Dispelling the Rheumas: All You Need to Know About Arthritis

It’s a word that means ‘painful inflammation and stiffness of the joints.’ That’s the dictionary’s definition of arthritis, but it doesn’t apply to just one condition. The term arthritis is an umbrella term for many types of joint disease, all with different underlying causes and symptoms.

What is Arthritis?

Many people suffer with at least one form of arthritis. Currently in the UK the figure is estimated at around ten million, and some of these are children and teenagers. Many people in their more senior years find that arthritis develops, and this is often a ‘wear and tear’ form of the condition known as osteoarthritis.

Osteoarthritis and rheumatoid arthritis are both long-term conditions. There is no complete cure, but treatments have improved greatly, and managing the discomfort of these debilitating conditions is now much more promising with the correct treatment and approach. It is particularly helpful when treatment can be started at an early stage in the condition.

Arthritis occurs in joints where two bones meet, so in shoulders, knees, and fingers. Joints are designed to hold two bones together while allowing them to move freely, so when things go wrong within the joint, inflammation, swelling, and pain follow. Most of our joints are surrounded by a capsule which is filled with a thick, cushioning fluid. This is called synovial fluid. The capsule is what keeps our bones in place with the help of ligaments which are like strong elastic bands. At the ends of each bone is a lining of cartilage which is a strong layer of tissue that lets bones move together without grinding. When we need to move a limb our brain sends a message to our muscle, and this then pulls a tendon which is attached to the appropriate bone. This is the reason why strong muscles are so important in joint function.

Regardless of which type of arthritis you have, keeping as physically active as you are able is very important as it will help your muscles stay strong, which in turn will enable you to stay as mobile as possible. It is also necessary for improving and maintaining your general health.

Recognising Symptoms

You may be experiencing pain in a joint and if the pain remains for several days, it’s a good idea to get it checked out by a doctor. Discovering what the cause of the pain and swelling is will mean you can start on the right treatment sooner, also get information on self-help methods to lessen your discomfort.

Arthritis can vary from being mildly troublesome to making life extremely difficult by causing mobility issues. It can also vary in intensity from day to day, going into remission for a day or two, then suddenly flaring up again.

Causes of Arthritis

There are various types of arthritis but the main two are inflammatory, such as rheumatoid arthritis, and the degenerative (wear and tear) type known as osteoarthritis. The causes are not definitely known for sure, and research tends to focus on highlighting the genetic predisposition or repetitive activities leading to the onset of symptoms.

Some types of the condition may be inherited from parents or grandparents. Some may be due to repetitive activities and acute injuries. For the inflammatory arthritis, exposure to environmental issues is possible and for the wear and tear arthritis, ageing and excessive repetitive movement may accelerate damage to the joints. This is particularly the case with knees of older and/or overweight people.

Different Types of Arthritis

Because there are various types of arthritis, it is necessary to establish which one you have, and as there are similarities in symptoms between the different types, it’s useful to understand some of the main features that help with identification.

Osteoarthritis

What is Osteoarthritis?

This is the most widespread form of arthritis, and it first presents itself when the cartilage in a joint becomes roughened. When this happens, the body begins a process of trying to replace the loss of tissue. This in turn causes various things to take place:

• Minute pieces of extra bone known as osteophytes may grow at the ends of a bone inside the joint.
• The synovial fluid within the joint may begin to increase.
• The capsule around the join can sometimes stretch, causing the joint to lose its shape. Quite often these early stages of osteoarthritis can happen without causing pain, but they can lead to damage within the joint and then the pain will begin.

Osteoarthritis is more common in women than men and is normally experienced by those of over 45 years. The most usual joints to be affected by osteoarthritis are the back, knees, hands, fingers, and hips

Keeping your weight to a healthy level will help to lessen pressure on joints and taking regular exercise will keep the muscles surrounding joints strong. Being active will also reduce stiffness of swelling in joints and will help reduce pain. Being overweight may be one of the contributory factors to the onset of osteoarthritis, and it will certainly make it worse.

What is the best treatment for Osteoarthritis?

You can find over-the-counter non-steroidal anti-inflammatory (NSAID) creams and gels that you can apply topically to the joint. This is a good place to start in managing your pain but there are further options. A doctor would give you advice specific to your needs.

