b>Stress how it affects arthritis -- WHAT CHRONIC STRESS DOES TO YOUR HEALTH

Stress how it affects arthritis -- WHAT CHRONIC STRESS DOES TO YOUR HEALTH






Stress how it affects arthritis -- WHAT CHRONIC STRESS DOES TO YOUR HEALTH

Compounding the burden of chronic disease

STRESS. There is no avoiding it completely.

It is a part of everyday life. Just when you think it is gone, it is back again

. It is the way the mind and body react to tension and pressure.

Too much stress can increase pain, can make a person prone to illnesses, and can make it more difficult for people with arthritis to cope with the added burdens imposed by their disease.
Stories abound of people who connect the evolvement of their arthritis to a stressful incident in their lives. The stressful incident (such as a car accident, death in the family, divorce, loss of job, or other personal tragedy) is regarded as the precipitating event which triggers the disease. Opinion varies on this theory because it is so difficult to prove, based on the variety of human experiences and human responses. Studies in laboratory rats have shown a definite relationship between stress and the development of arthritis. Researchers have been hesitant to formulate conclusions for humans based on the animal studies.
The quandary over implicating stress arises because stress is impossible to measure.

What one person considers stressful may be considered a challenge by another person. An event is viewed as stressful based on a person's perception of the event

. There are also a variety of stressors and it is difficult for researchers to assess if they all have equal impact.

Even though the issue of a cause and effect relationship between stress and disease remains complicated for researchers, recent research has implied that a high level of stress can disturb sleep, cause headaches, lead to high blood pressure, heart disease, depression, and likely contribute to other illnesses.

Arthritis and Stress: The Reverse Cause and Effect

People with arthritis must confront the same kinds of stress as everyone else. Additionally, living with chronic arthritis creates another medley of stressful problems.

Chronic arthritis adds the stressof pain, fatigue, depression, dependence, altered finances, employment, social life, self-esteem and self-image.

During stressful times, the body releases chemicals into the bloodstream and physical changes occur.

The physical changes give the body added strength and energy and prepare the body to deal with the stressful event.

When stress is dealt with positively the body restores itself and repairs any damage caused by the stress. However, when stress builds up without any release, it affects the body negatively.

A vicious cycle occurs in the relationship of arthritis and stress.

The difficulties which arise from living with chronic arthritis create stress.

The stress causes muscle tension and increased pain along with worsening arthritic symptoms. The worsening symptoms lead back to more stress.

Stress Management

The University of Washington, Department of Orthopedics, lists three components of a successful stress management program: learn how to reduce stress; learn how to accept what you cannot change; and learn how to overcome the harmful effects of stress.

Reducing stress

1 - Identify the causes of stress in your life.
2 - Share your thoughts and feelings.
3 - Try not to get depressed.
4 - Simplify your life as much as possible.
5 - Manage your time, and conserve your energy.
6 - Set short-term and life goals for yourself.
7 - Do not turn to drugs and alcohol.
8 - Utilize arthritis support and education services.
9 - Become as mentally and physically fit as possible.
10- Develop a sense of humor and have some fun.
11- Get help to cope with hard-to-solve problems.

Accepting what you cannot change

1 - Realize that you can change only yourself, not others.
2 - Allow yourself to be imperfect.

Overcoming the harmful effects

1 - Practice relaxation techniques.
2 - Learn to overcome barriers to relaxation.

Corticosteroid Use and Stress

Many arthritis patients are prescribed a corticosteroid, such as prednisone, as part of their treatment plan. Without some precautionary measures, stress can be dangerous to someone taking corticosteroids. Corticosteroids are closely related to cortisol, which is a hormone produced by the adrenal glands. Cortisol helps regulate salt and water balance and carbohydrate, fat, and protein metabolism. When the body experiences stress the pituitary gland releases a hormone which signals the adrenal glands to produce more cortisol. The extra cortisol allows the body to cope with the stress. When the stress is over, adrenal hormone production reverts to normal.

