Disabling Effects

People with this level of functional restriction would normally have gross joint deformity of at least one joint and swelling (with the exception of the shoulder), together with pain and significant limitation of joint movement. The joints would be likely to be stiff after resting for any length of time, and morning stiffness may be present. In many cases the finger joints would be deformed with swelling and pain leading to significant problems with manual dexterity. The joint pain may wake the person at night (even with the use of analgesics/painkillers). Where the neck is involved neck movements would normally be painful and restricted. Pins and needles, muscle wasting and weakness in the arms and very rarely in the legs may also occur. If the elbow is affected, a fixed flexion deformity may be present so that the person will be unable to straighten the arm fully. Rotational movements at the elbow (supination/pronation) will also be reduced.

Mobility

A person with severe restriction may need physical assistance from another person in getting around due to difficulty in gripping and/or holding prescribed mobility aids. They would not need guidance or supervision outdoors.

Care

A person with severe restriction would normally have difficulty coping with many activities of daily life. They may have difficulties getting out of bed and getting out of a bath. Manual dexterity may be severely restricted if the finger joints are involved, leading to problems with dressing, feeding, washing, shaving, toileting and aspects of main meal preparations such as lifting pans and peeling vegetables. Due to the severity of this condition simple aids are unlikely to be helpful and assistance may be needed in rising from a chair.