Training Manual: Working with Arthritis

Taylor Alexander, Emily Scoggins, and Isaac Smith

 TABLE OF CONTENTS

HOW TO USE THIS TRAINING MANUAL

PURPOSE 3

ACTIVITIES 3

TIMING BREAKDOWN 3

PRE-TRAINING OVERVIEW

OUR ORGANIZATION 4

COURSE PURPOSE 4

OBJECTIVES 4

INTRODUCTION: DEFINING ARTHRITIS

WHAT IS ARTHRITIS 5

ACTIVITY #1 7

STRUCTURE OF A HEALTHY JOINT 8

COMMON TYPES OF ARTHRITIS 10

SPECIAL SENSITIVITIES/ACTIVITY #2 15

SIGNS AND SYMPTOMS 17

TREATMENT FOR ARTHRITIS 18

TYPES OF ARTHRITIS 19

ACTIVITY #3 20

SUMMARY AND REFLECTION

REFERENCES 22

APPENDIX 23

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 How to Use This Training Manual
Purpose
The purpose of this training manual is to prepare staff for the Geriatric Exercise Program.
This manual will cover basic information and characteristics of arthritis and the
treatments that correlate with the condition.

Activities
There will be three activities to complete during this training. One activity will have the
correct answers built into the appendix. The other two activities will have the correct
answers built into them.

Suggested Timing
Listed below is the suggested timing allotted for each section. This is a guide for you to
plan your time accordingly.

Timing Breakdown

Introduction: Defining Arthritis 30 mins

Activity #1 15 mins
Structure of a Healthy Joint 30 mins
Types of Arthritis 30 mins
Special Sensitivities/Activity #2 30 mins
Signs and Symptoms 30 mins
Treatment Options for Arthritis 30 mins
Common Types and Treatments 30 mins
Activity #3 15 mins
Total Time 4 hours

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 Pre-Training Overview
Our Organization
Healthy Aging is a facility that provides highly adaptable exercise programs for senior
citizens. We offer program levels that are challenging enough for active older adults and
levels that are safe enough for the unfit or near frail. The classes range from basic
stretching, flexibility, balance, low-impact aerobics, and strength training.
People of any age can live with arthritis, rheumatic diseases, or any related
musculoskeletal conditions, and individuals with arthritis have varying levels of
capabilities and so these programs are geared to different levels. For example, we offer:
A basic program for individuals who seek a low-intensity exercise program.
A more advanced course for those individuals who live a more active lifestyle and
are able to tolerate moderate intensity exercise programs with longer periods of
endurance.
Our mission is to aid in providing exercise programs that support the health and well-
being of active adults aged fifty and older.

Purpose
The purpose of using this training manual is to educate and train our staff in the growing
geriatric customer base. The geriatric community continues to explore the field of
outdoor recreation, and this program is intended to provide individuals with an overview
of basic aspects of arthritis, its treatments, and impacts on those with the condition.
Completion of this training is a requirement for the Healthy Aging: Geriatric Exercise
Program.

Objectives
At the conclusion of this training, individuals are expected to be able to:
Define arthritis.
Understand joint function and the anatomy of a healthy joint.
Know the most common types of arthritis.
Identify the different types.
Support in the understanding of what it is like to be living with the condition.

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 Point out signs and symptoms of arthritis.
Recognize at least three treatment options/approaches.
Follow special sensitivity recommendations when referring to individuals with
arthritis.

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 Introduction: Defining Arthritis
What is arthritis? Most have heard of arthritis but do not have the basic knowledge of
what it truly is. Some have arthritis or know of someone who have it, and may have
slightly more knowledge than others. To begin this training module, it is important to
have a definition of what arthritis is.

The word arthritis is a general term that means joint inflammation (arth = joint; itis =
inflammation). A joint is where two bones meet. Inflammation is a natural protective
response but in various types of arthritis, it can damage joints and other body parts even
more.

This term refers to more than 100 rheumatic conditions, inflammatory and non-
inflammatory, affecting not only joints but surrounding structures and tissues. Many
forms of arthritis are systemic diseases (relating to or affecting the body as a whole) that
can cause widespread fatigue and problems with the skin, eyes, heart, lungs, kidneys, and
other parts of the body.

More than 50 million adults, and 300,000 children suffer and have been diagnosed with
some form of arthritis.

There are several misconceptions about arthritis. Some of these you may have some
knowledge about, and some you may have not even considered before. Below is a list of
beliefs about arthritis. For each belief, identify whether you think the statement is True or
False.

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This will be Activity #1; pre-test:

Activity #1: Beliefs True/False

1. Poor diet is the main cause of arthritis.
2. Every day is the same for someone struggling with arthritis.
3. Only old people have arthritis.
4. There is nothing that can be done to help people with arthritis.
5. Arthritis is a minor physical condition.

