The principles of joint protection program
1. Patients are advised not to engaged in activities or tasks that require a prolonged fixed grip or grasp on a tool, such as in the activity of cutting (where patient has to hold a knife in a fixed position), knitting a blouse, or even holding up newspapers to read.
2. Patients are to schedule their days and activities, and to schedule rests in between their activities, to prevent exacerbation of rheumatoid arthritis flare up
3. Patients are to respect pain and discomfort when it happens, and not continue to engage in a task or activity when there is pain already present.
4. Be compliant to splints fabricated and prescribed according to the time communicated by the hand occupational therapist
On top of that, all patients with rheumatoid arthritis need to be able to recognize and avoid any tasks or activities that causes pressure on the radial side of any finger and / or puts a strong pressure on the thumb.
We understand that the list of this joint protection program does seem more like a long list of “Do Not Do This”, and we have alternative solutions as well for patients to continue as closely as possible to their previously acquired roles and habits. As alternative to knitting, patients can consider engaging in activities that requires use of both hands such as weaving. Reading can be continued with a reading stand to place books or newspapers. Patients are encouraged to participate in as much activity as possible, just have adequate rest and do not push themselves harder when faced with pain in their joint already.
Splints can be alternated (with the permission and approval of the hand occupational therapists) with rests or soft splints for comfort.
Positioning of the joints for the patient with rheumatoid arthritis is the most serious aspect of the joint protection program. Because of general pain and discomfort, most patients enjoy the pain and discomfort relief when they sleep or rest with a pillow under their knees. No matter how comfortable this is, this must not be done or continued, as prolonged knee and hip flexion can and will cause joint shortening and tightening, leading to flexion contractures.
At rest, the legs and hips should be in straight (180 degrees), with the feet supported at right angles. If the occupational therapist or physiotherapist observes a tendency to have flexion patterns in supine, then a rather lying position must be encouraged.