Arthritis By the Numbers50M U.S.5.6M CA21MCA #1$128B3x more2/3 under 65
Arthritis120+ diseases – many of which include jointand/or organ inflammationCOMMON FORMSOsteoarthritisRheumatoidArthritis...
Other Forms of ArthritisPsoriatic ArthritisLupusGoutBursitisTendinitisLyme DiseaseSjogren’s SyndromeSclerodermaBack PainCa...
Osteoarthritis (OA) & RheumatoidArthritis (RA)What Is It?What Causes It?Signs/SymptomsHow Is It Diagnosed?What Happens As ...
Joint withoutarthritisJoint w/RAJoint w/OA
OsteoporosisDefinitionCauseSigns / symptomsRisk FactorsDiagnosisHealthy Bone Bonew/osteoporosis
FibromyalgiaDefinitionCauseSigns / symptomsRisk FactorsDiagnosis
Comprehensive Treatment PlanMedicationsExercise / physical activitySelf-management skillsStress managementPsychosocial sup...
Improving Quality of LifeEarly diagnosisAdhere to treatment planManage stress & activitiesGet psychosocial supportProtect ...
Physical ActivityPromotes…Joint flexibility and mobilityMuscle strengthNourishment of cartilageBone strengthEndurance, sta...
What To Do?Low-impactStretching / Range-of-Motion (ROM).StrengtheningAerobic Conditioning / Endurance.Balance (helps with ...
AF Physical Activity ProgramsEvidence-based programs proven to be both safe& effective for people living w/arthritis. Peop...
How Much, How Often & How Hard?30 minutes of moderate activity, at least 3 days perweekTIP: When starting out, try three 1...
0 Nothing at all1 Very Weak2 Weak3 Moderate4 Somewhat Strong5 Strong67 Very Strong8910 Very, Very StrongGOODlevel foraerob...
Signs of OverexertionChest pain or heart palpitationsSevere shortness of breathDizziness or nauseaWeakness, numbness, or t...
Safety TipsWarm up/cool downUse proper technique/good formAvoid activity on a full stomachWear comfortable clothes & prope...
Arthritis Foundation (AF)Mission3 focal areasNorthern California Chapter
Ways AF Helps The CommunityFree arthritis informationNational and local publicationsSpeakers BureauContinuing education fo...
Get Involved: Educational EventsJA Family Education Day (Livermore): 4/20/13Summer Science Internship (UCSF or Stanford):6...
Get Involved: Fundraising EventsArthritis Walks (Tri-Valley/Livermore): 5/4/13Arthritis Walk (SF): 5/18/13CA Coast Classic...
Contact InformationArthritis Foundation, Northern California Chapter657 Mission St., Ste. 603San Francisco, CA 941051-800-...
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Living Well with Arthritis


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Overview of some of the most common types of arthritis (osteoarthritis, rheumatoid arthritis, fibromyalgia & osteoporosis) and how physical activity can help reduce symptoms.

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  • GENERAL POINTERS Refrain from saying “You” (separating yourself from the audience, but make sweeping generalization of “Us” or “We” to create a more inclusive and less stigmatizing environment). NEVER ask a question or pick someone directly to do something but instead allow people to volunteer (“Does anyone know…” as opposed to “Michael, can you tell me…” We don’t want to alienate or embarrass anyone if they don’t know an answer or can’t see/read info off a slide, etc. Right off the bat, ask people if you are speaking loudly and slowly enough. Invite them to let you know throughout the presentation if they can’t hear or understand you. At natural pauses or after major ideas, stop an ask the audience if the information was clear and if they have any questions. When possible, ask audience questions instead of just delivering the information. (i.e., “Does anyone have a guess as to how many…” “Can anyone tell me what…”). This helps to make the presentation more interactive & helps to ensure the audience is actively listening and not zoning out from being lectured. Please don’t use words like “sufferer” “suffers” “victim” “handicapped” or other negative imagery. We’re here to uplift and help people feel inspired to self-manage and take control. Neutral words like “people living with arthritis” or “people living with disabilities” are much less stigmatizing or demotivating. Also, most people prefer titles like “older adults” to “elderly.” When/if you can’t answer a question, it’s perfectly good to say, “Unfortunately, I don’t know the answer to that, but it’s a great question, so I’d strongly advise you to ask your physician since s/he knows your specific situation OR contact the AF Chapter for general information. They have great free patient education brochures.” Please do not guess or offer medical advice if you’re not qualified to do so. Our job as speakers is to engage and inform audiences. The best way to do that is to be animated, inviting, friendly, positive and upbeat while still letting your own personality shine. NOTES SECTION BELOW EACH SLIDE: Meant to provide you w/info relevant to explaining the slide & provide you w/enough knowledge to answer questions that might arise. It is, by no means, meant to be shared w/the audience in its entirety. Use only the pieces you feel are helpful. *************************************** SUGGESTED OPENING BIG SMILE! <<Thank ORGANIZATION for invitation and the audience for coming. Introduce yourself—give a brief background or personal affiliation story—and mention that you’re a volunteer of the Speakers Bureau and are representing the Arthritis Foundation, Northern CA Chapter. Let the audience know if you’re NOT a healthcare provider. Inform them that you can not answer questions specific to their situation and that the best way to get answers is to speak to their physician or contact AF for free, informative patient education brochures.>> “ I’m so excited to have to opportunity to provide you w/information about the nation’s #1 cause of physical disability among adults. Before we get started, I have a few questions I’d like to ask…” SUGGESTED START QUESTIONS Does anyone here have or know someone that has arthritis? (Not surprised given the statistics) Do you think arthritis is inevitable? Will everyone eventually get it? (Not everyone will get it. It isn’t the inevitable consequence of aging as many people assume and it can be prevented.) Is arthritis a serious condition? (Yes. It’s the #1 cause of disability for American adults. We all know there is a connection between the mind, body and soul. Chronic disease and pain affects all parts of us, not just the physical.) Is arthritis one disease? [(No! More than 120+ diseases are a part of the ARTHRITIS FAMILY including diseases like Osteoarthritis (27M), Osteoporosis (10M), Fibromyalgia (5M), Gout (2.1M), RA (1.3M) & Lupus (nearly 250,000)]. Unfortunately, even today, we don’t have an exact known cause nor do we have a cure, but researchers are working on it. Meanwhile, so many people continue to live each day with the painful reality of arthritis. We hope that by providing you w/more information, you can help yourselves & your loved ones by sharing this knowledge & taking action.
