Arthritis is an inflammation of the joints that causes pain and immobility, ranging from mild to severe. In Ireland around 915,000 people, including 1,100 children, are living with arthritis, making it the single biggest cause of disability.
There are over 100 types of arthritis but the most common forms are osteoarthritis (OA), rheumatoid arthritis (RA) (also known as rheumatic arthritis) and fibromyalgia. Although many symptoms of arthritis are shared across the conditions, like pain, fatigue and inflammation, there are many unique to each condition too.
People of all ages are living with arthritis, not just the elderly – the average age of diagnosis for people with RA is 35. No arthritis cure exists at present and it is not known what causes it. However, there are many medical and non-medical arthritis treatments available that can help you to control your arthritis symptoms.
Our skeleton is made up of bones which are rigid, inflexible objects which require help to allow us to move. This help comes in the form of joints at the point where bones make contact. Arthritis damages joints; that is why people experience joint pain when they move.
The joint operates by connecting the bones with elastic band-type chords, called ligaments, which keep them in place. A protective coating, called cartilage, covers the bone surface at the joint to prevent bones from rubbing directly against each other. The joint is surrounded by a capsule also, and the space within the joint (joint cavity) contains a liquid, called synovial fluid, which provides nutrients to the joint and cartilage. It is produced by the synovial membrane (or synovium) which lines the joint cavity.
Movement of the joint is operated by the muscles attached to the bones as they lengthen and shorten. For example, when the bicep shortens and the tricep lengthens the lower part of the arm is pulled upwards towards the shoulder.
Arthritis affects joints in many different ways levels of joint pain can also vary depending on the type and severity of arthritis you have.
There are more than 100 different types of arthritis, ranging from the very common to the extremely rare. Many of these conditions share similar arthritis symptoms, such as joint pain and inflammation but they all have their own unique symptoms also. Below you will find a brief account of the most common arthritis types.
- Rheumatoid Arthritis
- Psoriatic Arthritis
- Juvenile Arthritis
- Ankylosing Spondylitis
- Polymyalgia Rheumatica
Osteoarthritis (OA) is the most common type of arthritis. It usually develops gradually, over several years, and affects a number of different joints. The cause is unknown, but it does appear more in females than males and often starts after the menopause.
For some people the symptoms of osteoarthritis are so subtle and develop over such a long time that they are hardly noticed. For others, problems may worsen over a number of months or years. When the overall condition process finishes, joints may look knobbly, but are usually less painful. In some cases they become pain free and, despite their appearance, still enable you to carry out most everyday tasks.
Osteoarthritis used to be considered wear and tear arthritis, but it is now understood that there are many more factors than age and use that contribute to the development of osteoarthritis – including obesity, past injury and genetics.
Rheumatoid arthritis (RA) is the most common inflammatory type of arthritis. In most condition inflammation serves a purpose – it helps healing and, when healing is done, the inflammation goes away. In RA the opposite occurs.
The RA inflammation causes damage – it can go on for a long time, or come and go. When it is active – known as a flare-up – you may feel unwell.
The body’s natural defences (the immune system) are part of the problem in rheumatoid arthritis. It somehow puts itself into reverse and attacks certain parts of the body instead of protecting it. This auto-immune reaction occurs mainly in the joints, but in a flare-up other organs can be affected. It is not known what causes the immune system to react in this way.
Fibromyalgia is a common arthritis type that causes widespread and severe pain, aching and fatigue but affects the muscles, ligaments and tendons rather than the joints. It may affect one part of the body or several different areas such as the limbs, neck and back.
Some people who live with the skin condition psoriasis also develop a form of arthritis known as psoriatic arthritis. It causes inflammation in and around the joints.
Psoriatic arthritis can affect most joints, but typically causes problems in fingers and toes, with pitting and discoloration of nails. About a third of people with psoriatic arthritis also have spondylitis – a stiff, painful back or neck caused by inflammation in the spine.
Ankylosing spondylitis (AS) is another form of inflammatory arthritis. Its symptoms are centred around pain and inflammation in the joints of the lower back. ‘Ankylosing’ means stiffening; ‘spondylitis’ means inflammation of the spine. If left untreated the joints of the spine may become fused (bridged by bone) and lose their movement.
Gout is a type of arthritis where crystals build up in the body and cause joints to become very painful. Once treated, gout is not a problem for most people. Gout symptoms are caused by uric acid crystals in the joints. We all have some uric acid in our blood but most of us pass out enough in our urine to keep down the amount in our blood.