There are several clinical options for easing the pain:

• Transcutaneous Electrical Nerve Stimulation (TENS) - This involves a small device which alters the way nerves react to pain by sending out small electric shocks via pads placed on your skin.
• Hyaluronic Acid Injections - These are not yet available on the NHS as there is no scientific proof of their effectiveness, but some people claim good results and they may be obtained privately.
• Alternative Treatments and Supplements - Many osteoarthritis sufferers use natural supplements and find they give much relief.
• Surgery - If pain from osteoarthritis is debilitating and severe, and when other forms of relief are no longer giving results, your doctor may suggest surgery. Knee and hip surgery is now highly sophisticated and successful and generally involves a replacement knee or hip.

Gout

What is Gout?

Gout is a form of inflammatory arthritis, and it causes painful swelling in joints. The most usual joint to be hit by gout is the big toe, but it can also present in other joints. Whichever joint is affected by gout becomes very red and feels as though it’s burning hot. The skin over the affected joint becomes smooth and shiny and may peel in the affected area.

Men can get gout at a fairly young age, so anything from mid-twenties onwards, but women tend to develop it after menopause. If you are taking diuretic medication (water tablets) this can increase the risk of developing this kind of arthritis.

Causes of Gout

You may have heard various reports on the causes of gout, and some of them may well be true. Gout is often attributed to the life-style habit of imbibing in too much alcohol, and this may certainly be one of the contributory factors, but by no means an exclusive cause.

The cause of gout is when an excess of uric acid builds in the body. Everyone has an amount of urate but if you are overweight or habitually eat and drink too much of certain kinds of food and alcohol, this can result in higher than safe amount of urate building up in the body. Genetics can play a part in making you vulnerable to developing gout. Not everyone is susceptible.

When urate reaches a high level, it can form into crystals which can lodge around the joint. They may not at first cause any problem but if you should have an injury to the joint, even a slight knock, or if you are unwell and running a high temperature, this can trigger the crystals to move into the soft area of the joint. This then results in swelling and pain within the joint.

In terms of self-help for the pain, NSAIDs such as paracetamol are usually helpful. Applying an ice pack wrapped in a cloth such as a damp tea towel, or a lavender and wheat bag straight from the freezer can ease the pain.

There are pharmaceutical drugs such as allopurinol and febuxostat which can be prescribed by your doctor for more long-term relief, but usually not until you have tried to control pain with NSAIDs.

Rheumatoid Arthritis

The other main type of inflammatory arthritis is different in that it is an auto-immune condition. The immune system is the body’s own defence mechanism which protects us from infections, so when you have an autoimmune condition, this is when something goes wrong, and your immune system attacks your own healthy tissue. In the case of rheumatoid arthritis this is the joints. The result is inflammation and pain.

The immune system creates extra fluid within the joint in a misguided effort to protect, but what that extra fluid does is to cause swelling within the joint as well as irritating the nerve endings, making movement difficult and very painful. Chemicals in the fluid can damage bone and the volume of extra fluid eventually stretches the joint capsule, causing lasting damage. Getting early effective treatment will help minimise that damage.

Rheumatoid arthritis can affect adults of any age. It most often presents in those between ages of 40 and 60 and tends to be more prevalent in women than men.

Early Signs of Rheumatoid arthritis:

• Swelling and stiffness in joints in the morning that doesn’t ease after about thirty minutes
• Severe fatigue
• Feeling generally unwell
• Often it starts slowly in the smaller joints of hands and feet

There are prescription drugs for suppressing the immune system and these will reduce pain and swelling. These are called disease-modifying anti-rheumatic drugs (DMARDs). This type of medication is the usual starting point in treatment of rheumatoid arthritis, but if they are not proving effective, there are new biological therapies which are able to have a more specific effect on the immune system.

Link Between Rheumatoid Arthritis and Osteoporosis

Studies have found that there is a link between rheumatoid arthritis and the bone density wasting condition of osteoporosis. The findings are that women who have rheumatoid arthritis, have an increased risk of also suffering with osteoporosis. One of the reasons for this may be that glucocorticoid medications prescribed for the treatment of rheumatoid arthritis can trigger significant bone loss. The other main cause is that pain and loss of joint mobility caused by rheumatoid arthritis can also result in inactivity which increases the risk of osteoporosis. Women are at greater risk than men of both conditions.

The recommendations for preventing and treating osteoporosis, whether you also have rheumatoid arthritis or not, is to follow a well-balanced diet rich in calcium and vitamin D. Good sources of calcium include low-fat dairy products, dark green, leafy vegetables, calcium-fortified foods, and a supplement of calcium each day. Taking a vitamin D supplement is recommended if you cannot drink sufficient milk or are lactose intolerant.

