Features

The daily grind

04 October 2019

Millions of people in the UK of all ages have one form of arthritis or another, and pain can be the biggest obstacle to a normal life, says journalist John Windell.

Things are not always quite what they seem with arthritis. It is not a single disease but ‘an informal way of referring to joint pain or joint disease’ (Arthritis Foundation, 2019), and the common view is that it’s a problem of old age, but it can affect people of all ages. The dozens of inflammatory diseases covered by the umbrella term ‘arthritis’ have one thing in common: the symptom of persistent pain in and around the joints. Some common forms of arthritis include osteoarthritis, rheumatoid arthritis, and psoriatic arthritis, and it can also be associated with conditions such as achilles tendinopathy, vasculitis, carpal tunnel syndrome and lupus (Versus Arthritis, 2019).

Around 10 million people in the UK have some form of arthritis (NHS, 2018). While certain types of the disease are indeed more prevalent in older people, it’s not unusual for children and teenagers to develop arthritis. A few of the conditions are even exclusive to young people, such as juvenile idiopathic arthritis.

Two of the most common types of arthritis are osteoarthritis and rheumatoid arthritis. Osteoarthritis is colloquially known as ‘wear and tear’ arthritis. ‘In general, this is something that will happen to everybody with age,’ says Professor Anisur Rahman, consultant rheumatologist at University College London Hospitals NHS Foundation Trust. ‘Just as if you were to drive a car for 90 years, the moving parts would wear out, so our joints have wear and tear, though it will vary from person to person.’

For now, by and large, this wear and tear process cannot be halted or reversed, so the treatment of osteoarthritis tends to be symptomatic, ranging from exercises that strengthen the muscles around the joints to surgical procedures such as hip replacements.

Disrupting people’s lives

Rheumatoid arthritis is caused by the immune system. ‘It becomes dysfunctional, overactive,’ says Anisur, ‘and starts to attack its own body tissues, including the joints. With these diseases you can address the underlying cause and you can suppress it. We now have a whole range of drugs that tackle this problem, so you can actually stop the patient getting joint damage and make them feel a lot better.’

This was not always the case. Back in the 1980s, rheumatoid arthritis was seen as a life sentence, with no cure and limited treatment, leading to disability and likely psychological issues. While the prognosis now is much more positive, it’s not necessarily good news for young people, who are more likely to encounter an immune-based type of arthritis. ‘I see many young people in my clinics, and their lives are disrupted,’ adds Anisur. ‘For young people of working age in the prime of life when they are having their own children, it can be a big problem. Even though we can suppress this disease, they are still going to be living with it and taking the drugs for many years.’

Look after yourself

People usually develop osteoarthritis in their mid-40s or older, but it can occur at any age following an injury, or be associated with other joint-related conditions (NHS, 2018). Over the age of 40, wear and tear becomes more of a factor, but that’s not the whole picture either. ‘General health can also play a big part,’ says Jack March, a physiotherapist and spokesperson for the Chartered Society of Physiotherapy. ‘People who smoke or who are overweight are more likely to get osteoarthritis because of the strain on their overall system.’

When treating osteoarthritis, physiotherapists focus on maintaining and improving the function of the affected joints. ‘That involves strengthening and widening the range of motion,’ says Jack. ‘Of course, that has to be based on the individual circumstances. But general conditioning exercises are also key, so that the health of the system is better. We try to get people walking or swimming, doing things that will get them fitter, because people who are fitter in general can tolerate and deal with arthritis better.’

Anisur echoes this point: ‘With most of these diseases, it helps if you look after yourself. So don’t smoke, don’t drink to excess, and eat a healthy diet. A reasonable amount of exercise will be good.’

‘We try to get people walking or swimming, because those who are fitter in general can tolerate and deal with arthritis better’

Dealing with discomfort

But when it comes to exercise, the biggest obstacle for most people with arthritis is the pain.

‘As human beings we are physically and emotionally affected by pain,’ says David Vaux, physical therapies manager at the charity Arthritis Action. ‘Arthritis pain tends to make us withdraw and think that any movement is going to make the condition worse. But this is one of the biggest myths in arthritis. In most cases, a multitude of reasons might explain the pain but it won’t necessarily be down to the deterioration of the joint.’

