Handy help to take control of arthritis
A practical guide for sufferers who live with arthritis, this book explains how genetics, age, infections, diet, excess weight, previous injuries, and stress can all contribute. It will teach readers how to choose beneficial foods and supplements, explain which types of exercise can best bring relief, and reveal practical tips to make everyday living easier.
About the Author
Wendy Green is a trainer for a health program.
Read an Excerpt
50 Things You Can Do Today to Manage Arthritis
By Wendy Green
Summersdale Publishers LtdCopyright © 2010 Wendy Green
All rights reserved.
This chapter gives you an overview of what arthritis is, including the commonest forms of the disease and their symptoms. It also discusses the various factors that may be involved, including age-related degeneration of cartilage, gender, excess weight, joint overuse and injuries, genetics, infections, female hormones, stress, diet and smoking.
1. Learn about arthritis
Arthritis is a term used to describe joint inflammation. The word comes from the Greek words arthros, meaning joint, and itis, meaning inflammation.
About synovial joints
A joint is where two bones connect. Most joints are called synovial joints. The purpose of a joint is to enable smooth and flexible movement. The bones are held together by ligaments, whilst tendons attach muscle to bone. A tough, flexible tissue called cartilage, which contains various proteins, including collagen, covers the ends of each bone, to help them glide over each other smoothly and to act as a shock absorber. The joint is encased in a tough, fibrous capsule (called the joint capsule) that protects it and holds it in place. The joint cavity in between the two cartilages is lined with synovial membrane (also known as the synovium), a delicate tissue that releases synovial fluid to provide nutrients and lubrication. Flattened sacs called bursae, which also contain synovial fluid, act like cushions to allow the muscles and tendons to slide over each other without friction, whenever the joint moves. The knees are the biggest joints in the body and support the most weight.
Common types of arthritis and their symptoms
There are over 200 types of arthritis — the two commonest types are osteoarthritis (OA) and rheumatoid arthritis (RA). Whilst both of these conditions can cause similar symptoms, such as pain, stiffness, swelling and limited movement, there are several major differences:
The result of some form of joint trauma e.g. overuse, bad posture or excess weight, which leads to loss of cartilage and inflammation.
Only the joints are affected, (usually just one or two, but occasionally more).
Can develop in just one side of the body.
Rheumatoid arthritis (RA)
Caused by the immune system attacking the joints, resulting in inflammation.
Usually symmetrical — affecting the same sites on both sides of the body.
Other parts of the body can also be involved, including the lungs, heart and eyes.
Other, less common forms of the arthritis include lupus, gout, ankylosing spondylitis, psoriatic arthritis and reactive arthritis.
What is osteoarthritis?
Osteoarthritis (OA) is a condition where the joint cartilage thins and roughens. The bone below then tries to repair the damage, but sometimes 'overgrows' leading to new bony outgrowths or 'spurs' on the joints, known as osteophytes. Eventually, as the cartilage wears away, the bones may rub together, causing pain and inflammation. Also, the joint capsule thickens and more synovial fluid may be produced, leading to swelling in the joints. In severe cases the cartilage disappears altogether and the joints become so mishapen that they push the bones out of their normal position, causing deformity.
Unlike many other forms of arthritis, OA affects the joints only and is thought to be largely due to 'wear and tear'. In effect, OA is a process where the body tries to repair damaged joint tissue. In some cases the joint eventually becomes symptom free, but with a different structure. But in some people this process is unsuccessful — perhaps as a result of ongoing, or extreme trauma to the joint, or a reduction in the body's ability to heal itself — and the joint damage continues.
Eight-and-a-half million people in the UK suffer from OA. Around half of people reaching the age of 65 have the condition, with symptoms ranging from mild (especially in the early stages of the condition) to severe; around one in ten sufferers aged 65 and over experience severe disability as a result of OA — especially in one or both hips or knees.
What are the symptoms of osteoarthritis?
The main symptoms are those affecting the joints. They usually occur in the fingers, thumbs, hips, knees, spine (including the neck) ankles and sometimes the shoulders and elbows and include:
The pain is mainly due to damaged joints and tense muscles. It can come and go, but tends to increase the more the joint is used - hence the pain is often at its worst in the evening - but improves with rest.
The stiffness usually eases after rest, but joint movement may be limited and the joint may 'crunch' or 'creak' as it moves - this is called 'crepitus'.
Swelling of the joints might be due to the synovium swelling slightly and producing more synovial fluid, or it may be down to the presence of osteophytes. The knees are especially prone to swelling after exercise.
Loss of balance
Instability, or loss of balance, when moving about. Some OA sufferers say that their joints 'give way'.
Reduced mobility and flexibility
All of these symptoms, depending on their severity, can make you less mobile and less able to carry out everyday tasks. For example, if your hips and knees are affected, you may find walking difficult, and if your fingers and thumbs are affected, you may have problems turning a tap on and off, or opening a jar.