Vitamin D is necessary to enable the absorption of calcium. Foods containing vitamin D are egg yolk, sea fish and liver. A vitamin D supplement will help give the recommended intake, which is 600 to 800 IU (international units) each day.

Spondyloarthritis

This covers several conditions that give pain and swelling, usually around the joints of the spine. The inflammation from spondyloarthritis forms in the connective tissue known as entheses which are small cords that join ligaments or tendons to bones.

Ankylosing Spondylitis

This is a response to inflammation around the spinal cord. Your body makes calcium, and this is normally used to strengthen bones, but with ankylosing spondylitis the extra calcium creates small fragments of bone to grow in the spine. This results in pain and stiffness. It usually strikes between ages of 20-30 and is more prevalent in men.

Sufferers usually experience pain during the second half of the night, together with swelling of the back in the morning which may persist for more than thirty minutes.

There are prescription drugs that can slow this down, and it is recommended that keeping active will help to minimise stiffening of the spine. Striving to keep a good posture will help minimise curvature of the spine.

Psoriatic Arthritis

What is Psoriatic Arthritis?

This condition is an auto-immune, but it is also a type of spondyloarthritis where the body’s immune system causes painful swelling in joints. One of its features is a red, scaly skin rash called psoriasis. The rash can appear on various parts of the body, especially elbows, knees, back, scalp, and buttocks. It often also causes severe fatigue.

Causes of Psoriatic Arthritis

It is most usual for psoriatic arthritis to affect those who already have the skin condition psoriasis, but in some cases the arthritis can present before the psoriasis sets in.

This is a condition that can affect people of all ages, but it does tend to be more prevalent in adults.

Psoriatic Arthritis Treatment

This is by use of anti-rheumatic drugs and biological therapies which target the cause of the inflammation in joints. There are also several psoriasis treatments including steroid creams such as topical corticosteroids.

Juvenile Idiopathic Arthritis (JIA)

When there is a diagnosis of inflammatory arthritis before the age of sixteen, it is called juvenile idiopathic arthritis. There are several types of JIA. Early diagnosis and treatment will help to minimise damage to the body.

Causes of JIA

These are auto-immune conditions which cause pain and swelling in joints.

Treatment of JIA

Drugs to treat the condition are non-steroidal anti-inflammatories, along with disease-modifying antirheumatic drugs. Biological therapies can also slow down or prevent the arthritis causing swelling inside the body.

Conditions Similar to Arthritis

There are a few other conditions that have very similar symptoms to arthritis and if you think you may have one of these, it is important to see a doctor for diagnosis and treatment. These conditions also cause pain and swelling in and around joints.

• Lupus
  • This is an auto-immune condition. It has a great variety of symptoms and may affect the heart, lungs, and other organs of the body. It is particularly common for swelling to take place in the small joints of the hands and feet, but lupus can cause pain to move around from one joint to another.
• Fibromyalgia
  • A chronic condition that causes pain and tenderness in many parts of the body, not necessarily at the same time. Symptoms are very similar to arthritis, but the pain is mostly in the muscle rather than the joints.
  • With fibromyalgia symptoms include all-over body pain, difficulty sleeping and staying asleep, headaches, concentration problems, poor memory, high sensitivity to pain or physical pressure.
• Polymyalgia Rheumatica (PMR)
  • A condition involving painful and stiff hips, shoulders, and thighs. Even raising arms above your head is painful and hard to achieve. Pain and stiffness may be more severe first thing in the morning. You may also feel generally exhausted and unwell.
  • Polymyalgia rheumatica mainly affects those over the age of 70. It can develop into a condition known as giant cell arteritis (GCA) which affects the blood vessels in the head and can lead to symptoms of pain and tenderness in the side of the head. In some very rare cases GCA can cause problems with vision or even loss of vision. If these symptoms occur, you need to see a doctor urgently to avoid permanent damage to eyesight.
  • Polymyalgia rheumatica and giant cell arteritis can be effectively treated with steroid medication.
• Tendinopathy
  • Affecting tendons (fibrous, rope-like tissue connecting muscle to bone). When tendons become inflamed, they will be hot and swollen and may give a grating sensation. This condition if often caused by repetitive use.
  • Firstly, it’s important to cease the activity to enable the tendon to heal. It’s important to remain generally active if possible. Using an ice pack on the affected area helps to reduce pain.
  • Tendons most commonly affected are Achilles tendon (joins your calf muscle to your heel bone), Rotator cuff tendon (attaches muscles to your shoulder joint)
    and Posterior tibial tendon (attaches your calf muscle to the bones inside your foot.)

