12
Occupational Therapy & Psoriatic Arthritis A positive approach to psoriasis and psoriatic arthritis
OccupationalTherapy &
Psoriatic Arthritis
A positive approach
to psoriasis and
psoriatic arthritis
2
IntroductionThis leaflet aims to explain what occupational therapy is andthe sort of help you might expect from an occupationaltherapist. It cannot be comprehensive and therefore does notclaim to cover all the possible problems encountered bysomeone with psoriatic arthritis.
About psoriasis and psoriaticarthritisPsoriasis (sor-i’ah-sis) is a long-termskin condition that affects around 2%of the UK population. It usuallyappears as raised red scalypatches known as plaques. Anypart of the skin surface may beinvolved but plaques mostcommonly appear on the elbows,knees and scalp. Estimates of thenumber of people with psoriasis whoalso develop joint problems (termedpsoriatic arthritis, or PsA) vary but it is thought that around 30%of people with psoriasis also have psoriatic arthritis. Onset isusually between the ages of 20 and 50, and affects men andwomen in equal proportion. Psoriatic arthritis can cause pain, swelling and early morning
stiffness in the joints and tendons. The most commonly affectedsites are the hands, feet, wrists, ankles, lower back and neck.
There is a spectrum of severity, with mostpatients experiencing mild to moderatesymptoms, but a few suffering moresevere symptoms. If left untreated,psoriatic arthritis may result inlong-term disability, reducedquality of life and employmentdifficulties. For more detailed information
on psoriasis and psoriatic arthritis,see our leaflets What is psoriasis?
and What is psoriatic arthritis?
What is occupational therapy?
“Occupational therapy is a client-centred healthprofession concerned with promoting health and wellbeingthrough occupation. The primary goal of occupationaltherapy is to enable people to participate in everyday life.”World Federation oF occupational therapists, 2010
3
Occupational therapy enables people to manage, to the best of their ability, all types of daily living skills which may have been affected by physical or mental illness. Occupational therapists may be employed in hospitals, socialservices departments, community rehabilitation teams andmany other settings.
What can occupational therapydo to help people with psoriaticarthritis?When you have psoriatic arthritis, pain, stiffness and fatiguemay make it more difficult to perform everyday activities suchas dressing, making meals, driving, sleep, household chores,work, socialising and hobbies. An occupational therapist willwork with you to help you find ways to overcome thesedifficulties. They will assess your physical restrictions, as wellas listen to how you are coping with them emotionally, andtogether you will agree a treatment plan. You can expect toreceive guidance on:n ways to protect your joints from further pain and stressn problem-solving to overcome difficulties with everyday tasksn equipment if required, to make daily tasks easiern splints or supports for your jointsn pacing yourself to save energy and manage your symptomsn relaxation and ways of improving sleepn strategies to help you to stay in work.Your therapist may also suggest certain exercises to maintain
range of movement and strength.
What can I do to protect my joints?Occupational therapists can teach you joint protectiontechniques; some departments offer this via individual sessionsand sometimes as a joint protection group programme, whichhas the benefit that you meet others with a similar condition.In this next section you’ll discover how to apply joint protectionprinciples to everyday tasks.Avoid staying in one position for too long
Some activities require you to maintain a single position andso restrict joint movement for long periods of time (eg sewing,driving, reading and even sitting in front of a computer screen).These activities tire your muscles and tired muscles are lessable to support your joints, which may lead to pain and damage.
4
Pace yourself
Learn to take a break or changeposition you get too stiff and beforepain increases. During breaks,move or rest your joints. Avoidstanding or sitting for longperiods of time. Use a timer toremind yourself to changeposition regularly. If you use acomputer for long periods, you candownload software which will providealerts on your screen at set intervals.Avoid gripping tightly or pinching
Some people with PsA experience problems with the joints intheir hands. A tight grip puts a lot of strain on knuckles andthumb joints and may increase your pain. You’ll tend to use atight grip when you do things like writing, knitting, using ascrewdriver and holding cutlery, a key or a toothbrush. n Choose pens, cutlery, utensils, combs, keys andtoothbrushes with thicker or padded handles. You can evenbuy foam to pad these items yourself. You will find it takesless effort to grip a large soft handle than than one that issmall and hard. Pen grips come in a various shapes andsizes.
n Do not struggle to open packages with your fingers – usescissors or a knife instead.
n Place your palm flat on top of the tap to turn it on and off.n When washing windows, worktops or other flat surfaces, donot grip the cloth or sponge tightly. Use a flat hand to cleaninstead.
n Do not remove water from a cloth by twisting or wringing itout. Instead press the cloth or sponge against the side ofthe sink with your palm to squeeze out excess water.
n If you do have to use a pinching or gripping action, takefrequent breaks to rest your handsbriefly.