  • 50M doctor-diagnosed adult cases; effectively 1 in 5 adults. Diagnosed cases are projected to rise from 50 to 67 million by 2030. <<Perhaps do a quick count of the # of people in the audience & highlight, “There are 22 people here. That means that at least 4 of us have doctor-diagnosed arthritis. But, how many more of us have it but have not yet had it formally diagnosed by a doctor? Many people haven’t sought or received a formal diagnosis.”>> Over 5.6M in CA alone (again, 1 in 5). That means that our state has over 10% of the entire arthritis burden for the country! 21M Americans have arthritis-attributable activity limitations. # of people with arthritis-attributable activity limitations will rise to 25M by 2030 as well. 3rd leading cause of work limitations. CA is the #1 state for Juvenile Arthritis. CA has 38,000 of the 300,000 doctor-diagnosed cases. JA is the 6th most common childhood disease after asthma, congenital heart disease, cerebral palsy, diabetes & epilepsy. Arthritis costs the US economy $128B each year (inc. DIRECT medical costs--hospitalizations, doctor visits, physical therapy, surgeries, medications, etc—AND INDIRECT costs to the individual (lost wages and medical co-pays) & companies (restricted activity days, arthritis-attributable activity limitations, sick days, etc.), according to the Centers for Disease Control and Prevention (CDC). Still, this doesn’t take “presenteeism” into account (decreased productivity due to health problems). Federal Arthritis Research Funding: Despite the fact that one out of every 5 American adults has doctor-diagnosed arthritis and that arthritis is the #1 cause of physical disability, in 2006/2007, the federal government only spent a paltry $361M on arthritis research. Compare that against $1.1B on diabetes (with 15M doctor-diagnosed cases). This is not to say that they should spend money on diabetes, but they need to raise research funding levels to address this very serious family of diseases. Many people living with diabetes, heart disease and hypertension also live with arthritis and arthritis is documented to be a huge barrier to physical activity for all of these populations. 3x more women have arthritis than men (60% of all cases are women). Women tend to get arthritis related diseases more often then men with one exception—gout (men get gout 3x more than women). 2/3 of all cases are actually in people UNDER the age of 65 (though 60% of the older adult population has arthritis). This should dispel the myth that arthritis is just for older individuals or that only older people should be concerned. <<ASK: Any questions?>> So, let’s move on to more detailed information about common forms of arthritis.
  • DEFINITION: Arthritis is an umbrella term for a family of diseases. Cause of most types is still unknown; as there are many different types, many causes are likely. NOTE: Arthritis can affect more than the joints. It can affect organs too. This is why many types people would not associate as arthritis do come under our umbrella such as lupus, some soft tissue diseases, etc. The word arthritis literally breaks down to: arth = joints itis = inflammation WARNING SIGNS Only a health care professional can diagnose it, but let’s talk about some of the things we may notice that may point in the direction of arthritis. Recurring pain and tenderness in one or more joints (may be constant or come & go); Inflammation/swelling, redness and/or warmth in one or more joints; Inability to move joint w/full Range-of-Motion (ROM), the maximum extent to which the joint should be able to freely move; Stiffness especially in the morning or after long period of inactivity (i.e., sitting for too long); and Unexplained weight loss, fever, weakness – combined with joint pain. If you have any of these symptoms in or around a joint and it lasts for more than 2 weeks, seek professional advice. DIAGNOSIS It may take more than one visit to make a diagnosis. If you’re interested in learning more about the lab tests, we have a great brochure about that. You can, however, expect that your health provider will do four key things: symptom history – very important tool that provides clues to inform the doctor about how your body feels and when it feels that way. As it’s often hard to remember everything you’ve felt, write down info about symptoms (what you feel, how often/’when you feel it, what might have brought it on, etc.). The more your doctor knows, the easier it’ll be. physical examination - to see if you have any swelling or mobility limitations blood & urine tests - to look for inflammation in your blood or kidney X-ray, MRI or other tests - to look for damage to the bones and joints <<If time or the audience is interested, describe some of the other forms of arthritis such as…>>
  • <<No need to go into details about any of these, but a great way to highlight some of the other arthritis-related conditions. Simply point out that bolded diseases on slide are autoimmune conditions. Tell audience that if they need any information, they should call AF for a free brochure.>> <<ASK: Any questions?>> SOME OF THE COMMON FORMS: Gout— Results when body produces too much or is unable to rid itself of uric acid. Build-up creates needle-like crystals in the joints, causing swelling. Usually in big toes, ankles and knees. More common in men and post-menopausal women and is usually the result of a defect in body chemistry. Can affect any joint but commonly affects the first metatarsal (1st toe). Gout can be well controlled with medication and changes in diet. Systemic lupus erythematosus (Lupus)— rheumatic disease that can inflame and damage skin, joints, connective tissue throughout the body, brain and possibly internal organs. Generally, symptoms first appear in women ages 18 - 45 including rash over cheeks/bridge of nose, scaly sores on face, neck and/or chest, abnormal sun sensitivity, kidney problems and arthritis. Ankylosing Spondylitis—a type of arthritis that affects the spine. As a result of inflammation, the bones of the spine grow together. Scleroderma— a disease of the body’s connective tissue that causes a thickening and hardening of the skin. Psoriatic Arthritis—an inflammatory joint disease associated w/psoriasis (inflammatory chronic skin disease--itchy patches of skin w/red base & silvery scales on top. Most commonly appears on the elbows, knees & scalp, but may be anywhere. Fingernails and toenails also are commonly affected by psoriasis, w/pitting, separation of the nail from the underlying nail bed, and transverse ridging and cracking.) Est. between 5-23% of people w/psoriasis will develop psoriatic arthritis (nail involvement is the only clinical feature that identifies patients w/psoriasis who are likely to develop arthritis). Bursitis– inflammation of a bursa (an enclosed sac lined w/a membrane that secretes & absorbs fluid). Bursae provide cushioning & ease mov't of skin across bone, muscle across muscle, muscle across bone & tendon across bone. If bursa gets overused, irritated or injured, it fills w/extra fluid, making the affected joint painful and more difficult to move. On occasion, a bursa can get infected & will become inflamed. CAUSE? Irritation & overuse is common. Whether you develop bursitis and what type of bursitis you get depends on which activities or occupations you participate. TREATED? Rest, anti-inflammatories &, rarely, surgical removal of the bursa. Bursitis resulting from bacterial infection requires antibiotic treatment along w/rest & anti-inflammatories. WHO? Anybody can develop bursitis, though rare in people <20 yrs. Tendinitis –A tendon is a cord of tough tissue connecting muscle to bone. Surrounded by a sheath that protects and lubricates the tendon. Sheath is lined by a layer of cells called the synovium. Tendinitis is when the tendon becomes inflamed or the tendon sheath becomes inflamed (called tenosynovitis). These conditions together are known as tendinitis and result in pain, stiffness and sometimes swelling. CAUSE? A specific injury or by repetitive overuse, especially w/poor body positioning. WHO? Can occur in young athletic people due to sports injuries & overuse, but as tendons become less flexible w/aging it's common in middle aged/older adults. TREATED? Can occur suddenly, may last for days, weeks or longer, and then go away. Can occur again in the same place. When properly treated, it general doesn’t result in permanent damage or disability. Rest, activity changes, NSAIDS or steroid injections to the inflamed area and physical therapy.