This is a fairly common complication of OA. It occurs when calcium deposits form in the cartilage. If these deposits work their way into the synovium, they can cause irritation and hot, painful, swollen joints.
Why do we feel pain?
Pain is the body's way of telling you that something is wrong. Irritation or injury triggers the nerves nearby to release chemicals that in turn stimulate nerve fibres to send messages to the brain, which are interpreted as pain. Pain is often a warning that you need to take action - for example if you touch a hot iron you will automatically respond by removing your hand, to avoid further injury. The pain of arthritis may indicate joint swelling, inflammation, or damage. Increased pain might suggest that you have done too much and need to rest, or that you've been sitting in one position for too long and need to get up and move around.
Diagnosis of osteoarthritis
Your GP will probably be able to diagnose OA if you present with these symptoms and signs. Your GP may examine your joints to check for tenderness, swelling and bony growths and may want to see if your movement is restricted. Your GP may also ask if your joints 'creak' or 'crunch' when you move them and may suggest a blood test to rule out other inflammatory forms of arthritis, such as RA. An x-ray may be requested to confirm OA, because it shows changes to the bone caused by cartilage thinning, calcification and bony outgrowths on the joints. However, an x-ray can't predict the level of pain and disability you might experience. Occasionally an MRI scan may be used - this shows the soft tissues such as cartilage, muscles and tendons that don't show up on an x-ray.
What causes osteoarthritis?
There is no single cause of OA, but there are several factors that can raise the risk of developing it.
Although OA can sometimes develop in young people, it more commonly develops from the late 40s onwards. This is probably down to changes in the body that tend to develop as the body ages, such as the muscles weakening, weight gain and a reduction in the body's ability to self-heal. However, OA is not an inevitable part of ageing: keeping your weight down, remaining active and avoiding joint strain can all help to keep symptoms at bay.
Before the age of 45, OA is more common in men. However, among the over 55s, women are more likely to be affected, which suggests a link with the menopause; some research suggests that oestrogen protects cartilage from inflammation and this effect is lost after the menopause. Another factor that has been suggested is that women's tendons are more elastic than men's to enable them to give birth; this means that their joints are less stable and more prone to injury. Some experts link it to female anatomy; women's hips are wider than men's to make pregnancy and childbirth easier, which means their knees are not quite as aligned with their hips and this puts more strain on the knee joints. It may also be because women have smaller, weaker bones than men, which are less able to withstand wear and tear.
According to Arthritis Research UK, twice as many women as men develop OA in their hands and four times as many women as men have OA in their knees. Equal numbers of men and women develop OA in their hips.
Being overweight puts extra strain on the weight-bearing joints, especially the hips, spine and knees, and not only greatly increases your chances of developing OA, but also makes it worse once it has developed.
Joint overuse or stress
If a joint is overused, or put under stress — for example through bad posture, repetitive use of the finger joints whilst using a keyboard at work, or through participating in a sport, it is more likely to develop OA at some point.
If you injure a joint, for example whilst playing sport, or through an accident, OA may develop in the affected area later on in life.
Other forms of arthritis
Having another form of arthritis, for example RA or gout, increases the risk of developing OA.
Nerve conditions such as peripheral neuropathy, which affects the nerves in limbs, may raise the risk of developing OA. Peripheral neuropathy can be caused by other health problems, such as diabetes or alcoholism.
Some rare forms of OA that develop in young people and affect the production of collagen (a major component of cartilage) have been linked to particular genes. A form of arthritis known as nodal osteoarthritis, which tends to affect the hands of middle-aged women, has a strong genetic link. However, in general, heredity plays a minor role, compared to the other factors mentioned above.
Heberden's and Bouchard's nodes
Heberden's and Bouchard's nodes are a sign of nodal osteoarthritis. Heberden's nodes are osteophytes on the end joints of fingers, named after the eighteenth-century English physician William Heberden. Bouchard's nodes are osteophytes found on the middle joints of the fingers, named after the nineteenth-century French pathologist Charles-Joseph Bouchard.
What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic (persistent), destructive inflammatory disease where the immune system attacks the lining of the joints and other parts of the body, including the tendons, ligaments and bones. The disease tends to flare up (relapse), usually for no obvious reason, and then disappear again (remission), sometimes for months, or even years. The affected joints may be damaged during each relapse, gradually increasing disability. This damage can range from mild to severe and usually affects the hands and fingers, making everyday tasks difficult to carry out; around 40 per cent of sufferers are forced to give up work within five years of developing the illness. In a small proportion of cases, the disease progresses continuously and fairly rapidly, leading to severe joint damage and disability.