While the true source of the discomfort may be hard to pin down, it is certain that if the muscles around the joint are weakened, the pain will feel worse. Conversely, if the muscles around that joint are strengthened, even if it hurts a little during exercise, the pain will be less in the long run.

‘Pain is not nice,’ says Jack. ‘It’s a warning system, so it serves a purpose. But a lack of function in the joint can be just as bad. If it stops people from doing what they enjoy, that can affect them a lot. We are not psychologists, so we have to tread carefully, but a lot of our role involves education. I spend much of my time reassuring people that when they think they are making things worse by exercising that’s not the case at all. Pain is very different to damage, and it can be helpful to explain to people that a moderate level of running actually protects against the symptoms of osteoarthritis.’

Doctors also have a role to play by helping to manage the pain, says Anisur. ‘Our job is to make things possible. So we need to give people effective drugs, and reduce the pain so they can exercise. It’s a good outcome if we can control their symptoms and then, with the help of a physiotherapist, they can get moving.’

For David at Arthritis Action, a big part of the strategy is to find ways to help people with osteoarthritis take more charge of their own condition. ‘We are advocates of empowering and educating people with the right information. We take the evidence on arthritis and try to break it down into usable, practical things that people can actually use. We try to get the individual to a point where they become a bit more resilient and don’t have to rely so much on health professionals.’


Seek out an expert opinion

Aches and pains are common, but it’s best to get in touch with a health professional when:

  • A joint has an unexplained swelling or stiffness that doesn’t ease after a few days and is painful to touch.
  • The pain isn’t linked to an injury or usual exercise, and won’t go away.
  • The swollen joint is red and warm, and may be accompanied by a fever or general unwell feeling.
  • The joint or muscle pain makes everyday tasks much harder.
  • Back pain doesn’t ease after a couple of weeks or so.

Versus Arthritis, 2019 


Nurturing hope

Helping people with arthritis in this way should, in turn, give them a little more hope. ‘That can be a hugely powerful thing in their daily lives,’ says David. ‘Hope may be the strongest thing any health professional can deliver. You can do that by taking the right information about self-management and delivering it in a way people understand.’

Community practitioners (CPs) can help in practical ways, says Anisur: ‘Children have all sorts of aches and pains, so what you are looking for is a child who has more than you would expect, especially with swelling. A child who already has a diagnosis may need help to get the best out of their school time: with their timetable and the location of classrooms, with sports and so on. School nurses can do a lot to help make life easier for these children.’

In the wider community, the key sign remains the swelling. ‘If it comes and goes, that’s a pointer to arthritis. Many areas now have early arthritis clinics because the sooner you get to a hospital and get treatment, the better the outcome. So, if somebody has pain and swelling, and is generally feeling unwell, get them to the GP so they can be referred.’

Dave says CPs can help by explaining that pain isn’t always a sign that more damage is being done. They can encourage people to become more mobile and active in the home and to engage more with the community. ‘With arthritis, people can have long lay-offs that leave them isolated. They need some help and encouragement to get out of the house. We have a saying: “Get strong, then get active. Get stronger, then get more active.”’


Keep on moving

Low-impact exercise is best to help manage arthritis. Brisk walking, cycling, swimming, yoga, pilates and tai chi, for example, can help ease the pain in a number of ways:    

  • Strengthens muscles, so they provide better support for joints.
  • Maintains the movement and suppleness of joints, so they are less likely to get stiff.
  • Improves overall health and fitness, and keeps body weight down.
  • Promotes good sleep, so the body can repair itself. 

Versus Arthritis, 2019


Resources

  • The UK’s leading arthritis charity (formed when Arthritis Research UK and Arthritis Care merged) has a wealth of information on the condition, plus dedicated areas for each of the four home nations at versusarthritis.org
  • Lots of practical advice for people with arthritis at arthritisaction.org.uk
  • An overview of the condition, along with links to the key individual conditions at nhs.uk/conditions/arthritis

References:

Arthritis Foundation. (2019) What is arthritis? See: https://www.arthritis.org/about-arthritis/understanding-arthritis/what-is-arthritis.php (accessed 9 September 2019).

NHS (2018). Overview: arthritis. See: https://www.nhs.uk/Conditions/Arthritis (accessed 9 September 2019).

Versus Arthritis. (2019) Conditions. See: https://www.versusarthritis.org/about-arthritis/conditions (accessed 9 September 2019).

 

 

Image credit | iStock

 

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