When there is too much uric acid in the tissues, it can form crystals. These crystals can form in and around joints, inflammation, swelling – and severe pain.
Most types of childhood arthritis come under the general heading of juvenile arthritis (JA), or juvenile idiopathic arthritis to give it its official title. JA symptoms include inflammation, pain and swelling in one or more joints.
Polymyalgia rheumatica (PMR) is an inflammatory condition affecting the muscles in and around the shoulder and upper arm areas, buttocks and thighs. The cause is unknown.
Polymyalgia rheumatica usually starts very suddenly. The stiffness in affected areas usually eases as the day progresses, but often returns in the evenings. In contrast to rheumatoid arthritis the joints are not usually involved, though occasionally there can be an associated inflammation in joints such as the shoulder, hip and wrist. Very occasionally, the arteries supplying the head and neck area of the body may be involved, causing headaches and possible loss of sight. This very serious complication of the disorder requires immediate treatment.
Systemic lupus erythematosus (SLE or lupus) is a condition in which the body’s natural defences (the immune system) are upset. Cells and antibodies, which are in the blood to defend the body against infection, begin to attack it instead and cause inflammation. Lupus is a systemic condition – that is, it can affect many different parts of your body.
Lupus may begin with an obvious, bad attack. It can also begin very mildly. Because it has symptoms like many other illnesses, it can be frustratingly difficult to diagnose. Often, other conditions with somewhat similar early symptoms have to be eliminated.
While pain, stiffness and swelling in your joints may indicate something as innocent as a slight strain, it could also be an early sign of arthritis. If you experience any prolonged feelings of pain or inflammation in your joint then it is important that you visit your general practitioner (GP) who will be able to test for arthritis.
Here are a few simple tips to help you get the most out of your GP visit:
- Be prepared: Before your appointment, think of ways to describe your symptoms, write down your questions and any changes in your condition.
- Be confident. Don’t be afraid to ask questions. If something is confusing then repeat it back to the doctor and ask him/her to explain more clearly.
- Two heads are better than one: Bringing a family member or friend will help you relax and remember to ask the right questions.
Your health professional will make an arthritis diagnosis on the basis of your symptoms, a physical examination and medical tests. In some cases your GP will be able to give you an immediate diagnosis or they may have to refer you to a rheumatologist or orthopaedic surgeon.
Testing for osteoarthritis (OA)
Your GP will:
- Check for any bony swellings and creaking joints, any restricted movement, joint tenderness or instability.
- Give you a blood test to rule out other types of arthritis.
- Perform X-rays to confirm OA and to see how much damage has occurred.
An osteoarthritis diagnosis means that your GP will be your main contact for managing your condition. You may also be referred to a physiotherapist for advice on keeping your joints mobile. If your arthritis is severe, the GP can refer you to a rheumatologist, orthopaedic surgeon or pain specialist.
Testing for rheumatoid arthritis (RA)
Your GP will:
- Examine your joints and skin, and test your muscle strength.
- Carry out blood tests looking for inflammation.
- Perform X-rays to find signs of damage to joints and bones.
A rheumatoid arthritis diagnosis means that your GP will refer you to other healthcare professionals, including a rheumatologist and physiotherapist. You will also be prescribed drugs to control the condition and reduce the inflammation.
The treatment and research into arthritis is known as rheumatology. However, arthritis treatments extend beyond rheumatology also. Striking the right balance of treatments to best control your arthritis isn’t easy and often differs from person to person.
- Occupational Therapy
- Complementary Therapies
Arthritis medication is a fact of life for most people living with the condition. It is important that you feel in control of your medication and can discuss what works best for you with your doctor or healthcare team.
There are two main families of drugs used by people with arthritis, and your doctor may prescribe a combination from each. They are:
Drugs which control the symptoms of your condition. These are used to treat most types of arthritis, including osteoarthritis and rheumatoid arthritis, and they alleviate specific symptoms such as pain, swelling and stiffness. They include painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)
Drugs which affect the disease itself. These drugs affect the progression of the condition through, for instance, suppressing the immune system (the body’s own defence system). These drugs include condition modifying anti-rheumatic drugs (DMARDs), like methotrexate and corticosteroids (steroids). They can also control symptoms.
Many people with arthritis find that having surgery brings about a dramatic reduction in their pain, and an improvement in their mobility and quality of life. A wide range of types of surgery can help people with arthritis, from small procedures (such as operations to remove cysts or nodules), to major surgery (which includes total joint replacement).