Use your joints in a goodposition
Joints work best in certainpositions. When they are used inthe wrong position, such as whentwisting, extra force is placedthrough the joint and the musclesare unable to work as well as theyshould, which may result in pain and, overtime, deformity. Avoid actions which push your joints intounnatural positions.
5
n Try to avoid activities which encourage your fingers to drifttowards your little finger, such as lifting a saucepan or platewith one hand. Use two hands instead or, where possible,slide these objects over the work surface rather thancarrying them.
n Avoid resting your chin on your knuckles or pushing up froma chair using your knuckles. Try to use the heel of your handinstead.
n Use mugs with large, thick handles or place fingers aroundthe mug, provided that it is not too hot. A cup with a smallcurved handle pushes the fingers into an awkward position.
n Use good posture and correct lifting and handlingtechniques. An occupational therapist can provide you withfurther information.
Use the strongest, largest joints possibleStronger, larger joints can manage greater forces than smaller,weaker joints.n Use your hip or shoulder instead of your hand to push a dooropen or close a drawer.
n Use the palms of your hands under a plate or cup instead oftaking all the weight through your fingers (only if the plate isnot too hot). Carefully use oven-gloves if you are picking upa hot plate.
n Carry light bags from a strap on your arm or shoulder oracross your body rather than using your hands.
n Push objects with your weight rather than pulling with yourfingers. This uses your hip and leg joints to do the workinstead of your arm and hand joints.
Use correct lifting and handling techniques
n Hold objects close to your body, hugging the object with botharms, rather than using your fingers. This way the largershoulder and elbow joints take the stress rather than thesmaller wrist and finger joints.
n Lift objects by bending the hips and knees instead ofbending at the spine.
Spread the load over several joints where possible
n Whenever you can, try to use two hands to carry objectsrather than one.
n Carry a backpack on both shoulders rather than just one.n Buy cooking pots and pans with two handles.Respect painIf pain continues for more than an hour after an activity hasstopped, this means that the activity was too much and shouldhave been changed or stopped sooner. Learn to pace yourselfby taking short breaks or changing position before you get toostiff and before pain increases.
6
Exercise for muscle strengthand range of motionWhile too much activity can placeexcess stress on joints, a lack ofmovement can cause joints andmuscles to stiffen. Exercise is animportant part of strengtheningthe muscles around the joint andmain ta in ing bone s t reng th .Exerc ise can a lso ass is t inmaintaining an ideal body weight,which is important as excess weight may add extra stress tojoints. It is important to talk to a healthcare professional aboutan appropriate exercise routine tailored to your individualcapabilities. Your occupational therapist (or physiotherapist)can provide exercises to maintain range of movement andstrength. For general exercises see our Physiotherapy and
Exercise: Psoriatic Arthritis leaflet.
Reduce the weight of objects you carryNot only is it important to keep your own weight down to reducestress on your joints, it is also important to reduce the weight ofthe things you need to carry.n Lightweight equipment can be purchased for kitchen, DIYor housework tasks. For example, travel kettles and travelhairdryers are normally much smaller and more lightweightthan standard ones.
n Shopping bags should not be too heavy. Use a wheeledtrolley for shopping and about the house to carry things.
n When making a hot drink, use only the amount of waternecessary and fill the kettle and saucepan using alightweight jug instead of having to lift the heavy kettle orsaucepan.
n Slide pots and pans along the work surface rather thancarrying them.
n Cook vegetables or pasta in a basket within a pan so youcan drain them easily and leave the water to cool down.
n Wherever possible, delegate the task to someone else if theobject is too heavy for you to carry without increasing yourpain.
Furniture heightIf you struggle when getting up from your bed, chair or toilet,you have several options available. When you next replaceyour furniture, consider having slightly higher items, as this maymake it easier and cause less strain on your knees and wrists.However, ensure that they are not so high that your feet aredangling. You should be able to place your feet flat on the floorwhen you are sitting on them. You could also ask to be referred
7
to a physiotherapist, for leg-strengthening exercises which willmake it easier to get up after sitting or lying down.Your table and chair should be at a comfortable height when
working. An occupational therapist can provide furtherinformation about the ergonomics of workstations.
