Many days Stanley Conyer can’t curl his fingers around a rod and reel.
“The arthritis keeps me from holding a fishing rod, and that’s extremely frustrating because that’s what I love to do,” says Conyer, 60, a retired teacher and former military man who lives in Glen Burnie, Maryland. Once upon a time he could wile away a whole day casting his line. Today, rheumatoid arthritis, an inflammatory form of the common chronic condition, makes it so he can’t twist off the top of a bottle without assistance.
Conyer was first diagnosed with arthritis in 1985, and today it affects almost every aspect of his life. That goes for the pain that inhibits his sleep, the disease’s assault on his dexterity and physical constraints that limit what he can do with family. No shooting baskets with his grandchildren, for example, like he did with his own kids. “Even walking — l love to walk. There are days I can’t walk because the pain I deal with keeps that from being a real possibility. It manifests itself in so many ways it’s scary sometimes,” Conyer says. “I had to give up work because of all the pain I was in.”
For millions of Americans, including Conyer, who also suffers from fibromyalgia, sleep apnea and glaucoma, among other health issues, arthritis has the added effect of compounding health and quality-of-life issues associated with facing multiple chronic conditions.
One of the most common causes of disability in the U.S., arthritis, in combination with other chronic health issues, such as heart disease and diabetes, can further restrict a person’s participation in social activities, make it more likely they’ll experience serious psychological distress and limit their ability to work. That’s according to the results of a survey published in June in the Morbidity and Mortality Weekly Report produced by the Centers for Disease Control and Prevention. Fully, 73 percent of adults 18 and older surveyed who had arthritis reported having another chronic condition as well.
“What we showed is the more conditions you have, the worse you do on those outcomes, and if arthritis is one of those conditions, you do even worse than that,” says Dr. Charles Helmick, one of the study’s authors and a senior medical epidemiologist at the CDC. Of those surveyed with arthritis plus at least one other chronic condition, 30 percent reported work disability, compared with 22.5 percent of those who had multiple chronic conditions but not arthritis, and nearly 16 percent of those who had arthritis alone.
What’s more, arthritis can make it difficult to exercise, Helmick says, an important tool in managing diabetes and lessening risk associated with other chronic conditions. That can also lead to weight gain, which further exacerbates health issues. “Half the people with diabetes have arthritis, half the people with heart disease have arthritis, and they’re told to be physically active. But nobody’s telling them how to be physically active in a safe, less painful way because of their arthritis,” Helmick says.
The CDC is seeking to change that as roughly one-quarter of Americans now struggle with multiple chronic conditions, and more than 1 in 5 of the adults surveyed reported they have arthritis. The agency emphasizes simple, proven approaches to lower disease risk, like maintaining a healthy weight, along with advising appropriate physical activity and patient involvement in disease management programs.
“What we normally recommend is that people do things that are easy on the joints,” Helmick says. “So that’s walking or swimming or bicycling — things like that are all fine — and you start slow and increase slowly until the point that you’re having good effects.” The Morbidity and Mortality Weekly Report also highlights the Arthritis Foundation’s Walk With Ease Program, an evidence-based approach to improve balance, reduce pain and improve overall mental and physical health of those with arthritis.
Given the complexity of dealing with multiple chronic conditions, including arthritis, at once, Dr. Ana-Maria Orbai at Johns Hopkins Arthritis Center in Baltimore recommends patients work with a health care team to ensure they and their physicians are all on the same page about treatment.
“It’s the doctor that takes care of the arthritis, working in a team with the doctor that takes care of the other comorbid condition, and making sure they receive treatment for both such that they can improve and that there are goals set for each of the conditions,” Orbai says.
Orbai, an assistant professor of medicine in the division of rheumatology at Johns Hopkins University, specializes in treating rheumatoid and psoriatic arthritis, inflammatory types of arthritis. Though both diseases involve similar symptoms, rheumatoid arthritis presents symmetrically — essentially symptoms, such as joint pain and swelling, on one side of the body are mirrored on the other — while psoriatic arthritis, which affects some people with the skin condition psoriasis, runs an asymmetrical course. The most common form of arthritis, osteoarthritis, which involves wear and tear on the joints, is typically treated in a primary care or an orthopedic setting.
“Frequently, in psoriatic arthritis, we will work with a patient’s dermatologist, we will work with a patient’s primary physician [and] sometimes we have to involve an endocrinologist to treat the diabetes. So this really becomes a whole other level of providing health care,” she says.
Stanley Conyer is one of Orbai’s patients. Though he long ago came to terms with pain and physical limitations being a constant for him, he says treatment of his arthritis alongside other chronic conditions he faces has helped improve his quality of life. “The network they use [at Johns Hopkins] is tremendous because my primary care doctor sees the notes from my surgeon, who sees the notes from my rheumatologist, who sees the notes from my eye doctor, who sees the notes from my pain management doctor,” he says.
Conyer says this ensures treatments and medications don’t counteract one another — a very real issue, experts say, when doctors prescribe without adequate communication between disciplines.
In addition to the effect of arthritis itself, treatment for the disease can raise a patient’s risk for other health issues or make those conditions worse. Orbai notes that Prednisone, which is sometimes used as an anti-inflammatory agent to treat inflammatory arthritis, increases the risk of heart attack and stroke, among other side effects.
Conyer says he was on a higher dose of the drug, blaming it for weight gain that put pressure on his lungs, which he says started him down the path to sleep apnea — a disorder in which a person’s breathing stops and starts while they’re sleeping. Weight gain is a known side effect of taking steroids, and being overweight or obese is a risk factor for sleep apnea.
Conyer says Orbai reduced the amount of Prednisone he takes, and his family has ceased waking him up at night concerned that he stopped breathing. He sees this as a sign his sleep apnea has improved somewhat. With a prescription that aids his sleep, he says he’s able to sleep longer at night, too — about five hours at a stretch, instead of three — without pain waking him up. “Which is tremendous for me … like finding a new world, a new planet,” Conyer says.
He’s learned to measure everything incrementally, and has found that different treatments for his arthritis, and associated pain, allow him to still do some of the things that give him back quality of life — like taking his grandchildren to the pool. And he’s able to swim.
He’s also able to fish — if not for a full day, sometimes up to a couple hours.
“You learn to adjust what you do so you can get back some enjoyment out of it,” Conyer says. “So while I can’t fish like I want to — like I used to — I can fish enough to keep me satisfied.”
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Arthritis Makes Life With Chronic Diseases Worse originally appeared on usnews.com