  • OSTEOARTHRITIS Definition: Osteoarthritis (OA) is the most common type of arthritis (about 27 million of our doctor-diagnosed cases). It is likely the disease that most people are thinking of when they think of the word arthritis. It's a degenerative joint disease in which the cartilage–-the lining in a joint that cushions the ends of the bones--deteriorates. CAUSE UNKNOWN Though we have identified correlations and risk/contributing factors: Injury to or overuse of a joint - athletes & professions requiring repetitive motion (i.e. landscaping, typing or operating machinery) have higher risk. Soft tissue injuries like ACL tears & bone fractures & surgeries may also factor in. Being overweight – higher body weight puts additional stress on lower body joints esp. knees which carry the brunt of our weight. (i.e., 1 lb gain = 4 lbs additional knee pressure & 6x hip pressure.) Losing 11 lbs, however, cuts risk of OA in the knees in half. Muscle Weakness - studies show that weakness of the muscles surrounding the knee is associated w/OA, especially in women, & makes pain and stiffness worse after onset. Strengthening thigh muscles is very important to reduce risk. Genetics/Heredity – inherited bone abnormalities affecting joint shape / stability or defects causing abnormal cartilage formation (esp in hands). More common in joints that don’t fit together smoothly (i.e., bowlegged or double-jointed). Not inevitable though so be vigilant. Age - incidence increases w/age due to simple “wear and tear” on the joints – the older you are, the more you have used them. However, it is NOT THE INEVITABLE CONSEQUENCE OF AGING! Not everyone gets it. Injury to a nerve Having another type of arthritis (i.e., RA) OA SIGNS/SYMPTOMS Joints ache, become painful or stiff 1) first thing in the morning 2) during/after use 3) after periods of inactivity. OA usually… begins after 45. Men under 55 more likely to have it than women in the same age range, but after 55, women are more commonly affected. Overall, women get OA more often than men. One possible reason--women’s broader hips may put more long-term stress on their knees. affects small joints of fingers, base of the thumb, weight-bearing joints (knees; hips; lower back; neck; & big toe). rarely affects other joints, except as a result of injury or unusual physical stress. is asymmetrical (i.e., may affect right hip, but not necessary the left. May have it in both but not always the case.) DIAGNOSIS Doctor will take medical history, ask about symptoms, conduct a physical exam paying special attention to your joints and how they move. Traditionally, an OA diagnosis is made only after joint pain and stiffness becomes persistent and an X-ray shows loss of cartilage and resulting bone damage. DISEASE PROGRESSION As the disease progresses: pain and limitations in movement/decreased joint functionality can occur joint may lose shape & alignment bone ends can thicken causing bone spurs bone on bone contact causes pain damage to ligaments, menisci and muscles may occur. *********************************** RHEUMATOID ARTHRITIS (RA) Definition: Rheumatoid Arthritis (RA) has been diagnosed in about 1.3 million people. It is an autoimmune disease in which the joint lining (synovial membrane) becomes inflamed (producing warmth, swelling and pain) as part of the body’s immune system activity. For unknown reasons, the immune system, which is designed to protect our health by attacking foreign cells such as viruses and bacteria, attacks the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing systemic joint pain and inflammation throughout the body. CAUSE UNKNOWN Chronic disease; can’t be cured). Most scientists agree that a combination of genetic and environmental factors is responsible. Researchers have identified genetic markers that increase chances 10x. Still, not all people w/these genes develop RA & not all people w/RA have these genes. Researchers are also investigating infectious agents (like bacteria or viruses) which may be a trigger for someone w/a genetic propensity. Other suspects include female hormones & the body’s response to stressful events such as physical/emotional trauma. Smoking may also play a role & impact treatment. Women: Men = 3:1. Women ages 30- 60 versus later in life for men. Children, teens, people in their 20s can also get this disease too though and it occurs in all ethnic groups. RA SIGNS/SYMPTOMS Vary from person to person & can change on a daily basis. Joints may feel warm/swollen/painful to the touch, decreased range-of-motion/difficulty moving and morning stiffness (usually greater than 30 minutes). Symmetrical disease (meaning if a joint on one side of the body is affected, the corresponding joint on the other side of the body is also involved). Because the inflammation is systemic, likely to feel fatigued, lose appetite, run a low-grade fever and possibly become anemic. RA DIAGNOSIS Medical history & questions about fatigue & an overall of stiffness Physical exam (swelling & warmth in joints, limited ROM, nodules under the skin). The pattern of joints affected by arthritis can help distinguish RAs from other conditions. Blood Tests to ID antibodies, levels of inflammation and other markers. X-RAYS show if there is any bone erosion and/or cartilage loss. RA DISEASE PROGRESSION Concern is with Bone Erosion/Loss. At present, we can not replace the bone so we need to prevent it from happening. May affect many joints, cause damage to cartilage, tendons and ligaments & even wear away the ends of bones. Common outcome is joint deformity and disability. Some people develop rheumatoid nodules; lumps of tissue that form under the skin, often over bony areas exposed to pressure (most often around the elbows but can also occur on the fingers, over the spine or on the heels). Over time, inflammation can affect numerous organs and internal systems. Some people experience “flares” (intermittent bouts of intense disease activity), others may have continuous disease activity that gets worse over time and some may enjoy periods of remission (no disease activity or symptoms at all). Evidence shows early diagnosis (a “Window of Opportunity”) and aggressive treatment can put the disease into remission and decreases joint destruction, organ damage and disability.
  • <<Describe what’s in picture and review key differences between OA & RA.>> To summarize: OA RA Usually begins after age 45 Usually begins between ages 25-30; Affects joints on ONE side of body Affects same joint on both sides of body (symmetrical) Usually, doesn’t cause inflammation of joint Causes redness, warmth, swelling of joint Affects certain joints Affects many joints Doesn’t cause a general feeling of sickness General feeling of sickness, fatigue, low-grade fever & w8 loss <<ASK: Any questions?>>
  • OSTEOPOROSIS Definition: Osteoporosis is marked by decreased bone strength that leaves the bones susceptible to fracture. Both the density of the bone and the quality of the bone structure are compromised. Bone is a living tissue; its cells die (resorption) and are replaced regularly (formation). As a child and young adult, our bodies produce more new cells than those that die, resulting in stronger, denser bones. Peak bone mass is reached at about 25, but turnover remains fairly stable for several years. At about 40, bone cells start to die at a more rapid rate than cells are produced resulting in a slow decline in bone mass. Prevention is the best treatment! Literally means: “osteo” = bone “porosis” - porous or filled with holes. CAUSES Bone remodeling, or the removal and replacement of old bone, is a normal process that keeps the adult skeleton healthy. When bone resorption and formation are balanced, the quantity of bone replaced is essentially equal to the quantity removed. Net bone loss occurs when bone resorption exceeds bone formation. This happens as a normal part of aging, but when bones get too thin and weak to support your activities, you have osteoporosis. Age-related declines in bone strength are caused not only by a decline in mass, but also by changes in the architecture of the bone tissues. As a result, older bones are weaker, independent of their lower mass. Bone may become so fragile, particularly in the spine, that stresses generated during normal activities can cause fractures. Osteoporosis may be attributed to these factors: Accelerated bone loss at menopause in women, or as men and women age Suboptimal bone growth during childhood and adolescence, resulting in failure to reach optimal peak bone mass Bone loss secondary to disease conditions, eating disorders (which result in nutritional deficiencies), or certain medications (see glucocorticoid-induced osteoporosis) Bone loss after menopause and with aging is natural and does not need to be treated unless the bone loss is so great that it leaves the bones fragile and prone to fracture. An individual who does not reach optimal bone mass as a young adult may develop osteoporosis without the occurrence of accelerated bone loss. Primary osteoporosis can occur in both sexes at all ages but often follows menopause in women and occurs later in life in men. In contrast, 2ndary osteoporosis is a result of medications, other conditions or diseases (i.e., glucocorticoid-induced osteoporosis, hypogonadism and celiac disease). Among men, 30-60% is associated w/2ndary causes (hypogonadism, glucocorticoid use and alcoholism) & in pre-menopausal women, more than 50% (most common being hypoestrogenemia, glucocorticoid use, thyroid hormone excess and anticonvulsant therapy). SIGNS/SYMPTOMS Beginning stages have no symptoms. 