Prolonged use of corticosteroids results in diminished production of cortisol by the body. With insufficient cortisol production, the body could be left inadequately protected against stress and open to additional problems such as fever or low blood pressure. Physicians often prescribe an increased dose of corticosteroid to compensate for this when there is a known or expected stressful event.

WHAT CHRONIC STRESS DOES TO YOUR HEALTH

Look around. One of ten people you see at work, at the store, and wherever you go in your daily life is over stressed at any given moment. Scientists agree that stress causes actual chemical changes in the brain, and these changes can influence the state of your health.

What is Stress?
Stress is any change in your normal routine or health. Stress occurs when bad things happen, as well happy things. Getting a raise or promotion is stress, just as getting fired from your job is stress.

Speculative changes cause just as much stress as veritable changes. Pensiveness or anguish about whether you will get that new job is stress the same as being offered a new position is stress.

What Causes Stress?
Women are particularly susceptible to stress caused by hormonal changes. During puberty, your menstrual cycle, pregnancy, and menopause your hormone levels fluctuate consistently and cause stress.

Emotional and physical changes that happen in your life, illnesses, and environmental components such as extreme heat, cold, or altitude, and toxins cause stress.

Pushing your body too hard at work or at play will soon deplete your body of the energy it needs to restore itself and result in your becoming over stressed.

Stress Related Illness
Science is constantly learning about the impact that stress has on your overall health.

Stress is or may be a contributing factor in everything from backaches and insomnia to cancer and chronic fatigue syndrome (many people believe that CFS and fibromyalgia are the same illness).

Stress is often a key factor when women experience either absence of menstruation or abnormal bleeding. Hormonal imbalances caused by stress may proliferate the symptoms of fibroid tumors and endometriosis, as well as make pregnancy difficult to achieve for couples with fertility problems.

Heart disease is the number one killer of American women. High blood pressure, heart attacks, heart palpitations, and stroke may be stress related cardiovascular conditions. Some women experience changes in their sexuality and encounter various sexual dysfunctions such as loss of desire and vaginal dryness as a result of stress.

Often people feel the effects of stress as fatigue, various aches and pains, headaches, or as emotional disorders such as anxiety, depression, and sleep disturbances.

Stress affects others by causing gastrointestinal disorders such as ulcers, lower abdominal cramps, colitis, and irritable bowel syndrome.

Frequently people under the effects of over stress will have more colds and infections due to lowered immune system responses. Stress can initiate dermatological conditions such as itchy skin and rashes.

Steps to Reducing Stress and Improving Your Health...
Eliminating stress completely from your life is impossible.

However, implementing some stress management techniques can subdue some of its' harmful effects.

Stress management includes following

a healthy diet,

getting regular exercise,

and making time for uninterrupted relaxation.

Managing Stress
Stress can exacerbate arthritis pain, as well as other conditions harmful to your health. Chill out, and feel better now by managing stress intelligently.

Chuck Currie, 35, knows plenty about managing stress. From serving sandwiches at Baloney Joe's soup kitchen to running operations for the Goose Hollow Family Shelter in Portland, Ore., Currie worked with the homeless, one of the nation's most stressed populations, for 17 years. He witnessed people suffering from disabling health conditions and teenagers dying from AIDS.

Two years ago when Currie moved to St. Louis, changed his career path and started a Master of Divinity program, he experienced a surge in his own stress. Help didn't come easily. "Moving, changing careers and entering seminary were all stressful things that happened in quick succession," he says. At the same time, Currie began experiencing swollen and painful joints in his hands and feet.

At times his symptoms were so severe he couldn't get out of bed; twice the flares sent him to the emergency room. Currie, who has psoriasis, had developed psoriatic arthritis, an inflammatory joint condition occurring in roughly 23 percent of people with psoriasis.