Hip and knee replacements are very common procedures. In the past, most operations were performed on people over 60 but, as the quality of artificial hips and knees has improved, younger people are having these procedures. Younger people who have joint replacements are likely to need revision surgery later in life, so the decision to have surgery needs to take this into account.
Physiotherapy plays an important role in treating arthritis by providing you with improved mobility, strength and flexibility. It is often used along with medication.
If you are referred to a physiotherapist, at your first appointment you will be given a full assessment of your joints, muscles, posture and how you walk and generally move around.
You will be asked about your pain and what problems you might have. Taking into consideration the general state of your health and arthritis, a treatment plan will be decided upon and agreed between you and your physiotherapist.
Treatment and general advice may include exercise, hydrotherapy, mobilisation techniques, relaxation techniques, pain relief, TENS, splinting, walking aids and advice on posture.
It is normal to have around six sessions with a physiotherapist.
If you are experiencing difficulty with day-to-day tasks like washing, dressing, cooking and cleaning you may benefit from visiting an occupational therapist. They have a wealth of expertise on what equipment is available to assist you with a particular task. They may also be able to supply, on temporary loan, some of the more expensive items.
Adaptations may include:
- ergonomic cutlery
- kettle tippers
- bath rails
- stair lifts
Your GP or consultant can put you in touch with an occupational therapist. There may be one at your local hospital or they may visit you at home.
Podiatry, or chiropody, specialises in care of the foot and can make a big difference to mobility and walking ability in people with arthritis.
The feet and ankles provide us with the ability to do some of the most essential tasks in life, like walking and standing, but are also two of the most arthritis-affected areas.
If you visit a podiatrist – an appointment can be made through your GP or independently in some cases – they will closely examine the way you walk (gait analysis), to assess the range of motion, pressure on the foot, forces on the joints and the way you protect your painful foot. An x-ray and ultrasound scans may also be carried out to get a better idea of your condition. You may then be prescribed with orthotic insoles and shoes, which are designed with good support and ease of movement in mind.
As their name suggests, these types of therapies are designed to complement and work alongside conventional medicine and treatments – not replace them. They concentrate on treating the whole person. Even if your usual drug treatment is working well, you may be curious to know why many people living with arthritis are choosing to explore therapies like acupuncture, aromatherapy and reflexology, and want to know whether you could benefit too.
The wide choice of complementary therapies can be bewildering, but they all have a common goal: to treat the person, not the condition itself.
Like conventional medicine complementary therapies cannot offer a cure for arthritis. Unlike conventional medicine, there is very little scientific evidence to support their benefits. However, many people claim they can help alleviate symptoms such as pain and stiffness, as well as counteract some of the unwanted side effects of drugs.
Popular forms for people with arthritis include:
Acupuncture: The roots of acupuncture lie in traditional Chinese medicine where it has been practised for thousands of years. It works on the theory that health is determined by the flow of internal energy (chi) through the body. By inserting fine needles at these special points, imbalances in the flow of energy can be corrected.
Alexander technique: The Alexander technique concentrates on how we use our bodies in everyday life and teaches people new ways of using the body to improve balance, co-ordination and awareness. By learning to stand and move correctly, people can ease stresses on their body and alleviate conditions that are made worse by poor posture.
Chiropractic: Chiropractic is one of the complementary therapies which has gained a lot of respect from the medical community. It aims to improve mobility and relieve pain by focusing on mechanical problems in the joints – especially the spine. Chiropractors use their hands to adjust the joints in the spine and other parts of the body where movement is restricted. While they cannot reverse the damage in joints affected by arthritis, chiropractors claim that this regular adjustment can keep joints healthier and more mobile, while also reducing pain and slowing down further damage.
Hydrotherapy: Hydrotherapy allows people with arthritis to exercise the joints and muscles while being supported by warm water. The warm temperature of the water aids muscle relaxation and eases pain in the joints, making it easier to relax. Because the water supports your weight, the range of movement in your joints should also increase.
Massage: We use massage instinctively to ‘rub something better’ or soothe and calm someone in distress. As a therapy it can loosen stiff muscles by using gentle, soothing and kneading movements, and improve the tone of slack muscles using firmer, faster movements. Massage can also increase the flow of blood and lymph through the body and ease tension. On a psychological level, a good massage leaves you feeling relaxed and cared for.
Reflexology: Reflexologists believe that stimulating the reflex points in the feet can help remove energy blocks, relieving stress and allowing the body to heal itself. The therapy is built on the principle that pressure applied to one part of the body can relieve pain in other parts. Practitioners apply a pressing movement using their finger or thumb.