1st sign may be a fracture caused by a minor trauma. Fractures of the vertebrae (bones of the spine) and wrist are the most common. Hip fractures, however, are the most devastating because recovery is very difficult. Most vertebral fractures in women are asymptomatic/not diagnosed. Occasionally a person w/osteoporosis will have a vertebral fracture causing severe back pain & disability. Even undiagnosed fractures found on X-ray are associated with increased back pain and difficulty in such activities as bending, putting on socks and getting in and out of an automobile. Vertebral fractures result in a loss of overall body height. Fractures in the top part of the spine cause a rounding of the upper back, aka DOWAGER’S HUMP. Fractures in the lower part of the back cause a flattening of the natural curve of the back. If you have a great number of vertebral fractures, the shape of your torso will change and your abdomen may protrude. WHO? In excess of 10M people have osteoporosis & additional 18M have low bone mass placing them at increased risk. Responsible for more than 1.5 million fractures per year. After menopause, a drop in estrogen levels in women results in a rapid decline in bone mass. By the age of 80, women have lost about 40% of their peak adult bone mass & men have lost about 25%. Postmenopausal White women are most commonly affected & most likely to suffer an osteoporotic fracture (which can occur from seemingly minor falls & such mundane activities as bending & lifting). Research has shown that White & Asian women generally have less bone mass than African-American women and are at greater risk of developing osteoporosis. American women are 4x more likely than men. Women are at greater risk of losing bone mass than men because they start out w/20-30% less bone density than men & they experience rapid bone loss in the early years following menopause. OSTEOPOROSIS RISK FACTORS Non-modifiable: Being a woman, especially past menopause Going through menopause early (before age 45) Starting your menstrual periods late, generally after the age of 15 years Having a small physical frame Having a family history of osteoporosis Having a history of low-trauma fractures as an adult Having an inflammatory form of arthritis or related condition Taking medications that reduce bone strength (glucocorticoids, anticonvulsants or heparin) Being a man with low levels of testosterone Modifiable: Not exercising regularly Smoking Being too thin for your frame Not getting adequate calcium Consuming excessive alcohol and caffeine (possible factors) DIAGNOSIS Doctor will take medical history and perform physical exam inc. an assessment for loss of height & change in posture. Low bone mass is the strongest predictor of future fractures. Bone Mineral Density (BMD) - most commonly used method of diagnosing osteoporosis and predicting fracture risk. Getting an accurate measure of bone density can help you and your doctor evaluate the need for preventive measures and treatment. This test also is used to monitor the effects of treatment. People with bone mineral density levels below a particular point are considered to have osteoporosis. People w/BMD levels higher than that set for osteoporosis, but lower than what is considered healthy, are considered to have osteopenia. People w/osteopenia also require evaluation and possibly treatment.
  • FIBROMYALGIA (fye-bro-my-AL-jah) Definition: Fibromyalgia is an especially confusing and often misunderstood condition. Because its symptoms are quite common and laboratory tests results generally are normal, people with fibromyalgia were once told that their condition was “all in their head.” However, medical studies have proven that fibromyalgia does indeed exist and about 5 million people have it. In 1990, the American College of Rheumatology, the official body of doctors who treat arthritis and related conditions, presented criteria for diagnosis. Fibromyalgia is a syndrome characterized by long-lasting widespread pain and tenderness at specific points on the body (generally muscles, ligaments and tendons). Although not defining characteristics, sleep disturbances and fatigue are also integral symptoms of fibromyalgia. Referred to as a syndrome because it’s a set of signs and symptoms that occur together with no known cause or identifiable reason. Fibromyalgia does not cause inflammation or damage to the joints, muscles or other tissues, but is a rheumatic condition because it impairs the joints and/or soft tissues and causes chronic pain. Although fibromyalgia has no cure, it isn’t a progressive disease (it won’t get worse over time and it’s never fatal). Treatment plans integrate several modalities that include exercise, rest, stress relief, coping skills and medications, people with fibromyalgia can live happy, productive lives. CAUSES No one knows what causes fibromyalgia. One hypothesis is that when a person who is genetically predisposed to the syndrome comes in contact with some environmental trigger, symptoms develop. Most patients attribute the onset of fibromyalgia to a stressor, such as an acute injury, an illness with fever, surgery or long-term psychosocial stress (sometimes childhood trauma). Most researchers agree that the central nervous system is not functioning properly and that components of the body’s stress response are responsible for symptoms. Sensory processing: Disturbances are probably general and not pain-specific. Experience great sensitivity not just to pain but to loud noises, bright lights, odors, drugs, temperature changes and chemicals. Substance P: Have approximately 3x higher concentrations in their spinal fluid of this chemical that amplifies pain signals than healthy controls. Serotonin: This brain chemical is believed to modulate pain signals and has been found to be low or processed poorly HPA axis: Several abnormalities in the hypothalamic-pituitary-adrenal axis (the brain and hormone interactions that regulate virtually all physiologic activities, including the stress response) have been noted. Growth hormone: Some people with fibromyalgia have low levels of growth hormone, which may contribute to postexertional muscle pain. Psychological and behavioral factors: Psychological disorders are no longer believed to cause fibromyalgia. However, the anxiety and depression brought about by chronic pain and fatigue can make fibromyalgia symptoms worse, creating a cycle of pain, fatigue, anxiety, maladaptive behaviors leading to more pain, etc. SYMPTOMS Pain and tenderness - musculoskeletal pain in all sections of the body. Pain may begin in one region, but eventually every section becomes affected. For some, pain waxes/wanes, & seems to travel. The muscle and tissue pain has been described as tender, aching, throbbing, sore, burning and gnawing; it sometimes is accompanied by strange sensations such as tingling, numbness, burning or prickling. Additionally, tenderness to the touch. When pressure is applied to different points on the body, a person with fibromyalgia feels pain whereas someone without it feels only a bit of pressure. Spots are called tender points. Studies now show, however, that people with fibromyalgia display increased sensitivity to pain throughout the body, not just at specific tender points. Fatigue and sleep disturbance - Most (75-80%) experience chronic fatigue and tire quickly after only mild exertion. 