If you answered False to all of these beliefs, you are correct. Great job! If you
answered True, thats okay. Thats what this training is for; many people who dont
know about arthritis think this way. The only way to change misconceptions is learning
the facts about arthritis:
1. Many who have arthritis have disease activity that varies with flare-ups, when
symptoms worsen, the remissions, times when symptoms lessen or disappear.
2. Arthritis affects all ages and is not a part of aging. Nearly 3 out of 5 people with
arthritis are under the age of 65, and even children can have the condition.
3. Diet can not cause or cure this condition; however, reducing weight can take
stress off of joints and reduce pain if the individual is overweight.
4. Arthritis is the most common cause of disability in the U.S., making it difficult for
many to do simple activities of daily living.
5. Most forms of arthritis are chronic. This means they last forever; early, aggressive
treatment can be essential in controlling symptoms and reduce impacts.

After the completion of this training manual, you will have a broader understanding of
what arthritis is, the effects it has on an individuals life, how to be sensitive to what is
happening, and what treatment options are available. There will be various activities
throughout this training, as well as a posttest to review and see what you learned.

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 Structure of a Healthy Joint
So you can understand what actually happens in arthritis, rheumatic diseases, and related
musculoskeletal conditions, it is helpful to first be familiar with the structure of a joint.

A Healthy Joint

Muscles tissue that moves the bones by becoming shorter or longer; moves you.
Fibromyalgia involves pain in the muscles and polymyositis is an inflammatory condition
of muscles.

Cartilage A tough material that cushions and protects the bone ends. The end of each
bone is covered with cartilage. In osteoarthritis, the cartilage breaks down.

Bone A hard, porous substance that provides a supporting framework for the body. It
serves as a place for attachment of muscles and provides a storehouse of minerals such as
calcium that the body needs. Bones are living tissue capable of local growth and
rebuilding, as in healing a fracture. In osteoporosis, bones lose mass and become thin and
brittle, leading to fractures.

Tendon A strong fiber which attaches the muscles to the bones. Inflammation of a
tendon is called tendonitis.

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Structure of a Healthy Joint (Continued)

Ligament Short, fibrous cords that attach bones to bones and reinforce the joint
capsules. In ankylosing spondylitis, there is inflammation where the ligaments and
tendons attach to the bone.

Joint Capsule A membrane that encloses the components of a joint and helps maintain
them as a unit.

Synovial Membrane Lines and protects each joint by secreting a fluid that lubricates
and nourishes the joint. In rheumatoid arthritis, the synovium becomes inflamed and can
damage the other joint tissues.

Bursa A small fluid-filled sac near the joint that acts as a cushion between the bone and
tendons or muscles. Inflammation of a bursa is called bursitis.

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 Common Types of Arthritis

There are more than 100 types of arthritis and related conditions. It is very important to
know the different types of arthritis or related conditions that your program participants
may have. Here are the four forms that are most commonly seen in participants.

Four Common Types of Arthritis

1. Osteoarthritis (OA)
2. Rheumatoid Arthritis (RA)
3. Osteoporosis
4. Fibromyalgia

Osteoarthritis is the most common type of arthritis, with no specific cause.

In OA, which is degenerative, the protective cartilage covering the bones wears away,
resulting in bones rubbing together. The cartilage breaks down, causing pain, swelling
and problems moving the joint. As OA worsens over time, bones may break down and
develop growths called spurs. In the final stage of OA, the cartilage wears away and bone
rubs against bone leading to joint damage and more pain.

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Osteoarthritis is most common in people older than 65. Common risk factors include
increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles,
and genes.

Usually involvement of one or a few joints; typical joints affected are the knees, hips, the
middle and end finger joints, and the spine; contributes to major stiffness after periods of
inactivity.

OA is a chronic disease, meaning there is no cure, but treatments are available to manage
symptoms. Analgesics can help reduce pain, weight loss could benefit is individual is
overweight, using applications of heat or cold compresses, and sometimes joint
replacement surgery is required in serious conditions.

Rheumatoid Arthritis is another common type of arthritis seen in participants.

RA is an autoimmune disease in which the bodys immune system which normally

protects its health by attacking substances like bacteria mistakenly attacks the joints.
This creates inflammation that causes the tissue that lines the inside of joints to thicken,
resulting in swelling and pain in and around the joints.

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These changes result in pain and loss of movement. Eventually complete destruction of
the joint can occur (see above picture). It usually begins between ages 25-50, but can
occur at any age and more commonly affects women.

These following joint symptoms are clues to RA: joint pain, tenderness, swelling or
stiffness for six weeks or longer, morning stiffness for 30 minutes or longer, more than
one joint is affected, small joints (wrists, certain joints of the hands and feet) are affected,
and/or the same joints on both sides of the body are affected. Along with pain, many
people experience fatigue, loss of appetite and a low-grade fever.