As Currie experienced, stress packs a powerful wallop for people with autoimmune diseases, because some of the biological pathways that ignite the stress response are the same pathways involved in immune-system malfunctions. For people with arthritis and other inflammatory diseases, stress prompts the release of chemicals in the brain and body that can trigger flares, inflammation and pain.

To make matters worse, some of those chemicals, like cortisol, increase the risk of developing other chronic health conditions, such as heart disease, obesity, anxiety and depression, which can often create more stress.

Managing your health after this cycle takes hold can seem like jumping for a helium-filled balloon that's floating out of reach.

Luckily, what goes up can come down, and managing stress through reduction techniques can help restore your system's balance and protect your overall health.

Chemical messengers

What exactly is stress? Hans Selye, MD, known as the "Father of Stress," defined stress as our response to any demand or stressor. Traffic jams.

Tiffs with family members. Long waits at the post office.

Many people experience stressors like these every day. If you're living with arthritis, you know a chronic condition can heap additional stressors on the pile.

Stiff joints can slow you down in the early morning, making you late for work. A favorite pastime like needlepoint can go from relaxing to aggravating.

Joint pain can keep you up at night, making you feel sluggish and cranky the next day. The potential result? Stress overload.

When we're sailing through life without any hurdles, our body's organs and the chemicals they produce are balanced. When we experience a stressor - for example, when our car fishtails on a slick highway - our bodies respond by activating chemical messengers, says George P. Chrousos, MD, chief of the National Institute of Child Health and Human Development, Pediatric and Reproductive Endocrinology Branch, National Institutes of Health, in Bethesda, Md.

The chemical message starts in the hypothalamus, the master gland in the brain, which spits out a hormone that zings over to the pituitary gland, which shoots out another hormone that signals the adrenal glands to release stress hormones, including epinephrine (adrenaline) , norepinephrine (noradenaline) and cortisol.

These releases occur in seconds and help fuel our natural fight-or-flight response - the jolt that enables us to focus and react, and right our fishtailing cars.

When these chemical messengers work well, they help us navigate around life's punches: a fever breaks, a bad mood lifts, pain subsides.

But, when one or more of these chemical messengers doesn't do its job just right, the balance can go down with the punch

. Stress hormones also control other chemical messengers that influence biological processes such as body temperature, heart rate, blood pressure, appetite, metabolism, mood, sleep, fertility, pain perception and immune system responses.

In Currie's case, his psoriasis was significantly linked to stress.

In fact, a Finnish study found that men, in particular, were more likely to experience psoriasis and joint pain when stressed. "It's cyclical," says Currie, "because the stress level will impact my arthritis, and the arthritis will impact my stress level."

Shared pathways

Because people with arthritis are already experiencing inner body stressors that affect cortisol production due to their disease, researchers are now examining how cortisol levels are affected by external daily stressors in people who have arthritis, as well as in those who don't.

Researchers at Pennsylvania State University's Milton S. Hershey Medical Center in Hershey, recently studied how a stressor such as sleep loss (six hours of sleep instead of the recommended eight) affected 25 young, healthy college students.

After one week with less sleep, the students' blood tests showed decreases in cortisol and increases in cytokines, chemicals that spark inflammation - changes also found in people with RA even when they get a full night's sleep.

With chronic stressors like consistent sleep loss, would the healthy college students be more susceptible to developing RA? While experts agree that many factors, including heredity, likely contribute to a person's chances of developing conditions like RA, stress is one of the suspected culprits. The reason? The stress response and the immune response share some of the same pathways.

"The processes that fire up the immune system and lead to the proliferation of inflammation- inducing chemicals are the same processes that are stimulated by stress," says Alex Zautra, PhD, an Arthritis Foundation-funded researcher and professor of psychology at Arizona State University in Tempe.

Some experts believe there's a chicken-and- egg predicament involved:

Immune system hiccups can cause stress,

and stress can cause immune system hiccups in susceptible people.

Who's susceptible? Experts say it depends on how we are "wired."