Helpful equipmentIf you find a particular activity painful,certain equipment can make a taskeasier by protecting joints andreducing the stress placed onsmaller and weaker body parts.Occupational therapists canprovide information and morespecific advice on equipment andtechniques which may assist inperforming everyday tasks.n Choose fittings that can be easilyoperated, like lever taps rather than knobs. Lever tapadaptors can be fitted onto your original tap fittings.
n When possible, put heavy or bulky objects on wheels. Forexample, kitchen and shopping trolleys, laundry baskets andsuitcases can be very helpful.
n Use labour-saving electrical items such as food processors,dishwashers and tin openers.
n Kettle and teapot tippers are available to help lift and pour.Hot water dispensers can also be useful.
n Cutlery can be padded or you can buy special, adaptedcutlery.
n You can also buy utensils designed to reduce physical effortand which help to keep your joints in good positions, eglarge-handled vegetable peelers and angled knives.
n Adapted scissors can be purchased if you find it difficult togrip standard scissors.
n Long-handled versions of items such as dustpans,shoehorns and even sponges can reduce or even eliminatebending and stooping.
n Non-slip mats can help to stabilise plates, bowls, choppingboards etc.
n Equipment is available for the bath, shower and toilet, suchas bath boards, shower seats, raised toilet seats and grabrails. An occupational therapist can advise you about thisequipment and may be able to supply it. If larger adaptationssuch as a wet room or stair lift are required, your socialservices occupational therapist will assess you and adviseyou about funding.
n If you find it difficult to dress yourself, there is equipmentavailable to make it easier, such as buttonhooks, reaching
8
aids, long shoehorns, sock aids and hook and loop fasteners(Velcro®). This equipment may also reduce the effortneeded to get dressed.
n If you struggle to move around in bed or get on and off yourbed or chair, the furniture can sometimes be adapted. Somepeople find it helpful to have an adjustable bed, a rail, or apiece of equipment to help them raise their heads off thebed.
SplintsYour occupational therapist may suggest the use of splints,such as wrist or thumb splints, during activities which arepainful. However, these should only be used during particulartasks to provide support to painful joints, rather than being wornconstantly, as this may affect your strength over time. Splintscan also be recommended for night-time use if you havedifficulty sleeping due to hand/wrist pain. They should be usedin conjunction with a prescribed exercise programme. It isimportant to discuss your needs with a trained healthcareprofessional before you use splints.
What about work?It may be that your condition makes it difficult to do your currentjob or to find suitable employment. If you have a long-termcondition (12 months or more) which has a substantial effect onyour ability to carry out normal day-to-day activities, then youmay be entitled to certain help under the Equality Act 2010. Anoccupational therapist can advise you on what help is availableand may provide advice to help you feel more confident whendiscussing “reasonable adjustments” with your employer. Theycan also look at the activities you carry out at work and suggestways of performing them which may reduce the strain on yourbody. If you have a desk-based job and use a computer,consider downloading free software to remind you to takebreaks. If you are not working, an occupational therapist mayalso advise you on studying or retraining options. The disabilityemployment advisor at your local job centre can advise youabout programmes and support to get you back into work.
Plan and structure routineIt is important that you keep active but do not try to pushthrough pain. Your occupational therapist can help you look athow you plan and structure your time so that you avoid eitherlong periods of rest, repetitive movements or excessive activity.A regular eating and sleeping pattern is very important and youshould try to avoid prolonged exposure to stress.
9
RelaxationRelaxation is a key skill inmanaging long-term pain. Manyoccupational therapists spendtime on fatigue and sleepmanagement, particularly inspecialist rheumatology services.In some settings, occupationaltherapists are able to teach this skilland advise you on how to incorporaterelaxation techniques into daily life.
Conclusion Occupational therapy is about doing the tasks that you want todo, but maybe in a slightly different way. An occupational therapist can help you find ways of protectingyour joints and avoiding pain, show you how to manage yourcondition and become your own expert, and advise you onequipment and general lifestyle changes.
How can I be referred for occupational therapy?
n Specialist rheumatology / handoccupational therapy services:a s k y o u r r h e uma t o l o g yconsultant / nurse if this isavailable in your area and askfor a referral.
n Community occupationaltherapy: these services canbe accessed by your GP orself-referral; try searching onlinewithin your specific county.
If you have any views or comments about this information orany of the material PAPAA produces you can contact us v i a t h e d e t a i l s o n t h e b a c k p a g e o r o n l i n e a t www.papaa.org/user-feedback.
Useful contacts:For information about health matters in general and how toaccess services in the UK, the following websites providenational and local information.n NHS Choices (England): www.nhs.ukn NHS 24 (Scotland): www.nhs24.comn Health in Wales: www.wales.nhs.ukn HSCNI Services (Northern Ireland): http://online.hscni.net
10
These are the official sites for the National Health Service andprovide links and signposting services to recognisedorganisations and charities.