Rheumatoid arthritis statistics
More than 380,000 people in the UK are thought to suffer from RA. It is three times more common in women than men and, though it can develop at any age, it usually starts after the age of 40. The condition is thought to cost the NHS in England alone around £560 million each year. The total cost to the UK economy each year, including NHS, carer, nursing home, sickness and incapacity benefit expenditure, is thought to be up to £4.8 billion each year
What are the symptoms of rheumatoid arthritis?
The main symptoms are usually those affecting the joints. The joints most frequently affected are those in the hands, i.e. the fingers, thumbs and wrists, followed by the feet and ankles. Quite often the knees are implicated. The hips, shoulders, neck and elbows are less commonly involved. The condition often affects the body symmetrically: if the joints in the right hand are affected, those in the left hand are also likely to be. In some sufferers, only one or two joints are involved, whilst others find that several are affected. The symptoms commonly experienced in the joints are:
This is due to the immune system attacking the synovial membrane that lines the joint (inflammation), damage to the joints, muscle weakness and secondary OA. The pain may continue through the night.
This is usually worse after being inactive, for example first thing in the morning, and usually lasts for more than an hour.
The immune response leads to inflammation and swelling in the joints.
Warmth and redness
The inflammation of the joint lining makes the skin over the joint warm, red and swollen.
As the disease progresses, the inflammation damages bone and cartilage and the whole joint can become weakened and deformed.
Loss of joint function
The combination of swelling and joint damage causes a loss of joint function, which makes carrying out everyday tasks, such as getting dressed and performing household chores, difficult.
Other symptoms of RA that may affect other parts of the body include:
Also known as nodules, these develop in about a quarter of sufferers - usually on the backs of the hands, the elbows, the forearms and the feet and are generally harmless.
The tissue around the tendons is similar to the synovial membrane around the joints, and can also become inflamed.
Numbness and tingling
Numbness and tingling in the hand - known as carpal tunnel syndrome - can develop when inflammation leads to pressure on the median nerve, the main nerve in the hand.
Sometimes the tendons - especially those on the back of the fingers - can rupture as a result of RA.
Inflammation of the blood vessels
RA can cause inflammation of the blood vessels, which can cause problems in any organ, including the heart, but the skin is most often affected. The inflammation can cause bleeding into the skin, which manifests as a rash called purpura, or there may be skin ulcers.
This is likely to be mainly due to the chemicals released during the immune response and is similar to the fatigue you experience when your body is fighting off a flu virus. Also, being in constant pain can wear you down and lead to disturbed sleep.
Auto-immune diseases like RA can cause fever - a sign that the immune response is active.
During a flare-up you may experience flu-like symptoms and feel generally unwell.
The condition can reduce the appetite, causing weight loss.
The inflammation can affect the tear glands, causing dry eyes and irritation.
The salivary glands can also become inflamed, causing a dry mouth.
Anaemia can occur if the bone marrow is affected and fails to produce enough red blood cells.
The immune system is designed to fight off foreign substances, such as bacteria and viruses, using various specialist white blood cells. In an auto-immune disease like RA, the immune system wrongly identifies healthy tissue in the body as a foreign 'invader' and attacks it. Autoimmune diseases are more common in women than men; female hormones are thought to influence immune activity.
Other conditions associated with RA
RA sufferers have an increased risk of developing other conditions, including heart disease, stroke, joint and other infections, certain cancers, lung diseases, gut problems, and osteoporosis (thinning of the bones).
Heart disease and stroke
RA can affect the heart, causing a build-up of fluid around it. Also, heart disease and stroke are both linked to insufficient physical activity and high blood pressure. People with RA may find it difficult to take exercise and some of the medications used to treat the condition can raise blood pressure.
Joint and other infections
Some of the medications used to treat rheumatoid arthritis suppress the immune system, which leaves sufferers more vulnerable to infections.
RA sufferers are twice as likely to suffer from non-Hodgkin's lymphoma. This is thought to be because the condition is an autoimmune disease, which means there is increased activity and division within the immune cells, a situation in which cancers of the immune system, i.e. lymphomas, certain types of leukaemia and multiple myeloma (bone marrow cancer), can develop. Sufferers also have a 25 to 50 per cent higher risk of developing lung cancer. This can be linked to rheumatoid lung disease (see below) and the fact that RA sufferers are more likely to have smoked.
Excerpted from 50 Things You Can Do Today to Manage Arthritis by Wendy Green. Copyright © 2010 Wendy Green. Excerpted by permission of Summersdale Publishers Ltd.
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Table of Contents
Chapter 1 – About Arthritis,
Chapter 2 – Medical and Other Treatments,
Chapter 3 – Eat to Ease Arthritis,
Chapter 4 – Supplementary Benefits,
Chapter 5 – Arthritis and Emotions,
Chapter 6 – Benefit from Exercise,
Chapter 7 – Living with Arthritis,
Chapter 8 – DIY Complementary Therapies,