Wired for stress

Researchers have a number of theories about how people become wired, or rather miswired, for stress. For instance, exposure to chronic, ongoing stressors such as living with arthritis or caring for an aging parent, can impact chemical messengers.

Ohio State University, Columbus, researchers measured an inflammatory chemical in older adults and found those who were taking care of a chronically ill spouse had four times the amount of it in their blood compared to non-caregivers. The increased inflammation marker persisted in the caregivers years after the sick spouse died, indicating that changes to stress circuitry can have long-lasting effects.

Fetal exposure

Some people can be predisposed to stress at birth.

Malnutrition in pregnant women, for example, can lead to low birth weight and stress in the fetus, which can set the child up for a lifelong hyperactive stress response, says Dr. Chrousos. Every time these small children are stressed, they have a big response.

By the time they are 35 or 40 years old, they have metabolic syndrome, which includes high blood pressure, high blood lipid levels, obesity, glucose intolerance and excessive cytokines in the blood. Having that constellation of risk factors, says Dr. Chrousos, predisposes people to higher rates of atherosclerosis, heart attacks, strokes, diabetes and early death.

Trauma

Physical or psychological trauma - sexual abuse or losing a loved one, for example - can also change stress circuitry in some people.

Some researchers think post-traumatic stress disorder (PTSD) occurs when, during the initial trauma, the norepinephrine that is released to help imprint memories acts too strongly or too intensely on the brain. People with PTSD have recurring, unbidden memories or flashbacks of their trauma, as well as nightmares and insomnia, which can keep their stress and norepinephrine levels high long after the trauma occurred.

People with fibromylagia who have symptoms of PTSD - 56 percent in one study - have higher levels of pain and stress than those with no PTSD symptoms.

Hormones

Women appear more susceptible to stress than men. The culprit? Estrogen. While intense stress suppresses estrogen production in the body - which is partly why female athletes who train intensely can stop menstruating - estrogen itself seems to make the brain more responsive to stress. Interestingly, men with RA tend to have elevated levels of pro-inflammatory estrogens and decreased levels of testosterone, an anti-inflammatory hormone, compared to men without RA.

Socioeconomic status

People with low education levels have more acute or severe daily stressors, according to a recent study from Wake Forest University School of Medicine in Winston-Salem, N.C.

For instance, rain is an inconvenience to an office worker, but it means lost wages to an outdoor laborer.

Your socioeconomic status also determines the type of resources you have to deal with stress, says study leader Joseph G. Grzywacz, PhD. Massages, mental health counseling or health-club memberships don't come easily to those struggling to meet basic life needs.

"Stress is really a component of every disease," says James Rosenbaum, MD, chair of the Division of Arthritis and Rheumatic Diseases and the Edward E. Rosenbaum professor of inflammation research at Oregon Health & Science University in Portland.

Take a look at the adverse health effects:

Increased abdominal fat, obesity. Researchers now know that excess cortisol ushers fat toward a person's middle, where the fat deposits and builds up around the abdomen. Even relatively thin, healthy women under chronic stress can exhibit some fat buildup around the middle.

Excess abdominal fat and obesity are risk factors for heart disease and diabetes, and this type of fat secretes copious proinflammatory chemicals, worsening inflammation.

Diabetes. Obesity is a leading cause of diabetes, but the chemical imbalances caused by stress, regardless of obesity, can also trigger type 2 diabetes development.

Researchers at the University of Washington, Seattle, found that increased levels of fear, lack of control and depression raise levels of glucose and insulin, each of which are danger signs for diabetes.

Cardiovascular illnesses. Acute stress increases blood pressure and constricts blood vessels, both cardiovascular concerns, and stress can also pump up levels of cholesterol, triglycerides and homocysteine - all heart disease indicators.

Sleep disturbances. In a 2003 nationwide sleep poll, 72 percent of people with arthritis reported sleep problems.

