classification of idiopathic inflammatory myopathies.J Intern Med. 2016; 280: 39-51https://doi.org/10.1111/joim.12524
- Development of the myositis activities profile–validity and reliability of a self-administered questionnaire to assess activity limitations in patients with polymyositis/dermatomyositis.J Rheumatol. 2002; 29: 2386-2392
- Role of Exercise in the Management of Myositis.Managing Myositis 2020. Springer, Cham2020: 323-334
- Hand exercise intervention in patients with polymyositis and dermatomyositis: a pilot study.Musculoskeletal Care. 2014; 12: 160-172https://doi.org/10.1002/msc.1069
- Examination of arthritis-related work place activity limitations and intermittent disability over four-and-a-half years and its relationship to job modifications and outcomes.Arthritis Care Res. 2011; 63: 953-962https://doi.org/10.1002/acr.20456
- Productivity losses and costs in the less-common systemic autoimmune rheumatic diseases.Curr Rheumatol Rep. 2017; 19: 1-20https://doi.org/10.1007/s11926-017-0698-9
- OMERACT filter evidence supporting the measurement of at-work productivity loss as an outcome measure in rheumatology research.J Rheumatol. 2016; 43: 214-222https://doi.org/10.3899/jrheum.141077
- Ergonomic intervention for employed persons with rheumatic conditions.Work. 2013; 46: 355-361https://doi.org/10.3233/WOR-131761
- Randomized prospective study of a work place ergonomic intervention for individuals with rheumatoid arthritis and osteoarthritis.Arthritis Care Res. 2012; 64: 1527-1535https://doi.org/10.1002/acr.21699
- Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: a pilot study.Musculoskeletal Care. 2018; 16: 398-404https://doi.org/10.1002/msc.1237
- Identification of modifiable work-related factors that influence the risk of work disability in rheumatoid arthritis.Arthritis Care Res. 2004; 51: 843-852https://doi.org/10.1002/art.20690
- Employment and arthritis: making it work” a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).BMC Med Inform Decis Mak. 2014; 14: 1-7https://doi.org/10.1186/1472-6947-14-59
- The ergonomic assessment tool for arthritis: development and pilot testing.Arthritis Care Res. 2008; 59: 1495-1503https://doi.org/10.1186/1472-6947-14-59
- Problems experienced by people with arthritis when using a computer.Arthritis Care Res. 2009; 61: 614-622https://doi.org/10.1002/art.24465
- Measures of work disability and productivity: rheumatoid arthritis specific work productivity survey (WPS-RA), workplace activity limitations scale (WALS), work instability scale for rheumatoid arthritis (RA-WIS), work limitations questionnaire (WLQ), and work productivity and activity impairment questionnaire (WPAI).Arthritis Care Res. 2011; 63: S337-S349https://doi.org/10.1002/acr.20633
- Management of fatigue in rheumatoid arthritis.RMD Open. 2020 May 1; 6e001084https://doi.org/10.1136/rmdopen-2019-001084
- Fatigue in systemic sclerosis: a systematic review.Clin Exp Rheumatol. 2018; 36: 150-160
- Fatigue in osteoarthritis: a qualitative study.BMC Musculoskelet Disord. 2008; 9: 1-8https://doi.org/10.1186/1471-2474-9-63
- Fatigue in systemic lupus erythematosus.Int J Clinical Rheumatol. 2012; 7: 217https://doi.org/10.2217/IJR.12.4
- The prevalence of severe fatigue in rheumatic diseases: an international study.Clin Rheumatol. 2016; 35: 409-415https://doi.org/10.1007/s10067-015-3035-6
- Measures of fatigue in patients with rheumatic diseases: a critical review.Arthritis Care Res. 2020; 72: 369-409https://doi.org/10.1002/acr.24246
- Fatigue and activity management education for individuals with systemic sclerosis: Adaptation and feasibility study of an intervention for a rare disease.Musculoskeletal Care. 2022; https://doi.org/10.1002/msc.1617
- Symptoms of anxiety and depression among adults with arthritis—United States, 2015–2017.Morb Mortal Wkly Rep. 2018; 67 (5): 1081-1087https://doi.org/10.15585/mmwr.mm6739a2
- Depressive Symptoms and the Arthritis–Employment Interface: A Population-Level Study.Arthritis Care Res. 2021; 73: 65-77https://doi.org/10.1002/acr.24381
- Anxiety and depression among US adults with arthritis: prevalence and correlates.Arthritis Care Res. 2012; 64: 968-976https://doi.org/10.1002/acr.21685
- The evidence base for psychological interventions for rheumatoid arthritis: a systematic review of reviews.Int J Nurs Stud. 2018; 82: 20-29https://doi.org/10.1016/j.ijnurstu.2018.03.008
- Mindful body scans and sonographic biofeedback as preparatory activities to address patient psychological states in hand therapy: A pilot study.Hand Ther. 2020; 25: 98-106https://doi.org/10.1177/1758998320930752
- Fostering holistic hand therapy: Emergent themes of client experiences of mind–body interventions.OTJR. 2020; 40: 122-130https://doi.org/10.1177/1539449219888835
- Rehabilitation in rheumatic diseases.Brit Med J. 1985; 290: 132-136https://doi.org/10.1136/bmj.290.6462.132
JHT Read for Credit
Quiz: # 870
Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to JHTReadforCredit.com. There is only one best answer for each question.
- # 1.The authors emphasize the role of
- a.NSAIDs
- b.caretaker efficiency
- c.self-management
- d.proper use of orthotic devices
- a.
- # 2.A National Health Survey found that approximately
- a.2/3 of patients were women
- b.2/3 of patients were male
- c.50% were female and 50% were male
- d.70% were left handed
- a.
- # 3.Well recognized is the existence of ______________ along with the rheumatoid disease
- a.depression
- b.fatigue
- c.anxiety
- d.all of the above
- a.
- # 4.The typical hand deformity accompanying scleroderma is
- a.claw hand
- b.swan neck
- c.reduced PIP extension and reduced MP flexion
- d.mallet finger
- a.
- # 5.The authors emphasize the need for therapists to be more aware and concerned about the far-reaching effects of rheumatoid disease beyond the obvious effects on hands
- a.not true
- b.true
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: August 16, 2022
Accepted:
July 3,
2022
Received in revised form:
June 23,
2022
Received:
March 25,
2022
Footnotes
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.