Useful websitesBritish Association of Occupational Therapists and The Collegeof Occupational Therapists: www.cot.co.ukGovernment services and information: www.gov.uk
References
n Parisi, R, Symmons, DPM, Griffiths, CEM & Ashcroft, DM(2013). Global epidemiology of psoriasis: a systematicreview of incidence and prevalence. Journal of InvestigativeDermatology, vol 133, no. 2, pp. 377-385., 10.1038/jid.2012.339
n Parisi R, Griffiths CEM, Ashcroft DM (2011). Systematicreview of the incidence and prevalence of psoriasis. BritishJournal of Dermatology 165: e5
n Gelfand JM, Weinstein R, Porter SB, Neimann AL, BerlinJA, Margolis DJ. Prevalence and treatment of psoriasis inthe United Kingdom: a population-based study. ArchDermatol 2005;141:1537-41.
n Henes JC1, Ziupa E, Eisfelder M, Adamczyk A, Knaudt B,Jacobs F, Lux J, Schanz S, Fierlbeck G, Spira D, Horger M,Kanz L, Koetter I. High prevalence of psoriatic arthritis indermatological patients with psoriasis: a cross-sectionalstudy. Rheumatol Int. 2014 Feb;34(2):227-34. doi:10.1007/s00296-013-2876-z. Epub 2013 Oct 10.
n Ibrahim G, Waxman R, Helliwell PS. The prevalence ofpsoriatic arthritis in people with psoriasis. Arthritis Rheum2009;61:1373-8.
n Kay LJ, Parry-James JE, Walker DJ. The prevalence andimpact of psoriasis and psoriatic arthritis in the primary carepopulation in North East England. Arthritis Rheum1999;42:S299.
n Gladman DD, Shuckett R, Russell ML, et al. Psoriaticarthritis - an analysis of 220 patients. Q J Med 1987;62:127.
n McHugh NJ, Balakrishnan C, Jones SM. Progression ofperipheral joint disease in psoriatic arthritis. Rheumatology2003;42:778. The above list is not exhaustive. For further references used
in the production of this and other PAPAA information contactus or go to: www.papaa.org/resources/references
About this informationThis material was produced by PAPAA. Please be aware thatresearch and development of treatments is ongoing.
11
The Information Standard scheme was developed by theDepartment of Health to help the public identify trustworthyhealth and social care information easily. At the heart of thescheme is the standard itself – a set of criteria that definesgood quality health or social care information and the methodsneeded to produce it. To achieve the standard, organisationshave to show that their processes and systems produceinformation that is:
l accurate l evidence-based
l impartial l accessible
l balanced l well-written.
The assessment of information producers is provided byindependent certification bodies accredited by The UnitedKingdom Accreditation Service (UKAS). Organisations thatmeet The Standard can place thequality mark on their informationmaterials and their website - a reliablesymbol of quality and assurance.
For the latest information or any amendments to this material,please contact us or visit our website: www.papaa.org. The sitecontains information on treatments and includes patientexperiences and case histories.This leaflet was originally written by PAPAA. Fully reviewedand revised by Ms Lucy Swift, senior occupational therapist,Royal National Orthopaedic Hospital, Stanmore, Middx, UK.May 2013.A peer review was carried out by Lucy Blenkiron, clinicalspecialist and lead OT, Avon Orthopaedic Centre, SouthmeadHospital, Bristol, in April 2014 and by Karen Merrison,occupational therapy, rheumatology and pain team lead,Addenbrookes Hospital, Cambridge, in June 2016.A lay review panel has provided key feedback on this leaflet.The panel includes people with or affected by psoriasis and/orpsoriatic arthritis.
Published: January 2017
Review date: November 2018
© PAPAA
The charity for peoplewith psoriasis and psoriatic arthritis
PAPAA, the single identity of the Psoriatic Arthropathy Alliance and the
Psoriasis Support Trust.
The organisation is independently funded and is aprincipal source of information and educationalmaterial for people with psoriasis and psoriatic
arthritis in the UK.
PAPAA supports both patients and professionals byproviding material that can be trusted (evidence-
based), which has been approved and contains nobias or agendas.
PAPAA provides positive advice that enablespeople to be involved, as they move through their healthcare journey, in an informed way which is appropriate for their needs and any
changing circumstances.
Contact:PAPAA
3 Horseshoe Business Park, Lye Lane, Bricket Wood, St Albans, Herts. AL2 3TA
Tel: 01923 672837Fax: 01923 682606
Email: [email protected]
www.papaa.org
®
OT/01/17
1432517819069
ISBN 978 1 906143 251
Psoriasis and Psoriatic Arthritis Alliance is a company limited by guarantee registered in England and Wales No. 6074887
Registered Charity No. 1118192
Registered office: Acre House, 11-15 William Road, London, NW1 3ER