Yoga: Yoga is a way of promoting flexibility and strength in mind and body. It can improve posture, muscle tone and mobility. It can also help relaxation. Yoga positions have evolved over thousands of years as a way of stretching and readjusting the balance of the spine (the structural and nervous centre of the body). Asanas (positions) move the body in many different directions and this, together with special yoga breathing, stimulates muscles and joints, circulation, digestion and the nervous and endocrine systems.
No matter what type of arthritis you have, what you do to help yourself is very important. You can choose to do nothing and gradually lose the ability to do things you want, or you can work at maintaining or regaining some of your former abilities and pleasures. These are different arthritis management styles.
The choice is whether or not you want to be passive or active managers. We know from research that those who are active managers have less pain, are more active, and are better able to do more of the things they want.
If the choice is to be an active manager, then we must be willing to take on three sets of self-management tasks.
- Take care of your health problem (such as taking medicine, exercising, going to your healthcare providers, changing diet)
Keeping informed about your status – asking questions, reading and when necessary carrying information from one provider to another. Taking part in planning your treatment programme by monitoring and reporting on your condition and sharing our preferences and goals with the doctor and all other members of your healthcare team.
- Carry out your normal activities (jobs, employment, social life, etc.)Doing the things in life that are important to us. This may mean changing the way we do things. For example, using a garden tool on wheels or having prepared dinners in the freezer for times we are not feeling up to cooking.
- Manage your emotional changes (Changes brought about by your illness, such as anger, uncertainty about the future, changed expectations and goals, and sometimes depression. Changes can also happen in your relationships with family and friends.)
Knowing that there will be emotional ‘ups and downs’ and that the ‘downs’ are not pits to crawl out of, but natural ups and downs that all paths have.
Many people assume that the symptoms they are experiencing are due to only one cause: arthritis or fibromyalgia. While it can certainly cause pain, fatigue, it is not the only cause. Each of these symptoms can by themselves contribute to the other symptoms, and all can make pain and fatigue worse.
Even worse, they can feed on each other. For example, inflammation from the arthritis can cause pain, which causes stress and anxiety, that can cause poor sleep, poor sleep can cause depression, depression can sometimes make it hard to take medications as we should, and these can lead to more pain or fatigue, and so on. The interactions of these symptoms, in turn, make our arthritis or fibromyalgia seem worse. It becomes a vicious cycle that only gets worse unless we find a way to break the cycle. This is called the Pain/Fatigue Cycle.
By understanding the Pain/Fatigue Cycle and how each symptom contributes to increase others, we can learn techniques that help break the cycle at these various points. Before we go on to talk about some of the tools we will learn in this workshop, there are a few key principles for pain management:
- Treating pain earlier is more effective than if you wait until it gets bad. Don’t wait to see if it’s going to get worse. Treat pain when you first notice it.
- Small changes in pain can make a huge difference. You do not have to be pain free to do what you want and like. Sometimes just taking the edge off the pain can make a great difference.
- Self-management activities such as exercise are not usually pain free. However, you can use pain as a way to judge when we have done too much or when we should be doing more. We will talk more about this when we discuss exercise.
An adequate self-management of arthritis requires a combination of tasks and activities that should be carried out by users themselves. In a way, we can use the metaphor of the “toolbox” for describing what is needed for addressing efficiently the condition (see image below). There are many things you can do to break the pain/fatigue cycle using your self-management tool box. This toolbox includes a variety of tools, such as physical activity (or exercise), healthy eating, problem-solving, modifying activities, planning, medications, communicating, and thinking activities that use the mind. We can use these tools at different times, as needed, to break this cycle and manage pain and fatigue. You don’t use a screwdriver for everything; sometimes you need a hammer or a drill. It’s the same way with this toolbox.
Exercise can help you improve your health and fitness without hurting your joints. Did you know you’re ‘feeding’ your joints when you’re active? Cartilage depends on joint movement to absorb nutrients and remove waste.
Maintaining a healthy body weight is another important part of arthritis management. Did you know that losing 1kg of excess weight decreases stress on your knees by 4kg? By increasing physical activity, you can make a difference to your joints and overall health.
