If you were recently diagnosed with arthritis or a related condition, you might feel anxious or overwhelmed. This is a natural response to an unexpected health change. However, living well with rheumatic disease is entirely achievable. Informed patients, working alongside their rheumatologists and healthcare teams, are the key players in maintaining their health and vitality.
These educational materials aim to complement the personal advice you receive from your healthcare provider. With proper treatment, careful planning, and a proactive mindset, you can manage your condition and continue to lead a productive, fulfilling life.
Physically active individuals are healthier, happier, and often live longer than those who are inactive. This fact is especially true for people dealing with joint pain. Yet, arthritis remains one of the most common reasons people limit their physical activity. Inactivity can lead to various health risks, including Type II diabetes, cardiovascular disease, and osteoporosis.
Decreased pain tolerance, weak muscles, stiff joints, and poor balance can all worsen if you stop moving. Finding the right kind of exercise is crucial. The three main levels of exercise include therapeutic, recreational, and competitive activities. Finding the right balance among these is the secret to living well with rheumatic disease.
Therapeutic exercises, prescribed by health professionals, target specific joints or body parts affected by your condition. This type of program is often the vital first step for individuals who have been inactive or are recovering from joint surgery.
Recreational activities range from walking and swimming to cycling and yoga. Appropriate exercises are those you can do safely, carrying little risk of injury and placing minimal stress on affected joints. The Arthritis Foundation offers excellent resources on joint-friendly activities you can incorporate into your daily routine.
Competitive activities happen at higher intensities and require greater skill. Exercising at an elite level is generally not recommended for individuals with severe inflammatory arthritis. Always consult your rheumatologist or a physical therapist before starting an intense regimen.
Arthritis and other rheumatic conditions represent a family of illnesses causing inflammation, joint changes, and pain in surrounding structures. In fact, medical professionals recognize more than 100 different rheumatic conditions. While symptoms vary, these conditions typically target the musculoskeletal system.
Taking control of your situation means ensuring you get adequate exercise, ample rest, and proper nutrition. The knowledge you gather and the positive approach you take will make the difference between merely coping and truly living well with rheumatic disease.
Because symptoms and disease progression vary wildly, it may take time for your primary care physician or rheumatologist to determine the absolute best treatment plan. Your patience and active participation contribute heavily to your overall comfort. You can learn more about specific disease classifications and treatments from the American College of Rheumatology.
For years, women with potentially serious systemic autoimmune diseases have been advised not to get pregnant. We now know that, with careful medical and obstetric management, most of these women can have successful pregnancies. Successful, however, does not mean uneventful. Doctors and patients must be ready to deal with possible complications for both mother and child. Further, women should not consider getting pregnant until their rheumatic disease is under control.
The effects of pregnancy on rheumatic diseases vary by condition. Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and APS typically are modified by pregnancy. For instance, symptoms of RA often improve in pregnant patients, frequently resulting in a reduced need for medication, but may flare up after delivery.
The relationship between lupus activity and pregnancy is more debated. In general, there is a tendency for mild to moderate flares, especially during the second half of pregnancy and the postpartum period. However, most of these flares do not endanger the mother’s or the baby’s life, nor do they substantially alter the long-term prognosis of lupus. A prolonged period of clinical remission before conception decreases the chance of a flare during pregnancy.
Antiphospholipid syndrome (APS) increases the risk of clots in veins and arteries as well as obstetric complications such as miscarriage, prematurity, or hypertension (high blood pressure) during pregnancy. When combined with kidney disease, the possibility exists of pre-eclampsia. Pre-eclampsia and eclampsia are conditions that may damage the mother’s kidneys and liver and also increase the risk of prematurity or death of the fetus. Thus, for women with APS, pregnancy, especially the time around delivery, is a particularly dangerous period and dictates special care.
Pulmonary hypertension, which complicates some rheumatic diseases (SLE, APS, Sjögren’s, and, particularly, scleroderma), also warrants mention. Because this severe disease frequently worsens during pregnancy, especially in the postpartum period, pregnancy is considered inadvisable.
