Most people with arthritis are in their prime working years, when diminished function and well-being can threaten their livelihood as well as their financial future. Often, staying employed takes precedence over everything else, and it may require extra effort to stay as productive as before. That can affect how people care for their health, says Canadian researcher Monique Gignac, PhD, because it leaves little time and energy for things like exercise and keeping up with medical appointments. And unless you take steps to protect your joints, work-related tasks may worsen your disease.

To meet the challenge of working with arthritis, begin with your healthcare team. Speak with your doctor to make sure you’re getting the medication you need to control inflammation, improve function, and manage pain. A physical therapist can provide an exercise plan to help strengthen your muscles and improve the range of motion in your joints. And an occupational therapist can teach you how to pace yourself, reduce stress on your joints, and conserve energy—all skills that can help you adapt to working with arthritis.

Small changes, big difference
Some people with arthritis get by with only minor changes to their work environment. Carol Mancuso, MD, an associate scientist at the Hospital for Special Surgery in New York City, interviewed patients with rheumatoid arthritis about the adaptations that had allowed them to stay employed. Many reported that having autonomy at work—being able to control their schedule and the pace of their work—went a long way toward reducing pain and fatigue. Using ergonomic devices, such as split keyboards, and making changes at home to conserve energy (see Home Energy-saving Tips) also enabled them to keep working.

Sometimes a worker can make adaptations without going through official channels, although often you’ll need to ask your employer. Lisa Whalen was an intensive care nurse when RA hit “like a ton of bricks.” To make it through the week she opted for 8-hour instead of 12-hour shifts, and scheduled a day off between shifts.

The Americans with Disabilities Act (ADA) requires companies with 15 or more employees to make “reasonable accommodations” to enable workers with disabilities to do their jobs. Many accommodations are simple and inexpensive. For example, you might benefit from a desk that’s nearer the elevator or a parking space close to the building entrance. Your employer may restructure your job to eliminate strenuous tasks, allow additional breaks, or provide joint-saving devices such as a telephone headset.

The best time to request accommodations is before your work performance shows signs of decline. Be prepared to suggest changes that could make you more productive, and include the cost of devices you think you may need. Large companies may have an occupational health department that can assess your workspace and make recommendations. To learn about your rights under the ADA, go to www.eeoc.gov/facts/ada18.html [2].

Time for Plan B?
Sometimes staying employed means rethinking career plans. In her study of people with RA, Dr. Mancuso found that some kept work manageable by declining promotions or taking jobs for which they were overqualified. An experienced trial lawyer, for example, took an entry-level job in a judge’s office so she could work slowly, avoiding fatigue.

“If work consumes all your energy and there’s nothing left for family or friends, it’s probably time for a serious change,” says Dr. Gignac. Refusing overtime, reducing your work hours, or becoming self-employed may allow you to restore balance in your life. If your job is physically demanding, look for opportunities in your field that are less taxing: A floor nurse may apply to be a case manager, for example, or a classroom teacher may move into administration.

Certain occupations, however, may be too strenuous for inflamed or damaged joints. To find out about job training offered through your state’s vocational rehabilitation training programs, log on to www.ssa.gov/work/ServiceProviders/rehabproviders.html [3].