Managing Symptoms of Arthritis

Alongside medical treatment, there are various ways of helping yourself manage your arthritis.

When you are in pain it isn’t always easy to feel motivated to exercise, and you may feel that you might make the problem worse by doing so, but exercise can help. These are the reasons why:

• When you exercise your muscles will become stronger and this helps support your joints. The more sedentary you are, the weaker your muscles will become until there is very little strength and use in them. Taking no exercise will hasten the onset of immobility.
• If you exercise, your joints will keep supple so you can avoid them becoming stiff.
• Keeping physically active will help you keep to a healthy weight, and this means less pressure on your joints.
• Exercise causes the release of chemicals called endorphins. These are the body’s own natural pain killers and mood boosters.
• Regular exercise will help you get better sleep and while you are sleeping your body is healing itself.

The best types of physical activities when you have arthritis are those which are low impact such as swimming, cycling, brisk walking, yoga, Tai chi, and Pilates. These are all great forms of exercise that don’t require you to push your body to extreme levels of stress or necessitate too much weight being placed upon your joints.

They are also exercises you can do as gently or vigorously as you feel able. It’s important to take it steady and not push yourself too much at first. If you feel pain that is not easily tolerated, then you should stop. The key to achieving a comfortable level of exercise is to always start gently and increase gradually to a point that is acceptable to you.

The most important factor is that physical activity is a regular part of your day and week. Much better to do a small amount, that you can manage and feel good about each day, than to have an occasional burst of activity which may leave you feeling sore, exhausted, and demotivated. Regular exercise will improve your symptoms as its effect on strengthening your muscles and helping control your weight will take pressure of joints as well as improving your mental state.

You can get support to help you with exercise. Because it’s such an important part of your treatment plan, you doctor will help by putting you in touch with a physiotherapist or occupational therapist who will know just how much, and what kind of activity, is right for your condition. There are even sitting-down exercises and isometric exercises if you have impaired mobility.

If you intend to use a fitness centre, health spa, or gym, you can get regular sessions with a personal trainer (who needs to be qualified at level 2 or above). They will work out a suitable plan for you and help you monitor your progress. It’s very important that you give them all the information you have about your arthritis to help them design a suitable plan for you.

Sometimes just those mundane tasks around the home and garden become too much if you are in pain. It’s possible to get an occupational therapist to give you some help via your local social services department. Alternatively, you can check out private physio help near where you live through the following websites:

Find An Occupational Therapist

Find a Physiotherapist

Does Knuckle Cracking Cause Arthritis?

To bust one of the popular arthritis myths – cracking knuckles does not cause arthritis. The Arthritis Research Centre of the John Hopkins University states that there is no evidence to suggest that cracking knuckles causes arthritis. However, there may be reason to believe that constant and prolonged knuckle cracking may cause damage to the ligaments surrounding the joints. The report also states that confirmed knuckle crackers may develop a less strong grip than their non-cracking cousins.

What Foods are Good for Arthritis?

Omega-3 Fatty Acids

Foods containing Omega 3 fatty acids have been found to be particularly helpful for easing inflammation in the joints. A study found that people with the highest consumption of omega-3s had lower levels of two inflammatory proteins, D-reactive protein, and interleukin-6. Researchers have found that taking fish oil supplements helps reduce joint swelling and morning stiffness, particularly if you suffer with rheumatoid arthritis.

The kind of fish to look for to get your omega-3s are sardines, salmon, tuna, herring, anchovies, scallops, and other cold-water fish. If you doubt you can eat enough fish to make a difference, studies show that taking 600 to 1,000 mg of fish oil, or the equivalent vegan omega-3 capsule, daily will help ease stiffness in joints and reduce tenderness and swelling.

Fruit and Vegetables

These are full of antioxidants which are powerful chemicals to support the body’s defence system. Research has found that anthocyanins from blueberries, cherries, blackberries, and other red and purple fruits, have an anti-inflammatory effect.

Citrus fruit is good too because it is rich in vitamin C which helps prevent inflammatory conditions such as arthritis.

Research has found that vitamin K found in green, leafy vegetables such as spinach, kale, broccoli, and cabbage, reduce inflammatory markers in the blood.