Loss of deep, restorative sleep can be attributed to stress and can lead to insomnia

. People not sleeping can then stress about losing sleep, and another cycle begins. Sleep deprivation, in turn, can prevent the brain from modulating pain.

Mental health challenges. Stress alters neurotransmitters that regulate mood and emotion, leaving a person more susceptible to depression and anxiety.

Depression can also worsen inflammatory conditions. For example, a study out of Stanford University Medical Center, Calif., discovered that people who are depressed experience two times more chronic pain than those who are not depressed.

"Depression itself has been associated with elevations in proinflammatory cytokines," says Zautra. "That's independent of whether the person has arthritis. So when you combine these factors, they become a more potent brew."

Premature aging. Connections among stress, premature aging and decreased lifespan were recently identified in a University of California, San Francisco (UCSF) review of women, aged 20 to 50, who were caregivers to children living with a chronic illness, such as autism.

Compared to women of the same age who were caring for healthy children, chronic stress levels speeded up the aging process in the women caring for sick children.

Researchers found that stress accelerated the division of telomeres on the end of chromosomes. As the chromosomes divide, telomeres get shorter, causing weakened muscles, deterioration of vision and hearing, increased aging of the skin, mental decline and failing organs.

Managing stress

Although stress can take quite a toll on the body, as Dr. Selye first examined, stress is our response to a stressor. By practicing methods of stress reduction, you can decrease the damaging effects of stress. The trick to stress reduction is finding strategies that work best for you, says Dr. Rosenbaum.

One person might find taking a drive in the country relaxing, while another might find the time behind the wheel stressful. Knowing you have the resources to deal with your disease and feeling empowered to control your health as much as possible can reduce the stress-load of having a chronic condition, says Dr. Rosenbaum. Bolster your stress management techniques by adding new ones to your repertoire, such as:

Release self-defeating thoughts.

Becoming aware of judgments about your health and body, such as "I'm too young to have pain" or "I should be stronger than this," can ignite the stress response. Mindfulness- Based Stress Reduction (MBSR) may help people let go.

It involves recognizing stressors, and letting them drift away like clouds, says Trish Magyari, the MBSR program director at the Center for Integrative Medicine at the University of Maryland Medical Center in Baltimore.

"People learn that self-defeating thoughts are doorways to the pit of their own personal despair. If they can learn to see the doorway, they can learn they don't have to go through it," says Magyari.

Breathe and focus. One MBSR technique for managing stress is diaphragmatic breathing, which is done by consciously taking deep breaths in through the nose, out through the mouth and expanding the diaphragm. Progressive skeletal muscle relaxation -- a series of tightening, holding, then releasing muscle groups in procession from toes to face - and imagery or focused attention - centering on a word, phrase or image to relax -- also are used.

Vent. Releasing anger, hurt or other negative emotions can diminish stress. A study of the effects of keeping a journal by researchers at Southern Methodist University, Dallas, found that those who logged 20 minutes a week for four weeks lowered their blood pressure, easing physical reaction to stress

. Help can be found by writing in a daily journal, calling a friend or joining a support group, providing a daily or weekly vent needed to keep stress from building.

Cap your sweet tooth. A body under stress craves carbs and sweets when the extra cortisol produced in response to stress triggers the cravings.

While carbs and sweets release feel-good endorphins, the effects are short-lived and the body begins to crave more, again putting a person in a hard-to-break cycle.

UCSF researchers studied women with high levels of cortisol and found the participants turned to sweets and ate more after stressful events.

Studies indicate that a diet rich in fruits, vegetables and proteins lowers cortisol levels.

Turn off the TV and get moving. Sedentary behavior, like chronic television watching, is associated with weight gain and increased health risks - hence, more stress.

A recent Harvard University, Cambridge, Mass., study concluded that men who watched TV more than 40 hours per week had almost three times the risk of developing diabetes, compared to men who watched TV for less than an hour per week.

Get a break in routine by taking short, brisk walks when stress starts to build.

