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Treating Arthritis

There is always something that can be done to help Arthritis

Around 20% of the UK population have some form of Arthritis. Arthritis affects both sexes and all age groups. Arthritis tends to be characterised by inflammation and degeneration of a joint, which causes joint pain and swelling. This can progress to the point where it affects everyday life.

Arthritis can affect one joint or many joints, with the hip joint, knee joint and the joints of the hand most commonly affected. There are many different types of Arthritis and these each present in slightly different ways.

Some Arthritis tends to be associated with advancing age and becomes more pronounced as we get older. Some types of Arthritis occurs secondary to damage to the joint, whereas other types of Arthritis are genetic.

Medical knowledge of Arthritis is developing rapidly and modern treatments are improving the quality of life of people with Arthritis. There is always something that can be done to help Arthritis and by understanding more about Arthritis, people are better able to help themselves. This guide briefly explains the most common types of Arthritis and what you can do about them.

Arthritis Pain

What is a Osteoarthritis?

Osteoarthritis is the most common cause of joint pain. X-rays will show Osteoarthritis in most people over 50 and in around 80% of people over 70.

Osteoarthritis most commonly affects the hands, knees, hips and back. It causes joint pain, stiffness, restriction of movement and a creaking noise known as Crepitus.

Some research suggests that a family history may predispose a person to osteoarthritis but other risk factors, such as being overweight or as a secondary consequence of a previous joint injury (for example a cartilage tear or ligament injury in the knee), are much more likely to cause Osteoarthritis.

How does Osteoarthritis cause Pain?

The surfaces of joints are covered by a thin layer of super smooth Hyaline cartilage that allows friction free movement of joints. The Hyaline cartilage can be damaged by trauma or excessive loading of the joint. It can become roughened and with further stress on the joint the Hyaline cartilage can become totally worn.

This exposes the underlying bone at the joint surface. This bone itself becomes damaged due to joint loading, with changes to its blood supply and the formation of bone cysts.

Further tissue damage and increased joint loading cause flare ups of inflammation in the joint that leads to joint swelling and pain. These symptoms prevent normal joint use and lead to muscle wastage around the joint. This further increases loading on the joint surfaces and causes more joint damage.

What should you do if you suffer from Osteoarthritis?

Consult an Orthopaedic Consultant. Early treatment may be able to slow the progression of Osteoarthritis. Painful flare ups can be treated with anti-inflammatory medication prescribed by a doctor. Hot and cold therapy is also helpful for symptom relief.

Avoid putting on excessive weight. Obesity increases stress on the joint surfaces and accelerates the progression of Osteoarthritis.

Some research suggests that increased intake of dietary antioxidants such as vitamins C and E might protect against Osteoarthritis by improving the quality of Hyaline cartilage.

Exercise and maintain an active lifestyle following advice from a Charted Physiotherapist. By maintaining muscle function the joints are protected and movement helps to prevent joint stiffness.

What is a Rheumatoid Arthritis?

Rheumatoid Arthritis affects approximately 1% of the population, with women affected more often than men. Rheumatoid Arthritis is most common between 40 and 70 years of age.

Rheumatoid Arthritis is thought to be caused by a faulty immune response which causes inflammation of the Synovial Membrane that encloses the affected joints. This causes pain and swelling in the joints.

Rheumatoid Arthritis most commonly affects the knuckles, thumbs, wrists and can also affect the hips, knees, elbows and shoulders. The affected joints become inflamed, swollen and painful.

How does Rheumatoid Arthritis cause Pain?

The specific cause of Rheumatoid Arthritis is still unknown. One theory is that antigens and antibodies that are normally involved in fighting infection increase in numbers and release inflammatory chemicals which cause inflammation of the joints.

This inflammation causes a marked increase in blood vessels to the membrane that surrounds the joint, a thickening of this membrane and an increase in inflammatory fluid within the membrane. The disease process can also affect tendons around the affected joint, causing pain and weakness.

The course of Rheumatoid Arthritis varies greatly among individuals. Some people can have severe flare ups that cause severe joint damage, while other people have relatively mild symptoms.

What should you do if you suffer from Rheumatoid Arthritis?

Early diagnosis and a referral to a Rheumatologist are essential. The modern approach to drug therapy for Rheumatoid Arthritis involves early prescription of Disease Modifying Anti Rheumatic Drugs (DMARDs). These minimise the early joint damage then the more disabling symptoms of Rheumatoid Arthritis can be minimised.

Physiotherapy treatment is also helpful. Exercises therapy is important to maintain joint range of movement, muscle strength and flexibility. The specific exercises can be formulated by your Charted Physiotherapist. Many people with Rheumatoid Arthritis find that exercises in water, with the help of a Bouyancy Belt, can be beneficial.

Your physiotherapist will also be able to give advice about the use of splints and braces to support the joints that are affected by Rheumatoid Arthritis. Splints and braces can relieve pain and prevent the formation of contractures in the tissue that surrounds the joint.

What are Psoriasis & Psoriatic Arthritis?

Psoriasis is a skin condition that affects around 1 in every 50 people in the UK. Around 10% of all people with Psoriasis will develop Psoriatic Arthritis, although a National Psoriasis Foundation survey in 2002 reported that persistent joint pain or stiffness was found in 31% of patients with Psoriasis, which means that many people with Psoriatic Arthritis may not realise they have the condition. In fact, Psoriatic Arthritis may develop before Psoriasis in some people.

Unlike Rheumatoid Arthritis, men and women are affected equally and it tends to affect the joints in different manners. Typically one or two joints are affected. Some people with Psoriatic Arthritis will have back or neck pain due to spinal inflammation. Common signs and symptoms include joint pain and swelling, as well as general tiredness and morning stiffness. Other characteristic signs include eye soreness, changes to fingernails, mouth ulcers and pain when passing urine.

