ARTHRITIS INFORMATION

by Arthritis Care

Arthritis accounts for one third of all physical disability - the largest single cause in the country.

There are 200 types of arthritis. This leaflet is about the commonest, Osteoarthritis and Rheumatoid Arthritis. This leaflet will help you to talk to your doctor, get a proper diagnosis and effective treatment.

The normal joint

Where two bones meet at a joint, they are held together by ligaments. Cartilage on the bone-ends allows smooth movement. The joint capsule is lined with synovial membrane which produces the synovial fluid that nourishes the cartilage.

Osteoarthritis (OA)

OA is due to wear and tear or breakdown of the joint's repair mechanism. Joints are not usually inflamed. The main symptoms are pain and stiffness. Although it is more common in older people it can affect anyone, of any age.

Despite being very common and potentially serious, ignorance of the disease remains widespread.

What happens?

OA usually develops over several years. In some the symptoms cease after a couple of years but, for most, problems gradually get worse over many years before eventually settling down and becoming easier to manage. Occasionally it gets suddenly worse after a minor bump or accident.

For a few people the cartilage becomes worn and rough. The bone underneath thickens and spreads out. Bony "outgrowths" form which make the joint look knobbly. The synovial membranes and the capsule also thickens and become a bit inflamed. The joint becomes stiff and painful to move.

If the OA worsens the cartilage may become badly worn away. The bones then begin to rub against each other. This causes a lot of pain and the shape of the joint is changed.

Which joints are affected?

OA is most common in knees, hips, feet and hands. It can also affect the neck and lower back. Often several joints are affected. OA may follow an injury to a specific joint.

OA can be mild, but it can become painful and disabling. OA does not make you feel ill. Its effects are limited to the joints.

How is OA treated?

OA is helped by maintaining good posture at home and at work. Keeping fit and active is very helpful. Stress on joints is reduced by keeping to your ideal weight. Physiotherapy can strengthen muscles which support the joints. Drugs may be used to relieve pain. Resting on a supportive bed and learning relaxation techniques also play a part. If and when joints are badly damaged, replacement surgery may be suggested.

Rheumatoid Arthritis (RA)

In most diseases inflammation helps healing. In RA, the opposite happens. Persistent inflammation causes damage. In contrast to early OA, RA can affect soft tissues in other parts of the body as well as affecting the joints. It can make you feel ill and tired. In RA, the body's natural defence system partially fails and becomes involved in the disease.

What happens?

RA can start quite suddenly, but more often it comes on over a few weeks, months or even years. The synovial membrane becomes inflamed and swollen, making joints stiff and painful. Active phases are called flare-ups. For many, the disease goes no further. For others, the continuing inflammation results in thickening of the synovial membrane, and the beginning of damage to adjoining cartilage and bone. In more advanced RA the bone beneath the cartilage may be worn. The whole joint, with its tendons and ligaments may be weakened. The joint changes shape and can become unstable.

Which joints are affected?

RA usually starts in the wrists, hands or feet. If it continues, it can spread to other joints.

No two people are affected in exactly the same way. The disease has active and inactive phases. Its effects depend on the severity, frequency, and length, of the flare up. The more active it is, the more pain, stiffness, and disability it causes. At the start there is no way to predict how the disease will progress. Regular medical assessments may be needed to plan and adjust treatment.

Out of every 100 people who get RA, about 30 recover almost completely within a few years, about 60 continue to have flare-ups, and about 10 have severe disease which eventually causes disability.

The main difficulties are stiffness, loss of movement, pain, and fatigue. Stiffness can be especially bad in the mornings, or after sitting still for a time.

People you live and work with need to understand that the symptoms of RA can come and go quite unpredictably.

How is RA treated?

There are two main kinds of drug treatment. Anti-inflammatory drugs can help relieve inflammation and pain. Other more powerful disease-modifying drugs can slow down the disease and the damage it causes.

You can help yourself with a range of movement exercises, using joints efficiently, relaxation techniques and by pacing yourself.

In severe RA, if joints become very damaged, surgery may be suggested. Hip and knee replacement surgery is now extremely successful in restoring mobility.

Who do you go to?

Your GP will begin diagnosis of the problem and recommend treatment. Some GPs have expertise in rheumatology, some might prefer to refer you to other professionals such as a consultant, a physiotherapist, or an occupational therapist.

If you prefer it, most GPs are willing to help you find a doctor of your own sex. In many places there are few or no women rheumatologists.

Rheumatologists are hospital consultants specialising in rheumatic diseases, including OA and RA. Orthopaedic surgeons specialise in the surgical treatment of joints. Some hospitals have "link workers" who will translate for you if necessary.

Physiotherapists provide treatment and advice to help you to maintain movement and mobility.

Occupational Therapists (OTs) advise about equipment to help with day-to-day life and possible modifications to your home.

What you can do?

Look after yourself, stay in control, adapt and manage your everyday life, following your professional advice and treatment.

Arthritis can affect the whole family. Discuss problems with your doctor, nurse, physiotherapist etc.