Arthritis

 

What is Arthritis?

Arthritis is a general term for joint inflammation and pain.  Although there are many types of arthritis and related diseases the most common are osteoarthritis and rheumatoid arthritis.
 
Both are long term conditions.  Rheumatoid arthritis usually starts at an earlier age than osteoarthritis. Osteoarthritis is uncommon in the under 45’s whereas rheumatoid arthritis may  present at any age but is most common in middle age.
 
Both types of arthritis affect women more than men and both are painful with a limited range of movement.  Morning stiffness and pain is very common.  It is estimated that around 10 million people in the UK suffer from arthritis and it can become a painful and disabling condition and during flare-ups it may lead to tiredness and exhaustion.
 
What is the difference between osteoarthritis and rheumatoid arthritis?
 
  • Osteoarthritis is mainly a degeneration of the joints sometimes referred to as “wear and tear” arthritis and is more common than Rheumatoid arthritis.
  • Rheumatoid arthritis is an autoimmune arthritis whereby the body’s immune system attacks its own tissues. Therefore it can affect the whole body including the lungs, eyes and skin and is not restricted to joints only. 
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Osteoarthritis
 
Although osteoarthritis does not have an autoimmune component it can still cause joints to become swollen and painful.  The cartilage, which has a cushioning effect in the joint, may become worn and damaged.  As a result bone may press on bone causing inflammation and pain.  Hence for those with obesity it may exacerbate osteoarthritis due to the extra strain on joints such as the knee joints.  Sometimes bony spurs can develop around a joint which may feel lumpy under the skin.  Osteoarthritis tends to affect parts of the body in an asymmetric fashion.  For example, the fingers of the right hand but not of the left hand, or the left knee but not the right knee.
 
 
What investigations may be helpful in diagnosing osteoarthritis?
 
  • X-rays may show a decrease in joint space and bony spurs.
  • Blood Tests: Normal Full Blood Count (FBC) and a normal or mildly raised Erythrocyte Sedimentation Rate (ESR) suggests osteoarthritis rather than rheumatoid arthritis.
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How is osteoarthritis treated?
 
Pain control is essential in order for a sufferer of arthritis to remain mobile.  Pain control may be achieved by any or all the following:
  • Regular paracetamol for pain
  • Topical Non-steroidal anti-inflammatory medicines (NSAIDs) for reducing inflammation which may lead to less pain.
  • Exercises to improve muscle strength and reduce pain e.g. walking for an osteoarthritic knee joint. Take advice from physiotherapists on the right type of exercises for the affected joint.
  • In severe osteoarthritis long acting steroid joint injections are often helpful.
  • Surgery: If there is significant disability with night pain, joint replacement may be recommended by an orthopaedic surgeon.
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Rheumatoid arthritis
 
As an autoimmune condition rheumatoid arthritis may attack any part of the body, for example, the synovial lining around joints also known as synovium.  The synovial lining is a connective tissue membrane surrounding the joint.  It encapsulates and maintains the synovial fluid ensuring a smooth movement of the joint.  As a result of autoimmune attacks on the synovium, joints become swollen and inflamed resulting in stiffness and pain.
 
Rheumatoid arthritis usually starts in the small joints such as in the fingers and progresses to the larger joints such as the knees.  In the early stages it may begin with muscle aches and tiredness. In the later stages tender nodules may appear around joints and the joints may become boggy and deformed.  Rheumatoid arthritis tends to manifest itself in a symmetrical pattern.  For example, both knees will often be affected rather than the left or right knee.
 
 
What investigations may be helpful in diagnosing rheumatoid arthritis?
 
Blood tests:
 
  • Full blood count (FBC) to check for anaemia, increased platelet and low white cell counts which confirm the presence of a chronic inflammatory disease such as RA.
  • ESR (Erythrocyte Sedimentation Rate) of 30 mm/hr and above points to rheumatoid arthritis. . (A normal ESR depends on age and gender.  Women under age 50 should have an ESR less than 20 mm/hr and women over age 50 an ESR less than 30 mm/hr.  Men under age 50 an ESR less than 15 mm/hr and over age 50 an ESR less than 20 mm/hr).
  • RF (Rheumatoid Factor) antibodies and anti-CCP (Anti-cyclic citrullinated peptide) antibodies are positive in most cases of rheumatoid arthritis.
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How is Rheumatoid Arthritis treated
  • Disease Modifying Anti-Rheumatic Drugs (DMARDs) such as methotrexate are an imperative, if tolerated. DMARDs will not cure rheumatoid arthritis but they may decrease the progression of rheumatoid arthritis by modifying the immune response.  It is important to start the drugs early in the disease, preferably in the first 3 months following onset, and should be supervised by a Consultant.
  • Regular paracetamol.
  • Topical Non-steroidal anti- inflammatories (NSAIDs).
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What can I do to help my arthritis?
 
Exercise
 
It is important to keep moving when you have arthritis.  There is a natural tendency to avoid any exercise but as long as you choose appropriate activities which do not harm the joints but help build up the muscles around joints, this may decrease the pain.  These may include stretching and moving your limbs so that you gradually increase the range of motion of the joints.  You could do some gentle walking or water exercises such as wading through water at the local swimming pool.
 
However avoid exercises that include repetitive actions such as in tennis where the action of serving is repeated.  Also avoid high impact exercises such as running and jumping.
 
 
Hot and Cold Treatment
 
Some people with arthritis find that heat pads and/or ice packs in a protective cloth applied to the joint reduce pain and stiffness.  Heat pads must not be used for more than 20 minutes and always remember to place a cloth on the skin to avoid any burns.  If you find that heat or cold makes the joint worse, it is best to stop using this approach.  Some find it helpful to have a hot bath or shower in the morning to counter morning stiffness.
 
 
Lose Weight
 
If you are overweight the joints of the lower limbs will come under stress which may increase the pain and swelling of arthritic  joints.
 
If you plan to lose weight by changing your diet it is important to discuss it with your doctor first.  This  is especially important if you are on medications such as warfarin and for those who have diabetes.
 
 
Diet
 
Foods to Avoid:
  • Sugary foods and sugary drinks. Also be aware of the hidden added sugar in foods by reading the label.
  • Refined processed carbohydrates:
Refined processed carbohydrates, known as starches, are easily broken down into glucose.  The processed starches include foods such as white bread, white rice and refined pasta.  If there is too much glucose and sugar in the blood it triggers a larger release of insulin from the pancreas. The result is usually weight gain.
  • A Alcohol provides a quick source of calories. The liver considers alcohol a toxin and its priority is to detoxify alcohol before processing anything else such as fats.  It slows down the burning of fat which leads to weight gain.
     
 Tips on choosing a healthy diet:
 
  • Eat a well-balanced diet. As opposed to refined carbohydrates choose whole grains, fresh fruits and vegetables, lean protein and dairy products with low fat. Always look out for added sugar.  Try to reduce the portion size if you are used to eating large portions. (For a more detailed discussion about healthy diet please visit our Nutrition page).