How does Psoriatic Arthritis cause Pain?

Psoriatic Arthritis appears to be triggered by an abnormal immune response, although the development of this condition has a lot to do with a person’s genes. High levels of specific antigens (cells that produce antibodies which fight infection) are associated with Psoriatic Arthritis and the disease process may be triggered secondary to an infection.

Psoriatic Arthritis is characterised by inflammation of the Synovial Membrane that surrounds joints. Inflammation of this Synovial membrane causes a marked increase in blood vessels to this tissue, a thickening of the membrane and an increase in inflammatory fluid within the joint. The inflammatory cells within the joint cause tissue damage and erosion of bone. This produces more pain and deformity of the affected joints.

Patients with Psoriatic Arthritis can also suffer from Enthesitis and Spondylitis. Enthesitis is inflammation of muscle and tendon insertions (typically the Achilles Tendon). Spondylitis is inflammation of the joints of the spine.

What should you do if you suffer from Psoriatic Arthritis?

Psoariatic Arthritis is a lifelong condition. Long term continuous management under a Consultant Rheumatologist has been shown to be the best form of therapy. Where symptoms are mild and infrequent then the Rheumatologist may manage the symptoms with anti-inflammatory medication.

In more severe cases early prescription of Disease Modifying Anti Rheumatic Drugs (DMARDs) are thought to help by minimising the early joint damage then the more disabling joint symptoms of Psoriatic Arthritis can be minimised.

Treatment of joint problems is often complicated by skin symptoms. Phototherapy using UVa and UVb lamps can help settle skin symptoms, together with medication prescribed by a Dermatologist (skin specialist).

What is Gout (Crystal Arthritis)?

Gout is also known as Crystal Arthritis. It is an extremely painful condition that affects around 60 people in every 100,000. It affects men more than women and it becomes more prevalent as we get older. The first attack of Gout mainly occurs in men aged 30 to 60 years.

Gout classically affects the big toe, but can affect soft tissues around a joint. The affected joint becomes hot, swollen and incredibly painful for no apparent reason. The pain can be so bad that the sufferer may be awoken from sleep. Touching the joint is often excruciating and it may not be possible to wear a shoe because of the pain.

Attacks of Gout may last for a few days or a few weeks before gradually resolving. 80% of people who suffer an attack will have a repeat attack, possibly in another joint, within two years.

How does Gout cause Pain?

Gout is caused by the formation of Urate Crystals within a joint. An attack of Gout is often preceded by an increase in the level of Uric Acid in the blood. This increased level of Uric Acid in the blood is mostly due to a lack of Uric Acid filtration and excretion by the kidneys, although in a small number of cases it may be related to dietary sources of Purine, which is converted to Uric Acid excessively.

High blood levels of Uric Acid can infiltrate the joints as crystal deposits of Monosodium Urate. These Urate Crystals cause the inflammatory reaction that produces the painful symptoms of Gout.

What should you do if you suffer from Gout?

Refer to a Consultant Rheumatologist for specialist care. Anti-inflammatory medication, together with Ice Packs can help to relieve the symptoms of an attack. Low dose Corticosteroids may be prescribed to prevent further Gout attacks and there are medications that can lower the level of Uric Acid in the blood.

Reduce dietary intake of foods containing Purine (beans, lentils, shellfish and red meats) as Purine is broken down into Uric Acid.

Vitamin C has been shown to help reduce blood levels of Uric Acid. Reduce alcohol intake, particularly beer which has a high Purine content.

What is Reactive Arthritis?

Reactive Arthritis is inflammation of a joint which is triggered by an infection. Unlike an infection inside the joint (Infective Arthritis), Reactive Arthritis is due to the presence of a persistent bacterial organism that remains in the body following a previous infection.

Reactive Arthritis affects 30 to 40 people per 100,000. It can occur secondary to a Urinary Tract Infection, Sexually Transmitted Infection or following Gastro Intestinal or Respiratory Infections.

Apart from inflammation, pain and swelling of the affected joints, Reactive Arthritis is accompanied by redness and inflammation of the outer layer of the eyes, skin inflammation, nodule formation on the palms of the hands and soles of the feet and a burning pain when passing urine.

How does Reactive Arthritis cause Pain?

Unlike Infective Arthritis the bacterial organism that causes Reactive Arthritis cannot be detected in the fluid that is removed from the affected joint with a needle and syringe.

The bacterial organism enters the joint via the bloodstream. Because this bacteria is in what is called a ‘persistent state’ it doesn’t directly cause the tissue damage that it may do within other body tissues. Instead, the body’s immune system recognises the bacteria and reacts to its presence by starting a defensive inflammatory response.

There is inflammation of the Synovial Membrane that encloses the joint. This causes a marked increase in blood vessels to this tissue, a thickening of the membrane and an increase in inflammatory fluid within the joint. However, total joint destruction is rare. This is thought to be due to the bacterial organism being less virulent because in its persistent state it cannot destroy its host.

What should you do if you suffer from Reactive Arthritis?

There is a good prognosis with Reactive Arthritis if early treatment is sought from a Consultant Rheumatologist. Antibiotic medication can eradicate the bacterial organism that causes Reactive Arthritis. Severe flare ups can be treated with anti-inflammatory medication.

Physiotherapy treatment is also helpful. Exercise therapy is important to maintain joint range of movement, muscle strength and flexibility. The specific exercises can be formulated by a Chartered Physiotherapist. Many people with Reactive Arthritis find that exercises in water, with the help of a Bouyancy Belt, can be beneficial.

Your physiotherapist will also be able to give advice about the use of splints and braces to support the joints that are affected by Reactive Arthritis. Splints and braces can relieve pain and prevent the formation of contractures in the tissue that surrounds the joint.