Olive Oil

Olive oil is rich in healthy fats, also in oleocanthal which has similar properties to nonsteroidal anti-inflammatory drugs such as ibuprofen. The best olive oil to use is extra virgin as it is put through less of a refining process, so the beneficial enzymes have not been filtered out. Avocado and safflower oil also have beneficial properties. Walnut oil is also loaded with omega-3s.

Foods You May Need to Avoid

Nightshade Vegetables

These are a family of edible plants which include tomatoes, aubergine, potatoes, and red bell peppers. They are excellent sources of nutrition, but they also contain a chemical called solanine. This is suspected of being the cause of increased arthritic pain. To date, there is no clinical evidence to prove this, but many arthritis sufferers report that nightshades trigger flare-up in their pain.

You may prefer to test for yourself by excluding all nightshade vegetables from your diet and then gradually re-introducing them one by one to see if one or more do trigger a flare up.

Processed Foods

It’s a good idea to avoid processed and sugar-laden foods. The main reason for this is that they are generally lacking in nutrition and will cause you to gain weight. This will impact on the inflammation in your joints.

Taking Natural Supplements for Arthritis

Various natural supplements have stood the test of time in their power to give support to those suffering with joint issues. Science has given its backing to certain key players in terms of natural help with the pain and immobility caused by arthritis:

• Curcumin
  • The active ingredient of turmeric root. Scientific research has found that curcumin has powerful ani-inflammatory and antioxidant properties. Studies indicate that it may provide relief for those suffering with osteoarthritis, rheumatoid arthritis, and other inflammatory conditions. Note that curcumin supplements need to include black pepper extract which allows the body to absorb the beneficial properties of curcumin. Read our blog on the benefits of curcumin.
• Glucosamine
  • Studies have shown that glucosamine may give relief for mild to moderate knee osteoarthritis and may help other joints too. It is a naturally occurring chemical found in your body, but it also comes as a supplement. Glucosamine helps maintain healthy cartilage which is the rubbery tissue that cushions joints. With advancing age, the levels of glucosamine begin to diminish, and this can lead to the slow breakdown of the joint. There is evidence that glucosamine supplement can help counteract this.
  • Some people have successfully used glucosamine to help treat rheumatoid arthritis and other inflammatory diseases.
• Omega-3
  • Clinical trials have found that omega-3 fatty acids can modulate the autoimmune inflammatory response and decrease disease activity in rheumatoid arthritis.
  • Taking an omega-3 supplement gives protection against many serious conditions such as cardiovascular health, neurological issues and ocular health, as well as supporting joints and decreasing the severity of rheumatoid arthritis. Because most omega-3 supplements are from fish oils, it is difficult for those who follow a vegetarian and vegan diet to find an alternative source of omega-3. Our Vegan Omega-3 is a fantastic alternative. Read our blog on Omega – Essential Life Support.
• Boswellia
  • The resin of the Boswellia serrata tree species has been used for centuries in regions of India, Northern Africa, and the Middle East as incense in cultural ceremonies as well as for medical purposes. As a medicine, the gum resin from the Boswellia tree is particularly valuable in the treatment of various inflammatory diseases. The plant compound most potent as an anti-inflammatory is Boswellia acid.
• Gamma-Linolenic Acid (GLA)
  • Some of the richest sources of GLA are to be found in hemp seed oil, borage seed oil, evening primrose oil, and blackcurrant oil. It is also present in reasonably useful quantities in oats, barley, spirulina, and hemp seeds. Alternative medicine practitioners often recommend GLA for reducing the level of inflammatory proteins (cytokines) in the body.
  • Cytokines are necessary to trigger inflammation as an immune response but if high levels remain, as often happens in cases of obesity high blood pressure, and autoimmune diseases the persistent inflammation causes damage to cells and tissue.
• Vitamin D3
  • This vitamin is vital to allowing your body to absorb calcium, and calcium is vital for healthy bones. There are three main areas of risk that may mean you are short of vitamin D, which can lead to osteoporosis:
    • One is a lack of sunshine, as vitamin D in the body is replenished by sunshine on your skin.
    • If you have had inflammatory arthritis for some time, you may not have been able to do weight-bearing exercise.
    • You may have needed to take steroid medication which can cause thinning of the bones.
  • Vitamin D is essential to help prevent bone loss and it also plays a major role in anti-inflammatory action. Taking vitamin D as a supplement can make a positive difference to the health of your bones. Read our blog on the benefits of vitamin D.

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