1/2 of individuals who meet diagnostic criteria also meet have chronic fatigue syndrome. For many, the fatigue can be more debilitating than the pain. People with fibromyalgia have trouble getting a good night’s sleep. Most can fall asleep w/out problem but sleep is light, easily disturbed & they wake up feeling exhausted and unrefreshed (deep sleep, stages 3 and 4, gets interrupted frequently and their best sleep comes in the hour or 2 before arising. Other common symptoms Frequent headaches: tension and migraine Cognitive difficulties: poor attention span, trouble with short-term memory, inability to think clearly; often called “fibro fog,” possibly related to lack of sleep Irritable bowel syndrome: abdominal pain, bloating and alternating constipation and diarrhea Dry eyes and mouth Temporomandibular joint syndrome (TMJ): pain around the joint where your lower jaw attaches to your skull Sensitivity to loud noises Unusual, uncontrollable eye movements Constitutional symptoms: weight fluctuations, heat and cold intolerance, night sweats, weakness “ Allergic” symptoms: multiple chemical sensitivity, nasal congestion, rhinitis (inflammation of the nasal passages). The reactions are not actually allergic because the defining immunologic responses are not present, but the symptoms felt are similar. Restless leg syndrome: numbness, tingling and crawling sensations that necessitate constantly moving the legs; contributes to poor sleep Urinary urge and frequency Painful menstrual periods, inflammation of the opening of the vagina and itching burning sensations around the vaginal opening DIAGNOSIS Can take years! Finding the right doctor can help expedite diagnosis (rheumatologists, pain clinics). Difficult to diagnose because 1) condition is still unfamiliar to many people inc. doctors 2) no clear-cut test since no evidence appears on X-rays or in lab tests 3) no diagnostic marker in the blood 4) people with fibromyalgia often look healthy and have no outward signs of pain or fatigue. BOTTOM LINE: Generally diagnosed by the identification of symptoms and exclusion of other conditions: A history of widespread pain (pain on both sides of the body and above and below the waist) that is present for at least three months. Pain in at least 11 of 18 tender-point sites. These points are considered positive when pain is felt upon the application of 4 kilograms of pressure – the approximate amount of pressure required to blanch the examiners’ fingernail. NOTE: Criteria were written to help researchers ID patients for clinical trials NOT for diagnosing the disease; at least ½ of those clinically diagnosed don’t fulfill this definition. RELATED CONDITIONS Simulate or occur concurrently with the condition: Hypothyroidism, Polymyalgia rheumatica, Hepatititis C infection, Sleep apnea, Parvovirus infection, Cervical stenosis / Chiari, malformation, Chronic fatigue syndrome, Medications such as lipid-lowering drugs or antiviral agents Less commonly: autoimmune disorders (such as RA or lupus especially early in the course of the disease), endocrine disorders (Addison’s disease, Cushing’s syndrome & hyperparathyroidism), lyme disease, Eosinophilia-myalgia syndrome, malignancy, tapering of corticosteroids. <<ASK: Any questions?>>
  • Let’s also talk about the interplay between body, mind and spirit as it relates to chronic illness. Let’s address the psychosocial impact of arthritis: Disability, depression and stress may accompany chronic pain Loneliness, fear of being alone Fear of deformity and disability Uncertainty Helplessness and dependency Anger and grief about loss of function and changes to lifestyle Financial difficulties Accessibility issues caused by physical and societal barriers Let’s not forget that many people living with arthritis may also be living with other chronic diseases (especially hypertention, heart disease and diabetes as we have lots of documentation on people with arthritis AND one of these conditions) and may have physical challenges (vision, hearing, etc.) or acute conditions (sprain, break, etc.) as well. So this cycle can easily become even more vicious/quickly spin out of control. DESCRIBE CYCLE It doesn’t need to go in order but can bounce around. Pain generally causes people to reduce their activity level which in turn, over time, decreases their flexibility, strength and functionality and increases stiffness. It also causes people to feel more tired and fatigued which translates into going out with friends and family less. The world goes on around them and they end up losing self esteem over all the things they “can’t” do anymore and they end up feeling more depressed and angry as they become more physically and mentally isolated from those they care about. This causes them to feel stressed because their quality of life is decreasing. Stress can physically manifest itself as muscle tension (and is also a major trigger for arthritis flare ups) which in turn causes more pain and so the cycle goes until something stops it. In order to stop the downward spiral of the pain cycle, we need to interrupt one of these points. <<ASK: “Any questions about this idea? Does any of this sounds familiar to anyone? YES? Then, let’s discuss how we can interrupt this cycle AND improve your quality of life!”>>
  • These items are not in any particular order. They are all just components/menu items of a comprehensive plan. Treatment plans must be customized to the individual and each person may have a different plan even if they have the same disease as someone else. Many factors play into this. TREATMENT GOALS: decreasing discomfort, pain, and inflammation while maintaining and increasing optimal joint function (keeping people functional in their everyday lives/improving quality of life). MEDICATIONS - 5 different classes of arthritis drugs available today. Bring a copy of our Drug Guide to your next appointment and discuss all the options with your healthcare provider. <<Show audience AF Drug Guide and tell them they can call the Chapter for a free copy.>> SELF-MANAGEMENT - Be your own best advocate! Communicate openly with all health care providers (including pharmacist, acupuncturist, chiropractor, naturopath, etc), personal trainer/exercise instructors, family, friends, etc. Utilize exercise, good nutrition, and all the other techniques we’re discussing now to take control of your arthritis. STRESS MANAGEMENT/RELAXATION TECHNIQUES (all used in AF’s Exercise Program) Breath Awareness/Deep Breathing Jacobson’s Progressive Relaxation Imaginary Progressive Relaxation Herbert Benson’s Relaxation Response Technique Schultz Autogenic Relaxation Training Posture Awareness Body Awareness/Body Scanning Guided Imagery Mind-Controlled Pain Relief SURGERY Usually used as a last resort, but can restore function and reduce pain. May include: Arthroscopy (can be for exploration or correction) Osteotomy (cutting of the bone to correct alignment or shorten or lengthen the bone) Arthrodesis (surgical fusion of a joint) Partial or total joint Arthroplasty (replacing the damaged joint, or a portion of the damaged joint, with an implant) COMPLEMENTARY THERAPIES vitamins and supplements – regulated by FDA as food products, not as pharmaceuticals. Need to be aware of side effects and dosage levels. No prescription required. May have drug interactions. Examples of common supplements: Glucosamine, SAM-e, Collagen, Chondroitin Sulfate, DHEA. Remember: Claims of “Natural” do not mean they are safe/beneficial (i.e., arsenic, poison ivy/oak, etc...are natural yet not safe!). Everyone is an individual, and what might work for one person, may not work for another. <<Show audience 2008 Vitamin and Supplement Guide and tell them they can call AF for a free copy.>> massage (by certified massage therapist who has been trained to work with chronic disease patients) acupuncture/acupressure heat and cold therapy yoga/tai chi ****************** MORE ON MEDICATIONS Need to let physician know everything they're taking (OTC, vitamins, supplements, prescription drugs for all conditions) because they may be doubling up on a class of medications without realizing it (i.e., taking a prescription and OTC NSAIDs). Best to talk to pharmacist to avoid interactions/contraindications. Get all prescriptions filled (and vitamins/supplements/topicals) at the same pharmacy so interactions/contraindications can be flagged by pharmacist or pharmacy computer. DRUG CLASSES Analgesics – pain reliever. Acetaminophen (OTC) is an example of an analgesic that provides relief of arthritis pain. There are also prescription narcotics such as acetameniphen with codeine, oxyContin, Vicodin, etc. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – pain reliever, fever reducer, etc. Higher doses reduce joint inflammation. 3 categories: a) traditional NSAIDS, b) COX-2 inhibitors (celecoxib (Celebrex), and formerly, valdecoxib (Bextra) and rofecoxib (Vioxx). Safer on stomach than NSAIDs) and c) salicylates. Block prostaglandins (hormone-like substances that contribute to pain,. Inflammation, fever and muscle cramps). Corticosteroids, viscosupplementation (approved ONLY for OA in the knee), and Glucocorticoids. Disease-modifying antirheumatic drugs (DMARDs) – ONLY for inflammatory forms of arthritis (although there are OA biologics in Phase 1, 2 and 3 clinical trials currently) Biologic response modifiers – ONLY for inflammatory forms of arthritis (although there are OA biologics in Phase 1, 2 and 3 clinical trials currently) Analgesics May be recommended by doctor for pain relief. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Reduce pain and swelling Block the production of prostaglandins, which are important in inflammation Include aspirin, ibuprofen, and naproxen Available with or w/out prescription Effects include upset stomach Glucocorticoids Reduce pain and inflammation Given in pill form, intramuscular injection, or joint injection Injections provide quick relief but should only be done several times a year (may weaken bone, tendons, and cartilage) Long-term oral prednisone can cause significant side effects Viscosupplementation Purpose is to restore natural elastic and viscous properties of the joint fluid in the knee 5 products available, all hyaluronic acid products (Synvisc, Hyalgan, Orthovisc, Supartz, and Euflexxa) Series of either 3 or 5 injections Disease-Modifying Antirheumatic Drugs (DMARDs) Slow down disease process and limit joint damage Include methotrexate, sulfasalazine, hydrochloroquine (Plaquenil), and leflunomide (Arava) Prescription only Have to monitor for side effects Biologic Response Modifiers (BRMs/“Biologics”) Selectively affect pathways of the immune system Current drugs include Remicade, Enbrel, Humira (TNF-α therapies), Kineret (IL-1 therapy), Orencia (T-cell therapy) and Rituxan (B-cell therapy) Used in patients who have not found adequate relief from other treatments
