Osteoarthritis can occur in the fingers, knees, toes, hips, base of thumb and spine, but as it takes a long time to develop, there is plenty of time to be proactive. It involves the loss of cartilage, the protective surface over the end of the bone, so that joints become swollen and painful. On the other hand, rheumatoid arthritis is an auto-immune disease. It also causes swelling, pain and stiffness in the joints, but is well managed with drugs when caught early. Standard treatment is to manage pain with paracetamol and codeine, and reduce inflammation with NSAIDS (non-steroidal anti-inflammatory drugs). If this isn't working, doctors have the option to refer patients to a rheumatologist and/or a physiotherapist. 'We see patients when the GP can no longer manage their pain,' Dr Hughes says, 'or they can't take anti-inflammatory drugs, due to intolerance or stomach problems 'We have a wider range of drugs to use, including steroids, which can be taken as tablets or injected into the joint or muscle. I'm a fan of steroids, but they're very sensitive drugs that must be used carefully, because large doses can cause side-effects. In the right doses they are very effective.'
Drugs for rheumatoid arthritis include anti-inflammatories and painkillers for pain relief, e.g. standard Naproxan or Ibuprofen in the early stages, low dose steroids or hydroxychloroquine. Specific second line agents, or disease modifiying drugs (DMARDS), such as methotrexate, leflunomide and sulphasalazine, are used to control pain, but new biologic drugs, such as anti-TNF, are even more potent and precise at targeting the disease.
A controlled exercise programme can also help to control symptoms. A physiotherapist may offer manipulation and stretching, and pain relief. 'We want people to be empowered, so they can go away and be able to cope if they have a flare up. For instance, icing the joint, if it flares up helps to bring down swelling.'
Dr Chris Steele, GP, sees plenty of people with arthritis and says that osteoarthritis can cause a vicious circle, particularly among the elderly. 'Whenever I see a rug in an elderly person's house I ask them to remove it, because they're so easy to trip over. People who can't move easily tend to shuffle their feet, making them more likely to fall over and fracture bones.' So, how can we help ourselves?
Rule one: lose weight
Losing weight is crucial, says Dr Roger Wolman, consultant rheumatologist at the Royal National Orthopaedic Hospital and Spire Bushey. He claims exercise, weight loss and wearing the right shoes can keep a patient off drugs and injections and prevent surgery. In fact, he cites a woman who was due to have a knee replacement.
'She lost 10 kilos and the pain improved so much she was able to come off the waiting list for surgery. If someone commits to weight loss the reduction in pain is significant.'
A recent article in Arthritis Today, claims every extra pound gained puts four times the amount of stress on the knees. Conversely, even a small weight loss gives relief. The article explains, 'Research shows losing as little as 11 pounds may improve joint health and cut the risk of osteoarthritis of the knee by 50 per cent.'
Rule two: exercise
'There's been much more emphasis on muscle building to alleviate and prevent arthritis in the last 40 years,' says Dr Hughes. 'In the past, someone with a bad back was told to rest in bed for six weeks.'
Better muscle strength has other advantages, too. Natural balance awareness is lost because the sensors don't work efficiently inside a joint that has deteriorated, explains Dr Wolman.
Building up muscle strength improves the function of the joint and retrains it in balance awareness. 'Exercise slows down deterioration in joints due to ageing. If a joint is painful we do less exercise increasing the pace of deterioration; so if you can't jog try something else such as cycling or rowing exercises. Exercises in water, such as walking, take the stress out of the joint.'
In fact, hydrotherapy has become a part of the treatment for arthritis.
'It's important to exercise while in the hydrotherapy pool,' Dr Hughes explains. 'The warm water soothes muscles and enables people to do exercise they couldn't do on dry land.'
Dancing: any type which involves movement of the arms and hands, such as Indian style.
T'ai chi: helps balance and flexibility.
Swimming: is 'excellent for arthritis in the lower limbs (hips, knees and feet),'
according to Dr Hughes.
Walking: is good for your heart, lungs, and joints, so take the stairs instead of the lift, or walk to the station.
Knitting or sewing: keep your hands moving and flexible.
Yoga: helps balance, firms up muscles, eases stress, and keeps the body supple.
To supplement or not to supplement...
Many people with osteoarthritis, or those who have a few early twinges, try supplements, such as glucosamine with chondoitrin, green lipped mussel, fish oils, and rosehip. Evidence is mixed - with glucosamine some trials say it is helpful, and others claim it is not - while people who take them also report different results.
Dr Hughes admits, 'There is some strong evidence that supplements may help pain and stiffness in osteoarthritis. 'The evidence is best for daily GOPO® (rosehip), omega-3 fish oils may help pain, and glucosamine might slow down progress of osteoarthritis.' 'Patients try a variety of dietary changes to try to help arthritis but say that there is little evidence that the exclusion or inclusion of certain foods helps arthritis,' Dr Hughes adds. 'Obviously, calorie restriction may help with weight loss.'
However, he is convinced of the importance of vitamin D and explains, 'About 50 per cent of the population is deficient in vitamin D, due to lack of exposure to the sun.
'Deficiency can mimic arthritis providing the same symptoms. It's very easy to take a blood test and treatment is simple with capsules or injections, and the patient gets better very quickly.'
Replacing joints may prove the only solution if all else fails, but according to Dr Hughes, 'There has to be X-ray evidence as well, of course. Whenever a joint still has life in it, we try to keep it going.'
Suggestions for easing the pain of arthritis have been passed down from generation to generation. Evidence tends to be anecdotal, but you may want to give some of the following a try:
- Some acidic foods appear to make symptoms worse but this varies according to individuals - red meat, tomatoes, potatoes, citrus fruit, red wine, aubergines and strawberries have been cited.
- Good news foods cited are turmeric, ginger (considered warming in Chinese medicine), olives, green tea and grapes.
- Cider vinegar with (or without) a teaspoonful of honey in warm water each morning is said to be very helpful for easing symptoms.
- Soaking in a hot bath is soothing, but even better with Epsom salts which may release toxins from the body through the skin.
- Copper or magnet bracelets have a positive effect on some people, but others say they do nothing.
5 ways to prevent osteoarthritis
Posture: review how you use your body- what position do you spend your day in - are you sitting at a computer? How do you sleep at night? The Alexander Technique can be great for gaining awareness about where you are putting strain on your body and changing your existing habits.
Footwear: shoes that absorb shock such as trainers or running shoes are the best to wear to protect hips, knees and ankles. If you wear high heels you are putting enormous strain on your hips and knees. 'Wear flat shoes out and change into your heels when you get to the restaurant,' says chartered physiotherapist, Sammy Margo.
Core stability: Pilates helps with strengthening muscles in the tummy and buttocks which in turn helps to protect the lower body. Sammy Margo advises: 'Take a piece of string, suck in your stomach muscles, and then release by 50 per cent. Tie the piece of string around your waist to encourage you to engage your tummy muscles.
Weight control: being overweight puts huge strain on hip, knees and ankles.
Exercise regularly: strengthen muscles around joints and protect them, as well as for all round health.
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