Yoga and tai chi are more meditative forms of exercise that can also be easy on the joints, providing flexibility and strength training as well as stress relief.

A study from Reed College in Portland, Ore., suggests 90 minutes of yoga reduces perceived stress as well as salivary levels of cortisol; other studies have shown two to three hours of tai chi a week improves sleep quality and mental health.

Medication. As inflammatory chemicals ignite or perpetuate swelling and pain, pharmaceutical companies design drugs that target or block those specific chemicals to reduce inflammation.

For example, the biologic response modifiers (BRMs) adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) target and block the proinflammatory chemical TNF-a, which accumulates in the joints of people with certain types of arthritis, like RA, contributing to flares and tissue damage.

Researchers are now reviewing if stress reduction itself can work like a BRM and block the build-up of proinflammatory cytokines in people with autoimmune diseases.

If stress relievers like practicing breathing techniques or following a more nutritious diet don't work, a doctor can provide short-term relief for acute stress or severe anxiety through medication.

To keep his stress in check, Currie practices meditative prayer and exercises to his ability, which is especially important now that he's taken on a new stressor in his life - parenthood.

He and his wife are experiencing twice the stress - and twice the joy - after welcoming twin daughters last July.

While not all stress is avoidable, and some can even spur you on to try new experiences and grow, you can find strategies that help you overcome detrimental stress or stress overload so you're less susceptible to flares.

People with arthritis, like everyone else, can benefit from learning to cope with stress in a positive way.

What is stress?

Stress is a term used to describe the body and mind's reaction to everyday tensions and pressures.

Too much stress can increase pain, and can make a person more prone to illnesses such as heart disease or mental problems.

Stress and arthritis

Too much stress can also make it harder for people with arthritis to face the extra problems imposed by their disease.

These problems may include medical expenses, changes in lifestyle, side effects from drugs, and concern about the future.

By learning to cope with stress in a positive way, you can reduce your pain, feel healthier, and deal better with the extra demands of your disease.

It is for these reasons that stress management is an important part of taking care of your arthritis.

Learning stress management, or how to cope with stress in a positive way, is a skill. Like any skill, it needs to be practiced.

This information first explains how the body and mind react to stressful events.

Then it describes a program for managing stress. For more help, ask your doctor or see a counselor or psychologist.

Reactions to stress
Typical stressors

Stress is a normal part of life. Many things in life can be stressful, such as a move to a new town, a change in jobs, marriage or divorce, the birth of a child, or the death of someone close to you.

Trying to meet such basic needs as having food to eat and a roof over your head can be stressful, too.

Stress and chronic disease

People with arthritis experience the same kinds of stress as everyone else. However, sometimes having a chronic disease as well can add special problems.

People with arthritis may become more dependent on family members and health care professionals. They may also have to adapt to changes in their job status, hobbies, energy level, or body image. None of these adjustments are easy--and all can be upsetting.

Reacting to stress

When you are under stress, your muscles become tense.

This muscle tension can increase your pain. A vicious cycle of stress, pain, and depression may develop. However, if you learn how to manage stress, you can help break that cycle.

Some of the body's reactions to stress are easy to predict. At stressful times, the body quickly releases chemicals into the blood.

This sets into motion a series of physical changes. These include a faster heartbeat and breathing rate, higher blood pressure, and increased muscle tension.

These physical changes give the body added strength and energy.

They prepare the body for dealing with stressful events such as giving a speech, aiding an accident victim, or fighting or fleeing from an attack. When stress is dealt with in a positive way, the body restores itself and repairs any damage caused by the stress.

However, most of the time, people don't deal with stress in a positive way. Thus, stress-related tension builds up and, with no outlet, takes its toll on the body.

The mind's reaction to stress is harder to predict. These mental reactions vary according to the situation and the person. They may include feelings of anger, fear, anxiety, annoyance or frustration.

A small amount of stress can help people perform their best--during an exam, an athletic event, or on stage.

With too much stress, people may become accident-prone, make a lot of mistakes, and may not be able to function.