Along with your current treatment programme, regular, moderate exercise offers a whole host of benefits, including:
- Reduces your joint pain and stiffness
- Strengthens the muscles, ligaments and cartilage around your joints
- Helps you maintain bone strength and quality
- Increases your joint range of motion and joint mobility
- Improves your balance
- Gives you more strength and energy to get through the day
- Helps you control your weight
- Makes it easier to get a good night’s sleep
- Makes you feel better about yourself and improves your sense of well-being
- Improves your ability to manage stress
- Reduces the risk of other chronic conditions
- Promotes stronger heart and lungs
- Lowers your blood pressure and cholesterol
There is no set arthritis diet but eating a balanced diet and maintaining a healthy weight can make a big difference to your overall wellbeing and your arthritis. As well as ensuring that your body has all the essential nutrients to function, eating healthily may help reduce the symptoms of arthritis both directly and by reducing the stress on your joints through weight loss. If you are underweight, a balanced diet should help you overcome exhaustion and gain healthy weight.
- What to eat
- Being overweight
- Controlling your diet
- Breaking it down
What to Eat
There is a lot of confusing and conflicting information on arthritis diet, and whether or not particular foods are helpful or harmful. Although certain foods might have more of an effect on your arthritis than others, the most important thing is to have a balanced diet to ensure you get all the nutrients your body needs. The basic idea is to eat less fat, less sugar, more fruit and vegetables, more oily fish and plenty of calcium and iron-rich foods.
You will probably find that everyone wants to give you advice on what to eat and what not to eat. Remember that everyone reacts differently to specific foods and that you have to work out for yourself what suits you best.
Carrying excess weight is a common problem for people with arthritis. Certain drugs, such as steroids, can lead to weight gain, and others, such as non-steroidal anti-inflammatories (NSAIDs), can lead to stomach problems, making dietary choices harder. Some people may find that being unable to exercise or prepare fresh food means that they put on weight easily. Others get trapped in a similar cycle during a flare-up, but one in which they are too tired to eat and consequently lose weight, becoming even more exhausted.
Eating a balanced diet is key to maintaining a healthy weight. Controlling your weight is often the most effective thing you can do to reduce the symptoms of arthritis. Even a small weight loss can reduce strain on the hips, back, knees and feet if you are too heavy. And making sure you are not underweight should help to give your body the necessary strength and nutrition to get through a flare-up and to fight disease.
A healthy body weight is achieved by balancing the energy intake in our diet with the energy we use through activity. However, every individual has unique nutritional requirements, depending on your age, gender, body size and level of activity. A guideline daily intake is 2,000 kilocalories (known as kcal) for an active woman and 2,500 kilocalories for an active man. If you need to gain weight, eating slightly larger quantities of the healthier foods is the best approach so that you are taking in more calories. Rather than simply eating more fried foods and chocolate (which won’t help your overall health in the long run). Try things such as having an extra slice of toast at breakfast, or an extra helping of pasta or rice.
Controlling your Diet
Lots of foods, particularly processed foods, contain hidden fat, sugar and salt. Preparing your own food allows you to control what you are eating. If you have difficulties cooking from scratch but need to lose weight, choose the low fat versions of ready meals from the supermarket, checking the calorie and salt content on the back of the packaging. You should always consult your doctor or nurse before embarking on a weight loss programme as it is important to lose weight in the correct way – crash diets can harm your body.
Breaking it Down
Eating a healthy diet is about getting a variety of food from different food groups. In general, a healthy diet is one that is:
- high in fruit and vegetables
- high in starch and fibre
- low in fatty foods and salt
- low in added sugars.
A balanced diet contains carbohydrates, protein, fat, vitamins and minerals, and fibre. Carbohydrates provide us with energy. Protein is essential for growth and repair of the body. Vitamins and minerals play a major part in the healthy functioning of our bodies. Although it is healthy not to consume too much fat, our bodies do need some fat. It provides us with energy and also helps us to absorb certain vitamins. Fibre helps with bowel health (especially important for those who have slower bowel movements as a result of not being able to exercise or taking certain medications).
There are five main food groups. The diagram below shows the proportion of your diet they should make up. You do not need to have this balance at every meal, but you should aim to achieve this over the day or the week.
- breads, cereals and potatoes
- fruits and vegetables
- meat, Fish and alternatives
- milk and dairy foods
- fatty and sugary foods
Looking after and caring for someone with arthritis is a challenge. You need to achieve the right balance between providing support and motivation without being overprotective. Most people with arthritis will wish to retain as much control over their lives as possible, and you need to help them to retain their independence. This might mean that in certain circumstances help may not be wanted. This can be difficult to judge and you must be sensitive to signs to stand back and not insist on helping with a particular task or activity. For example, if the person you care for usually stands up from a chair on their own then it is best not to try and help them – unless they appear to be severely struggling or request assistance.
Kind permission by