Medical History

Jenny is a 35 year old professional woman who was diagnosed with acute rheumatoid arthritis 2 years ago. She takes non- steroidal anti-inflammatory medication on a regular basis. Since diagnosis she has had four episodes of acute exacerbation of her condition each time she was treated with a short course of steroids.

Social History

Jenny stated her work is important to her but it could be very stressful in terms of working long irregular hours, meeting short deadlines. Jenny works from home two days a week, other days she drives to her office, a journey of about 30 miles. Her job also involves her travelling to London and abroad on occasions.

Jenny lives alone in a small village and her family do not live locally. Until recently she enjoyed socialising with friends. In her leisure time she enjoyed caring for and riding her horse and walking her dog.

Presenting Problems

  • Denial of her condition, she stated if she ignored it she hoped it would go away, she did not want to give in to arthritis. Only her family, her line manager and one close friend knew of her condition. She thought people would treat her differently and feel sorry for her.
  • Anxiety, low in mood and tearful at times, she felt very negatively about the future.
  • Pain and stiffness in joints, particularly hands and feet
  • Fatigue
  • Sleep disturbance

Jenny's RA affected all aspects of her daily life, work, leisure, managing her personal care and carrying out domestic tasks.

Occupational therapy intervention can be classified under the headings

  • Joint protection
  • Energy conservation
  • Aids and adaptations
  • Anxiety and stress management
  • Support and advice

The aim of Occupational therapy intervention was to enable Jenny to take a positive approach to managing her RA .By following the principles of energy conservation and joint protection and making changes in her daily life and around her home she can help to reduce the symptoms during an acute episode and keep problems to a minimum both now and in the future and have more energy to do the things she enjoys doing.

Mobility

Jenny was able to walk without aids only short distances due to painful feet and fatigue. She was unable to take her dog for a walk.

Jenny was advised by the Occupational Therapist to see a podiatrist re pressure relieving insoles. Plan to take the dog for short walks at a time of day when she is least fatigued and rest after doing so. And ask a friend to take the dog on longer walks.

Driving distances was a problem, she found maintaining the same position uncomfortable and gripping the steering wheel painful. Jenny was advised to increase the grip size of her steering wheel, to plan short breaks into her journey time when she should get out of the car and walk around. When considering purchasing a new car she should consider one with power steering and cruise control.

Transfers

Jenny was independent with all transfers, however low furniture did not encourage good posture and movement.

The Occupational Therapist advised her to purchase a more suitable armchair that supports her back, thighs and arms and facilitates easier transfers.

Personal Activities of Daily Living

Jenny had difficulty getting in the bath during periods of exacerbation and difficulty putting on her socks. The Occupational Therapist demonstrated ways of getting in and out of the bath and reducing the effort of putting lower garments on.

Gripping a pen was painful and using her computer for long periods increased the stiffness in her fingers. Using different weight and sized pens and changing them frequently were discussed with Jenny and she was advised to try different keyboards and types of mouse that may be beneficial.

Domestic Activities of Daily Living

The Occupational Therapist suggested that Jenny employ help with housework, ironing and gardening and to consider doing her shopping on line and have it delivered.

Kitchen tasks were difficult for jenny, she was advised to: use electrical aids when possible to reduce the effort and strain on joints; to use lightweight equipment. And large handled item; Sit to carry out tasks whenever possible; Use larger stronger joints and spread the load over several joints; Use two hands instead of one when lifting eg the kettle, saucepans and carrying items; Avoid lifting, when possible, slide items along surfaces.

Leisure

Jenny was unable to enjoy caring for and riding her horse, grooming and stable management were carried out at the livery yard. She found gripping the reins difficult and her feet were uncomfortable in her boots.

She was advised to increase the girth of the reins, see a podiatrist re insoles for riding boots and plan her time for riding so she could rest before and after.

She had withdrawn from socialising with friends and neighbours. The Occupational therapist suggested that Jenny plan ahead, rest before the event, if entertaining prepare things in advance or buy in and plan things for a time of day when she feels less fatigued eg lunch instead of dinner.

Work

Jenny was advised about her work environment eg desk height, chair height, organisation of items to avoid bending, twisting, and stretching. She was advised to avoid working in one position for long periods, take a break for a few minutes every half an hour,stretch upper limbs and walk about. The Occupational Therapist taught Jenny short relaxation techniques that she could use during the working day and discussed the importance of incorporating relaxing activities into her daily life.

The Occupational Therapist discussed with Jenny that she might benefit from counselling to enable her to express how she feels about her condition, to help her to communicate with other people about her condition and to help her to think more positively about the future. Information about RA organisations and support groups were given Jenny for to her follow up if she wished to.

Declan McNichol

Bill Young

Angela Gordon

Birgit Rathje-Vale