Joint Protection Principles

Introduction

Functional ability is reduced in 60% of people with rheumatoid arthritis (RA) within the first five years from diagnosis, with 16% developing more severe functional disability and 44% following a remittingurelapsing course. Within two years 50% experience difficulties in household tasks. Women with RA can have on average only 40% of normal power and pinch grip within six months of diagnosis, even with early commencement of disease-modifying drugs (DMARDs). This suggests therapy to help maintain hand function and independence should be provided early for those developing functional limitations.

Joint protection is a self-management approach that aims to maintain functional ability through altering working methods and movement patterns of affected joints, using assistive devices and pacing activities. This helps reduce pain, inflammation and stresses applied to joints during daily activity and may help preserve the integrity of joint structures longer term. 4,5 Rheumatology health professionals commonly teach joint protection. Focus is on changing hand habits, and increasingly people are referred earlier in the disease process for this education.

Providing self-management information (such as joint protection advice) does not, on its own, lead to significant improvements in adherence or health status.6 Behavioural approaches (i.e., skills prac-tice, goal-setting and home programmes) are significantly more effective in increasing use of joint protection than ‘standard’ education (i.e., information, demonstration and short supervised practice) anduor information booklets.
7,8 This approach is effective for people with both early (B/5 years) 7,8 and established RA (�/5 years). 9,10