Stress can be compared to a violin string. If the string is too loose (not enough stress), it won't produce music. If the string is too tight (too much stress), it will break. Some degree of stress is necessary to function properly.

Realize that people respond in different ways to events and situations.

Some people like to be busy, with lots of activity. Other people may prefer a slower pace, with less activity. What one person finds relaxing may be stressful to another.

Manage Stress
Signs and symptoms of stress

Managing stress begins with learning the signs and symptoms of stress.

Tiredness/exhaustio n

Muscle tension
Anxiety
Indigestion
Nervousness/ trembling
Sleeplessness
Cold, sweaty hands
Loss of or increased appetite
Grinding teeth/clenching jaws
General body complaints, such as weakness, dizziness, headache, stomachache, or pain in the back or muscles.
It's possible that some of these symptoms may be caused by problems other than stress, such as the flu. Ask your doctor about symptoms that last for more than a week.

If your doctor decides that stress is the problem, you can work together to understand and relieve it.

Make stress work for you

The key to managing stress is to get stress to work for you instead of against you. A complete program for managing stress has three parts:

Learn how to reduce stress.
Learn how to accept what you can't change.
Learn how to overcome the harmful effects of stress.
Suggestions for following these guidelines are described in the following pages.

Ways to reduce stress

Identify causes of stress

What causes you the most worry and concern?

What situations make you feel anxious, nervous or afraid?

Once you know what the stressful aspects of your life are, decide whether or not you can change them.

Keep a "stress diary" to record the events in your life that cause stress.

Record any physical symptoms you have.

Try some of the ways to manage stress suggested in this program, noting if they helped you.

Soon you will learn what upsets you the most, and which ways help you cope the best. Then try to prevent those situations from occurring.

For example, if important family events usually make you anxious, plan to get extra rest ahead of time so you are better able to cope.

Share your thoughts and feelings

It's usually helpful to talk to someone about your concerns. Perhaps a family member, friend, co-worker or member of the clergy can help you see your problems in a different way.

Learn to tell people when you can't do certain things. Saying "no" to people is important and you shouldn't feel guilty when you do. You may find that turning down extra duties--even for a short period of time--reduces your stress.

Respect your limits of energy, pain, and time. If you don't, you can become so worn out that you can't be the kind of friend, lover, or parent you want to be.

Realize that you have the right to decide if you want to discuss your arthritis.

If having arthritis limits your activity, that may be a good reason to mention it. Otherwise, your arthritis is a private matter.

Learn to express anger and other negative emotions without hurting others. It's all right to be angry! However, try to say, "I'm feeling angry, " instead of, "you are making me angry. "

This lets you express your feelings without blaming someone else. "Striking" someone with words will only make that person feel under attack. This can make the conflict harder to resolve. Learning to express your feelings will enable you to improve relationships with the people who are important to you.

Try to avoid depression

A condition such as arthritis can bring about feelings of depression. You may feel sad or "blue, " or have more serious thoughts of hopelessness and despair.

Depression can make you feel miserable and also increase your pain.

You may wonder, "why me?" or "why are other people able to do things I can't do?"

You may be angry or feel sorry for yourself. It might help to know that these are common feelings of people who have arthritis.

Usually feeling depressed depends on how you deal with events in your life, whether they are real or imagined. If you believe you're a helpless victim of depression, you probably won't do anything to overcome it. Here are some tips to help you manage depression:

Realize that you are responsible for how you feel. If you are aware that your state of mind is up to you, then you are more likely to take an active approach to improving your mood.

Take care of yourself. You're special--so pamper yourself. Try something good to eat, take a leisurely bath, or buy something nice for yourself.

Be a "doer." When you're sad or lonely, go to an event. Get involved in neighborhood or volunteer organizations. Don't forget the joy of giving.

Find new activities to replace old ones so you can continue to grow and develop. Discover new creative outlets, such as hobbies, skills or interests.