  • Current knowledge says there are many things that people with arthritis can do to take control of their arthritis. These are some of the keys to break the Chronic Illness Symptom Cycle. Early Diagnosis: The earlier the better. Adhere to Treatment Plan: Do what you and your physician have agreed upon and if you can’t, discuss it openly to try to find some common ground or alternatives. Communication is key! Stress Mgmt & Psychosocial Support: covered in previous slide. <<Really highlight the following…>> PROTECT JOINTS Use joints wisely in order to minimize the stress placed on them through daily activities. Respect Pain! Slow down or stop any activities causing undue pain. Use good body mechanics and posture. Poor posture or joint position can lead to fatigue, pain, joint strain and deformities. Be aware of body positions & attempt to reduce joint stress. Correct body alignment requires less energy. Avoid knee rotation, twisting with feet planted, jumping, bouncing, or ballistic-type movements (slow, rhythmic movement is best). Those with osteoporosis or back problems should avoid sudden or extreme forward or side trunk twisting. Avoid static positioning. CONSERVE ENERGY Structure and simplify work and daily tasks to decrease fatigue and minimize energy. Pace (balance work with rest). Prioritize and plan tasks. Reduce effort required to do activity: simplify, delegate, eliminate, use adaptive self-help devices, and use lightweight equipment. Tune into your energy level and fatigue. Move at a comfortable pace and breathe easily and regularly. Flexibility/modify activities depending on the day and how you are feeling. LOSE WEIGHT Drop 11 pounds = cuts risk of knee osteoarthritis in half Losing 1 pound reduces 4 pounds of pressure on your joints BE PHYSICALLY ACTIVE Physical activity is one of the most important things people with arthritis can do for themselves. Moving is the best medicine. LOW IMPACT exercise focusing on range-of-motion, strengthening and stretching are highly recommended. <<Share the website: and>> <<ASK ABOUT PICTURE: “What’s is Harold doing that might impact his arthritis? What’s Alice doing well?”>>
  • <<VERY SLOWLY SHARE THIS QUOTE BY JOHN BLAND ALLOWING PEOPLE TO REALLY CONCENTRATE ON THE WORDS: "The weakest and oldest among us can become some kind of athlete, but only the strongest can survive as spectators. Only the Hardiest can survive the perils of inertia, inactivity and immobility." Ask people to really think about this statement.>> LOGIC/RATIONALE FOR IMPORTANCE OF MOVEMENT Previously, many people adhered to this notion: “Go home, rest, relax and don’t use your joints or else you’ll wear them out.” Today, we know the exact opposite is the absolute truth. You have to use it or you’ll lose the ability to use it! We ALL need to safely and properly use our joints in order to continue to be able to use them. However, the old adage “ No pain, no gain” DOES NOT apply here! We go for “No Pain = No Pain). When we get out of bed, often times we already feel stiff and have pain. That is because of the inactivity during sleep. When we first put our feet on the floor, many of us might hobble to the bathroom complaining (Oooh! Aaah! Ouch! Oooof!). <<ASK: What makes that better?” Hopefully you get an answer like: “You have to get moving!” Exactly!>> GOAL: reduce pain & stiffness and increase range-of-motion through movement. Keeping muscles strong, reduces load on joints. Work with your physician and/or a physical therapist to determine what’s best for you and consider joining an Arthritis Foundation physical activity program near you. Additionally… Improves cardiovascular health and circulation Regulates bowel habits Promotes a sense of well-being Decreases stress and depression Weight control Improves quality of sleep. WARNING: Before Starting... Consult your healthcare provider if you have: been physically inactive, severe arthritis or joint-problems, other serious conditions such as uncontrolled heart disease, diabetes, or high blood pressure. Ask if there are any exercises you shouldn’t do. Ensure you are doing LOW-IMPACT exercise. <<ASK: Any questions?>>
  • Low-impact requires one foot to always be on the ground. So, no jumping jacks or other bouncing or ballistic movements. Smooth not jerky! Form is more important than speed or even number of repetitions. MAKE SUGGESTION: Consider classes (such as the Arthritis Foundation Aquatic Program, the Arthritis Foundation Exercise Program, the Arthritis Foundation Tai Chi Program or the Arthritis Foundation Walk with Ease Program) or personal coaching with a trainer who understands how arthritis affects the body. Ask the trainer if they have worked with others who have the same condition(s) you do. Get references! <<SHOW BROCHURES OR FLYERS>> <<ASK: Any questions?>>
  • <<SELL OUR PROGRAMS! Get them excited and make them want to take these classes because they CHANGE PEOPLES’ LIVES ALL THE TIME. Improvements begin just in the first few weeks!>> PROGRAMS FOR BETTER LIVING Developed by physical therapists, AF’s physical activity programs are evidence-based which means they’re proven to be both safe and effective in helping people take control of their arthritis and improve their overall quality of life. Our programs are endorsed by the Centers for Disease Control and Prevention (CDC), CA Public Health Department, rheumatologists, etc. Programs are highly customizable and can accommodate people who are fit and active, sedentary or new to exercise, people using wheelchairs, canes or walkers and people who are fit / can perform daily tasks unassisted in the same class. Individuals of all ages, mobility, ability and fitness levels living w/any form of arthritis have greatly benefited from AF’s low-impact programs. Outcomes include, but are not limited to: decreased join pain and stiffness; increased range-of-motion (ROM), flexibility, endurance and energy levels; and improved joint functionality, muscle tone, ability to perform daily activities & overall health status. Arthritis Foundation Exercise Program®: Developed by physical therapists in 1986, addresses the pain, fatigue and decreased strength that often accompany arthritis. Exercises may be done seated or standing and also includes optional floor exercises as well. Arthritis Foundation Aquatic Program®: Co-developed by AF and the YMCA in 1983, improves and sustains participants’ joint functionality, muscle tone, endurance, independence and self-efficacy. Water’s buoyancy assists movement, protects joints and is great for resistance training. Heated pools (83-94o) are a safe and ideal environment for water exercise. Arthritis Foundation Walk with Ease Program®: Structured 6 week program that may be done individually or in leader-led groups. This program helps participants make walking a habit by assisting with the development of customized walking plans, providing motivational strategies and offering exercise safety tips. Can also be done on your own by buying our book from the National Office ()1-800-283-7800) or the AF Online Store on the website ( Arthritis Foundation Tai Chi Program®: Based on the Sun style, this program includes agile steps and exercises that improve mobility, breathing and relaxation. Movements may be done seated or standing and don't require deep bending or squatting. NOTE: Safety is our primary concern. Programs may only be taught by certified instructors who have been trained by AF on how arthritis affects the body, arthritis safety principles and joint-friendly exercises. Classes must be one hour long and held at least 2x p/w, with the exception of the Arthritis Foundation Walk with Ease Program® which must be held at least 3x p/w. Call the Chapter (1-800-464-6240) to find a location near you or check the website, Programs are also available on VHS or DVD on the website (except for WWE).