RA can be treated with medications to reduce inflammation and stop or slow down
disease progression; balanced exercise program; joint protection and energy
conservation; physical and occupational therapy; and surgery as needed.

Osteoporosis is another arthritis related condition that does not directly affect the
joints.

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In osteoporosis, bones break down faster than they can be replaced, resulting in a loss of
bone mass, making the bones brittle and more likely to break.

This can cause painful fractures, dowagers hump, rounded shoulders, and results in the
loss of height.

More than 10 million people have osteoporosis. Each year, this contributes to more than
1.5 million fractures of the back, wrists and hips. Osteoporosis is more common in
women. It is the main cause of bone fractures in post-menopausal women and the
elderly. However, men can also get osteoporosis.

Some treatment options for individuals with osteoporosis include: exercise, increasing
calcium and vitamin D intakes, taking hormone replacement and other medications to
reduce bone loss, and teach fall prevention techniques.

Fibromyalgia is a related condition that does not affect the joints.

This is a condition that involves pain in the muscles and soft tissues.

Fibromyalgia is a condition associated with widespread chronic pain, fatigue, memory

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problems and mood changes. Pain at distinct tender points as well as generalized pain,
aches, and stiffness. This may also cause fatigue and disturbed sleep.

Fibromyalgia affects more than 3.7 million Americans, the majority of whom are women
between the ages of 40 and 75, but it also affects men, young women and children.

Treatment options include: exercise, relaxation techniques, medications to reduce pain

and improve sleep, such as low-dose antidepressants.

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 Special Sensitivities

There are a number of special sensitivities to be aware of when interacting with

individuals who have arthritis. It is very important to create a supportive, non-threatening
environment when referring to participants in this program.

Activity #2

Here are some possible terms to use when referring to participants. Choose whether each
term is appropriate to use when you referring to your participant with arthritis.

Ways to refer to individuals with arthritis Is it okay to use?

YES or NO

Arthritic NO

Patient NO

Person with a disability YES

Person with arthritis YES

Sufferer NO

Remember that your participants are people first, who happen to have arthritis. Use
positive language when teaching your class. As an Instructor, your role is to make sure
everyone feels included and welcome. Work with and include every participant as much
as possible so no one feels left out.

Always remember:

1. Avoid referring to individuals with arthritis as sufferer, victim, arthritic, or

cripple or calling the condition a crippling disease. These words can carry an
inferiority which is not an image we want to condone.
2. A general rule is to refer to people as participants with arthritis.

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3. The word disability is preferred rather than handicapped when referring to
people with severe physical impairments.
4. Do not refer to people who do not have arthritis as whole. Does having arthritis
make someone less than? NO.

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 Signs and Symptoms

Arthritis is a disease that can start in a variety of ways, and is difficult to be recognized
more often than not. Arthritis can develop very slowly over extended amounts of time, or
it can start showing symptoms within hours of onset. There are many different, but
related, health problems that can occur in conjunction. For example, a rash can be seen in
the early stages, or joint pain and swelling in the more advanced. Sometimes the early
stages of arthritis can be mistaken for overexertion during daily physical activities.

Below are the 4 most important warning signs, and if present, you should consider
seeking medical advice:
Pain. Pain from arthritis can be constant or it may come and go. It may occur when at
rest or while moving. Pain may be in one part of the body or in many different parts.
Swelling. Some types of arthritis can cause the skin over the affected joint to become red
and swollen, feeling warm to the touch. Swelling can last for three days or longer, and
can occur more than three times a month.
Stiffness. This is a classic arthritis symptom, especially when lasting longer than hour.
Difficulty moving a joint.

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 Treatment for Arthritis

What types of treatments do you think are available for individuals who have arthritis?

Medications

Drug therapy for arthritis can limit disease progression, control your symptoms, and
prevent serious complications.

Self-management

There are many things that people with arthritis can do on their own to help in the
reduction of pain and improve their overall quality of life.

Regular exercise helps lessen pain, increase mobility, and prevent weight gain.
o Core exercise
o Stretching
o Upper Body Exercise
o Lower Body Exercise
o Weight-bearing Exercise
o Tai Chi Exercise
o Go to www.arthritis.org to watch exercise options.
Relaxation techniques such as deep breathing and guided imagery can help
manage stress and reduce pain.
Heat and cold treatments to reduce pain.
Weight control by maintaining a healthy weight or losing weight, if overweight.
This will reduce stress on joints.

Surgery

Joint replacement surgery is performed mostly for severe destructive arthritis of the hips
or knees, which causes severe pain or activity limitations. This procedure can
considerably reduce pain and improve quality of life.