Remember that it's all right to cry. A good cry can be a healthy way to relieve tension.

Keep in touch with family and friends, by phone if you can't get out. Don't let your arthritis set you apart from others.

Try to discover what set off your depression and learn to avoid those events in the future.

Be alert for signs of depression that last for more than two weeks.

If you continue to have signs such as eating or sleeping too much or too little, or feeling hopeless, forgetful, restless, or more tired than usual, tell your doctor.

Sometimes this type of depression is caused by a change or an imbalance in the body's chemistry. Often certain drugs can correct such an imbalance.
Simplify your life

Look at your activities.

Decide which ones are most valuable and omit those that aren't.

Many tasks or chores may seem necessary.

But are they?

They may be important only in your mind.

Your family and friends enjoy you more when you're rested and healthy. Therefore, don't get worn out trying to do too much. Instead, do a few things well.

In addition, ask for help when you need it, and accept it gratefully. You may also use aids and devices to make your everyday tasks easier.

Manage time and conserve energy

When you usually have pain and limited energy, it's natural to work harder on days you feel well. Instead of getting worn out trying to do everything, organize each day the night before or in the morning.

Plan to do the most stressful or hardest task early in the day.

Schedule rest periods, and remember to take them before you get worn out.

Pace your activities by doing a heavy task and then light ones. Don't try to do too many heavy chores in one day.

Set goals

Goals give you something to work for, and they give you satisfaction once you achieve them. Set short-term, achievable goals, taking one day at a time.

Remember to include hobbies and friends. Because of the uncertainty of your arthritis, be flexible about the time needed to complete a goal. Take some time to think about your long-term goals.

How has your life changed since you last thought about your goals?

Has your arthritis affected them?

What is most important to you now? What do you want to achieve?

Avoid drugs and alcohol

Realize that drugs and alcohol don't solve life's problems. When people who smoke are under stress, they tend to smoke more. Some people use alcohol, marijuana, or other drugs in an attempt to solve or to escape from life's problems. These substances can only add to your health problems. They don't help you manage stress. In fact, in the long run they can increase your stress. Instead, see a mental health counselor or ask your community health service or hospital about programs offered in stress management.

Seek support and education

Sharing will help you realize that you are not alone.

Try to stay healthy

Remember that having arthritis is only one part of your total health picture.

Sometimes people feel so overwhelmed trying to manage their arthritis that they forget about the rest of their health.

You control your diet,

weight,

exercise,

and attitude, for example.

By becoming as physically and mentally fit as possible, you can improve your energy, state of mind, and your level of stress.

Make time for humor and fun

Schedule time for play and become involved in activities that make you laugh. There is almost a magical quality about laughter.

No matter how sad your mood, laughing can make the world look brighter. Laughter dissolves tension--you can't be "uptight" and laugh at the same time!

Joke with friends or see a funny movie. You know yourself--do what is fun for you.

Seek help if you need it

Get help to cope with constant, hard-to-solve problems.

For instance, a mental health counselor or therapist may be able to help you work through a serious marital problem or severe depression.

He or she might be able to help you find positive ways to express anger, if that has become a major concern.

Change yourself, not others

Realize that you can change only yourself, not other people.

Many people spend too much time and energy trying to reform their spouses, children or doctors.

They want to make them different, or to have them act in a certain way.

When these changes don't happen, people tend to feel frustrated, tense, and upset. No one has the power to change another person.

When people change, it's generally because they wanted to do so.

Accept imperfection

Have the courage to be imperfect.

Stop trying to be the ideal parent, spouse, child, patient, employee, or boss. No one is perfect! Trying to be perfect is admirable, but doing so takes its toll on your time, energy, and the way you feel about yourself.

Realize that life isn't always fair.

Drugs have side effects, doctors may sometimes be grouchy, and families don't always understand.

Try to "roll with the punches." Being flexible helps you keep a positive attitude, despite hardships.postedby MERM for wellnesstrain group

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