  • OR EVEN try ten 3 minute segments…whatever makes physical activity comfortable, possible, do-able and enjoyable. If we do even the slightest bit more today then we did yesterday, we’re on the right track. One step at a time brings us closer to our goals. Even on a flare day… Do even a little bit…doesn’t have to be a ton but some is better than none. Try just a few slow, gentle repetitions Alternate activities Do very low-impact activities Exercise for briefer period Listen to your body As prescribed by your doctor, take pain medication before starting activity & if possible soak in bathtub before & after
  • <<Describe exertion scale.>> How hard the person feels like they are working. It’s all relative. My 4 may be your 6 and your 2 could be my 7. If I ask you to pick up a book, it could feel like you’re picking up a tv. It’s how you feel (relative) not what someone else says or an objective measure. Every person must monitor themselves to stay safe and not injure themselves. Go at your own pace and don’t compete with others. If so, we advise that you scale back to MODERATE intensity (again, only a moderate increase in breathing, heart rate and light perspiration/sweating). You SHOULD NOT STRUGGLE OR FORCE yourself past these limits…more reps or faster speed doesn’t mean more results. For arthritis exercise, it’s all about having “good form” (doing the exercise as it was designed to be done, aiming for as large of a range-of-motion as you can get without any pain…moving till you feel a gentle stretch). Form = best results. <<ASK: Any questions?>>
  • Call your health care provider if you have any of these symptoms. A bit of muscle soreness is expected if you haven’t been active until your muscles get used to the activity. BUT doing exercises properly should not results in a severe increase in joint pain. Pain, aching and stiffness increases temporarily ? Modify, but do not stop. Regular physical activity decreases pain and stiffness, helps you to sleep better and gives a noticeable boost of energy.
  • <<BE VERY SPECIFIC ABOUT THIS...Wording is very important>> Two Hour Pain Rule: You should not experience more JOINT pain than you normally do 2 hours after exercising. If you do, you have overexerted yourself and should cut back and build up slowly. A bit of muscle SORENESS is understandable if you haven't used those muscles in a while. But again, you should not feel excruciating pain. Also, choose appropriate time you won’t be disturbed. Begin low impact activity 1-2 times per week. What you can manage, don’t push yourself too hard. You’ll steadily progress over time while staying safe. Week 1: walk for 10 min Week 2: walk for 15 min Week 3: walk for 20 min, etc. <<ASK: Any questions?>>
  • MISSION: AF works to improve lives through leadership in the prevention, control, and cure of arthritis and related diseases. Established in 1948. AF is a volunteer-driven, national nonprofit organization dedicated to finding a cure for over 120 types of arthritis and improving quality of life for those living with the number one cause of disability in the US. FOCAL AREAS Research – AF is the largest nonprofit contributor to arthritis research in the world. Throughout its history, AF has given nearly $400 million to research, supporting over 2,200 scientists at 100 institutions whose work has resulted in breakthroughs in diagnosis and treatment. Not only does the Chapter contribute to the national research fund, but it also gives additional money to fund research at UCSF and Stanford, two of the nation’s powerhouses of arthritis research. The Northern California Chapter has funded over $1.3 million in 2008. Fundraising: To raise these funds for research, not only does the Chapter request donations from corporations, foundations and individual private donors, but it also hosts many special events. Advocacy - Seek to educate legislators about the realities of arthritis and to ensure passage of the Arthritis Prevention Control and Cure Act which, among other things, seeks to dramatically increase the federal government’s investment in arthritis research. Arthritis Prevention, Control and Cure Act (APCCA): Enhancing CDC’s Public Health Activities related to Arthritis through the full implementation of the National Arthritis Action Plan (NAAP); Establishment of the HHS Interagency Coordinating Committee on Arthritis and Rheumatic Diseases; Innovation of Research and Public Health Activities related to Juvenile Arthritis; and Pediatric Rheumatology Loan Repayment Program. Public Health - (see items on next slide) Chapter – Located in SF, serves 16 counties closest to the coast (from OR border to Monterey county). Our counties include: Del Norte, Humboldt, Mendocino, Sonoma, Lake, Napa, Solano, Marin, Contra Costa, Alameda, San Francisco, San Mateo, Santa Clara, San Benito, Santa Cruz; and Monterey.