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 Types of Arthritis

There are over 100 types of arthritis. Below is a list of the different types to give an idea
of the different conditions that you could come into contact with. Eachs participants
treatment plan must be individualized and will vary person to person, so it is important to
remain open-minded as to how to work with these individuals.

Adult-onset Stills disease, Ankylosing Spondylitis, Back Pain, Bechets Disease,

Bursitis, Calcium Pyrophosphate Deposition Disease (CPPD), Carpal Tunnel Syndrome,
Chondromalacia Patella, Chronic Fatigue Syndrome, Complex Regional Pain Syndrome,
Cryopyrin-Associated Periodic Syndromes (CAPS) , Degenerative Disc Disease,
Developmental-Dysplasia of Hip, Ehlers-Danlos, Familial Mediterranean Fever,
Fibromyalgia, Fifth Disease, Giant Cell Arteritis Gout, Hemochromatosis, Infectious
Arthritis, Inflammatory Arthritis, Inflammatory Bowel Disease, Juvenile Arthritis,
Juvenile Dermatomyositis (JD), Juvenile Idiopathic Arthritis (JIA), Juvenile
Scleroderma, Kawasaki Disease, Lupus, Lupus in Children & Teens, Lyme Disease,
Mixed Connective Tissue Disease, Myositis (Inc. Polymyositis, Dermatomyositis),
Osteoarthritis, Osteoporosis, Pagets, Palindromic Rheumatism, Patellofemoral Pain
Syndrome, Pediatric Rheumatic Diseases, Pediatric SLE, Polymyalgia Rheumatica,
Pseudogout, Psoriatic Arthritis, Raynauds Phenomenon, Reactive Arthritis, Reflex
Sympathetic Dystrophy, Reiters Syndrome, Rheumatic Fever, Rheumatism, Rheumatoid
Arthritis, Scleroderma, Sjgrens Disease, Spinal Stenosis, Spondylarthrosis, Systemic
Juvenile Idiopathic Arthritis, Systemic, Lupus Erythematosus, Systemic Lupus
Erythematosus in Children & Teens, Systemic Sclerosis, Temporal Arteritis, Tendinitis,
Vasculitis, Wegeners Granulomatosis

Conclusion
You should now have a better understand of arthritis, the anatomy of a healthy joint, the
four most common types, and the signs and symptoms you may see in your participants.
With the completion of this training, you will be able to aid in the understanding of what
individuals living with arthritis experience physically and emotionally. Please remember
to follow the guidelines given related to special sensitivities.

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 Knowledge Check

Activity #3

1. Osteoarthritis affects the same joint on both sides of the body (symmetrical).
True
False

2. The lining of the joint that can thicken and cause damage in and around the joint
is called_______________.
Bone
Tendon
Synovial membrane
Cartilage

3. Which of following facts is NOT true of Rheumatoid Arthritis?

Causes redness, warmth, and swelling
Doesnt cause a general feeling of sickness
Joint stiffness
Usually begins between the ages of 25-50
4. Arthritis is an unavoidable part of getting older.
True
False
5. Treatments for arthritis include:
Exercise
Medication
Relaxation techniques
All of the above
6. People with arthritis should avoid doing cardiovascular exercises.
True
False

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7. The treatment and exercise programs for individuals with arthritis will vary from
person to person because disease activity may cause flare-ups and remissions.
True
False
8. On a daily basis, people with arthritis should try to move each joint through its
range of motion to maintain flexibility.
True
False

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 References

Arthritis. (2016, January 07). Retrieved April 17, 2017, from

http://www.mayoclinic.org/diseases-conditions/arthritis/home/ovc-20168903

Arthritis-friendly Exercise Videos. (n.d.). Retrieved April 17, 2017, from

http://www.arthritis.org/living-with-arthritis/exercise/videos/

Do I have arthritis? (n.d.). Retrieved April 17, 2017, from http://www.arthritis.org/about-

arthritis/understanding-arthritis/do-I-have-arthritis.php

WebMD Arthritis and Joint Pain Center: Symptoms, Causes, Tests, and Treatments.
(n.d.). Retrieved April 17, 2017, from http://www.webmd.com/arthritis/

What Is Arthritis? (n.d.). Retrieved April 17, 2017, from http://www.arthritis.org/about-

arthritis/understanding-arthritis/what-is-arthritis.php

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 Appendix

Training Manual Minutes

02/22/17
5:45 7:00
All group members were present.
Discussion, Cover Page, Table of Contents
03/02/17
9:30 12:00
All group members were present.
Discussion, Abstract & Outcome, Researched Potential References
03/13/17
11:30 1:30
All group members were present.
Discussion, Formatted Manual, Started PowerPoint
04/10/17
12:00 1:30
All group members were present
Discussion, Created Activities and Knowledge Check
04/17/17
12:00 1:45
All group members were present.
Discussion, Fixed Formatting on Manual and PowerPoint, Created Reference
Citations

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