Other diseases, such as scleroderma (in the absence of pulmonary hypertension or lung fibrosis), polymyositis, dermatomyositis, and vasculitis, do not seem to be particularly influenced by pregnancy. However, it is still recommended that you consider pregnancy only when these diseases are under control and with the care of your rheumatologist.
During pregnancy, the effects of inflammation when rheumatic disease becomes active, as well as the then necessary anti-inflammatory and/or immunosuppressive drugs, can cause problems. Those diseases with the potential to affect the kidney and, especially, APS are more likely to affect pregnancy outcomes than others.
Patients who have or have had kidney disease, due to vasculitis, scleroderma, or, more frequently, lupus, in general, are at increased risk of severe hypertension and pre-eclampsia. If renal function and blood pressure before pregnancy are normal and the disease is inactive at the time of conception for a period of at least six months, the outcome is likely to be good. Conversely, women with severely impaired renal function, uncontrolled hypertension, and/or active kidney involvement usually are advised against getting pregnant.
APS probably has the greatest impact on pregnancy. It is related to both early and late miscarriage, prematurity and low-weight babies, as well as thrombosis and pre-eclampsia. Thus, pregnancy in women with APS should always be considered as high risk and be the subject of close medical and obstetric monitoring. Therapy is based on low-dose aspirin and heparin.
Finally, a rare condition named congenital heart block can occur in 2% of children born to mothers with anti-Ro antibodies (most frequently seen in patients with LUPUS and Sjögren’s syndrome). Anti-Ro antibodies can gain access to the fetal circulation and produce disturbances in the baby’s heart, which result in a slow heart rate. These babies may need a permanent pacemaker. Thus, women with anti-Ro antibodies also should be closely monitored, including fetal heart scans during pregnancy.
Sexuality is an integral part of being human. It is linked to our quality of life and self-identity. Yet, living with the pain, stiffness, fatigue, limited movement, decreased strength, and depression associated with arthritis can reduce our ability for sexual expression and enjoyment.
Sex is not simply about reaching rapid orgasms with a partner. A slower approach can prove satisfying for partners who share mutual respect, care, trust, and love. Exploring ways of returning pleasure can build excitement and intimacy. Begin overcoming potential barriers by letting your partner know if something is uncomfortable, as well as what is particularly pleasurable.
While arthritis rarely affects the sexual organs themselves, the physical effects of the disease can also have an emotional impact on sexual relations. A change in appearance, weight gain or loss, or a decrease in mobility or energy can affect self-esteem and self-image. The person with arthritis may feel less desirable or more fragile. The fear of pain can prompt anxiety that makes it difficult to relax and enjoy sex or cause sexual partners to worry about causing pain.
Address the emotional effects openly and honestly with your partner. Express your fears with statements like “I am afraid that …” This provides your partner with the chance to reassure and support you. Also, talking about these fears early on allows you to let go. Remember, one partner’s discomfort or fears may be misread as rejection by the other, causing greater distance and emotional pain.
If talking is too sensitive initially, consider writing a note to your partner to express your fears or concerns. Talking openly about the sentiments expressed in your letter is often an easier next step.
Psychological well-being and social support contribute more to a fulfilling sexual life than does the condition of arthritis. By separating the limitations of pain from sexual self-confidence, you can take a more practical approach to the changes brought about by arthritis.
Keep fatigue or stiffness from getting in the way of pleasurable sexual activity by thinking about the times of day you are likely to be more rested. For instance, if you experience morning stiffness, the afternoon or evening is probably a better time for sex.
Women with arthritis may experience vaginal dryness, making manual stimulation uncomfortable or penetrative sex painful. This can be relieved by water-based lubricating gels. Never use petroleum-based products.
Discussing the issue of arthritis and sex may be uncomfortable for you and/or your partner. In some cases, it may even make your doctor uncomfortable to discuss it.
Do not let awkwardness stop you from enjoying a fulfilling intimate life. Living well with rheumatic disease means addressing all aspects of your health, including your sexuality. Talk openly with your partner and your doctor to find the techniques and positions that offer maximum pleasure with minimum discomfort.