  • *available in Spanish too and text size may be altered. Besides the Life Improvement Series programs we previously discussed and funding arthritis research, AF offers these programs and services to the community to help improve quality of life. WAYS WE HELP: Free Arthritis Information – patient education brochures, physician referral services (area rheumatologists—not an endorsement, just those who have asked to be listed), assistive devices (products that make everyday tasks easier), non-AF sponsored area support groups and online resources listing; Publications: national magazine, Arthritis Today & Chapter newsletter, Joint Efforts; Speakers Bureau – provides on-site public health presentations; and Continuing Education for Healthcare Professionals –Annual Knowles Lecture, the area’s preeminent educational event for health professionals, disseminates information and increases knowledge in the field. Online peer support communities (community-based programs consisting of peers who assist each other to solve problems associated with a specific form of arthritis—RA CHAT on our website); Instant access to additional materials via AF’s website (;
  • <<GET PEOPLE EXCITED AND ENCOURAGE THEM TO PARTICIPATE IN SOME WAY!>> Juvenile Arthritis Family Education Day is an annual spring conference for JA families featuring medical professionals from Stanford & UCSF. Excellent opportunity for families to learn from the professionals in a small intimate setting and build strong, social, peer- support networks. Summer Science: Elite 8 week program allows 12 upper level high school and lower level college students to experience arthritis research first-hand at UCSF and Stanford laboratories. The labs receive invaluable assistance and students gain exposure to the field. AFNCC is proud to say that more than 90% of student participants go on to careers in a research or medical-related field. Camp Milagros (Spanish for “Miracles”), AF’s camp specifically for children with arthritis and related rheumatic diseases, is a 5 day / 4 night camp is for children 8-13. Campers experience typical summer camp activities with their peers in a fun and safe environment (medical professionals are on site). For many, the experience is life-changing because they bond with other kids facing the same challenges. Teen Retreat is a three-day event enabling teens living with arthritis or rheumatic disease ages 14-18 to make new friends and strategize about the best ways to handle the difficult transitions and challenges they face entering and adjusting to high school and college life. Annual Bone & Joint EXPO: Each October EXPO offers participants access to a large slate of intimate, interactive, doctor-led educational seminars; exercise demos and products designed to improve quality of life for people living with arthritis. Ways to help: 1) Attend 2) Encourage your company to sponsor the event 3) Be an exhibitor
  • Without financial support from the public, AF can’t do all that it does. The great strides we have made in these past years with research and the fantastic community programs we offer, can only happen with your support. So, we ask you to support and participate in great events like: Arthritis Walk - our signature fundraising event and will take place in both Livermore (Tri-Valley) and SF. A fun-filled fundraiser occurring at various locations throughout the greater Bay Area usually in the month of May. After walking a scenic course, teams—composed of families, friends, colleagues, neighbors—are invited to explore around the exhibition area. Free giveaways, good food, health information and products, games, entertainment and live music. Raise public awareness and much needed funds to help the Arthritis Foundation fight against the county’s #1 cause of disability. Please walk, form a team and make a difference!  California Coast Classic - magnificent cycling tour along the spectacular California coastline in which participants may select from one of two tours designed for both the beginner and experienced cyclist. If you’re a cyclist who wants to participate in a life changing adventure, but you think you need a little help getting there, don’t fret, we have training rides to help you prepare. Fashion Show - a fashion show luncheon with silent and live auction components. Held in the fall, this spectacular event is hosted by the Bay Area Arthritis Auxiliary. Participate: Buy an individual ticket or gather up some friends and family and buy a table, be a part of an exciting fashion show and bid on auction items! Jingle Bell Run / Walk - Festive way to kick off the holidays with family, friends and coworkers. Form a team, raise funds and organize your very own holiday-themed costumes. Then tie jingle bells to your shoelaces, and complete a 5K route. Participate: Consider running/walking, forming a team and making a difference! We also seek planned gifts, individual donations, memorial gifts <<ASK: Any questions?>>
  • <<ASK: “Did you learn something new about the most common cause of disability? Eliminate any myths and misconceptions? Give you anything to think about? Any changes your going to make in your life as a result of this new information?”>> Arthritis affects us all, so we should ALL be doing something about it. Please help us educate others--share what you have learned—and help us raise more money for research & programs—Invite your family, friends, colleagues, neighbors to participate in AF events and programs. We’ve got to be in this together and if we are, we WILL make a difference. Thank you so much for joining us today. One final thought before we go… <<If desired, insert a motivational/inspirational quote to end on a high note. i.e., “This life is yours…Take the power to control your own life. No one else can do it for you. Take the power to make your life happy.” Susan Polis Schultz >>
  • Living Well with Arthritis

    2. 2. Arthritis By the Numbers50M U.S.5.6M CA21MCA #1$128B3x more2/3 under 65
    3. 3. Arthritis120+ diseases – many of which include jointand/or organ inflammationCOMMON FORMSOsteoarthritisRheumatoidArthritisOsteoporosisFibromyalgiaCOMMONALITIESChronic PainDecreased Range-of-MotionStiffnessLoss of Mobility/Possible Disability
    4. 4. Other Forms of ArthritisPsoriatic ArthritisLupusGoutBursitisTendinitisLyme DiseaseSjogren’s SyndromeSclerodermaBack PainCarpal Tunnel SyndromeRaynaud’s PhenomenonAnkylosing SpondylitisSpinal StenosisMyositis
    5. 5. Osteoarthritis (OA) & RheumatoidArthritis (RA)What Is It?What Causes It?Signs/SymptomsHow Is It Diagnosed?What Happens As The Disease Progresses?
    6. 6. Joint withoutarthritisJoint w/RAJoint w/OA
    7. 7. OsteoporosisDefinitionCauseSigns / symptomsRisk FactorsDiagnosisHealthy Bone Bonew/osteoporosis
    8. 8. FibromyalgiaDefinitionCauseSigns / symptomsRisk FactorsDiagnosis
    9. 9. ChronicIllnessSymptomCycle
    10. 10. Comprehensive Treatment PlanMedicationsExercise / physical activitySelf-management skillsStress managementPsychosocial supportOccupational TherapyPhysical TherapySurgery
    11. 11. Improving Quality of LifeEarly diagnosisAdhere to treatment planManage stress & activitiesGet psychosocial supportProtect jointsConserve energyLose weightBe physically active
    12. 12. Physical ActivityPromotes…Joint flexibility and mobilityMuscle strengthNourishment of cartilageBone strengthEndurance, stamina, energyAbility to perform daily activitiesBetter posture, balance and coordination
    13. 13. What To Do?Low-impactStretching / Range-of-Motion (ROM).StrengtheningAerobic Conditioning / Endurance.Balance (helps with fall prevention)TIP: Walk, bicycle or swim
    14. 14. AF Physical Activity ProgramsEvidence-based programs proven to be both safe& effective for people living w/arthritis. Peopleinterested in prevention & those living w/otherchronic diseases (heart disease, hypertension &diabetes) will also greatly benefit.Call the Chapter at: 1-800-464-6240 for locationsnear you.
    15. 15. How Much, How Often & How Hard?30 minutes of moderate activity, at least 3 days perweekTIP: When starting out, try three 10 minutes segmentsover the course of the dayModerate intensity results in moderate increase inbreathing & heart rate and light perspiration orsweatingTIP: You should still be able to speak and breathe fairlyeasily
    16. 16. 0 Nothing at all1 Very Weak2 Weak3 Moderate4 Somewhat Strong5 Strong67 Very Strong8910 Very, Very StrongGOODlevel foraerobic exercisePerceived Exertion Scale
    17. 17. Signs of OverexertionChest pain or heart palpitationsSevere shortness of breathDizziness or nauseaWeakness, numbness, or tinglingProlonged pain, aching and joint swellingExcessive fatigueRESPECT PAIN! STOP exercise & tell someone ifyou don’t feel well. Seek help!
    18. 18. Safety TipsWarm up/cool downUse proper technique/good formAvoid activity on a full stomachWear comfortable clothes & properly fittedwalking/running shoes with cushionStart low & progress slowly over long time periodGo at your own pace; don’t compete with othersListen to your body; you’re the expertAdhere to AF’s Two-Hour Pain Rule
    19. 19. Arthritis Foundation (AF)Mission3 focal areasNorthern California Chapter
    20. 20. Ways AF Helps The CommunityFree arthritis informationNational and local publicationsSpeakers BureauContinuing education for healthcare professionalsOnline peer support communitiesAF’s websites (*,,,
    21. 21. Get Involved: Educational EventsJA Family Education Day (Livermore): 4/20/13Summer Science Internship (UCSF or Stanford):6/12/13 – 8/2/13Camp Milagros (Livermore): 7/10/13 – 7/13/13Teen Retreat (Marin): 11/1/13 – 11/3/13Bone & Joint Expo (Pleasanton): 10/19/13
    22. 22. Get Involved: Fundraising EventsArthritis Walks (Tri-Valley/Livermore): 5/4/13Arthritis Walk (SF): 5/18/13CA Coast Classic (8 day ride from SF to LA): 9/28/13- 10/5/13Fashion Show (SF): October 2013Jingle Bell Walk/Run (Pacific Grove): 12/14/13Jingle Bell Walk/Run (San Rafael): 12/7/13
    23. 23. Contact InformationArthritis Foundation, Northern California Chapter657 Mission St., Ste. 603San Francisco, CA