The basic description of Arthritis is inflammation of the joints, which causes pain and mobility problems. This can range from mild to severe. There are many different types of arthritis, but the most common forms are osteoarthritis, rheumatoid arthritis and fibromyalgia. Many symptoms of arthritis are common across the different forms, such as pain, fatigue and inflammation. There are also symptoms unique to each disease.
Arthritis is commonly associated with the elderly, however it is actually something that affects people of all ages. In fact, 1 in every 1000 children in Ireland is diagnosed with arthritis, usually known as juvenile arthritis.
Osteoarthritis (OA) is the most common type of arthritis. It usually comes on gradually over a number of years, and affects different joints. It can be seen more commonly in females, after the menopause, but is also seen in males. This type of arthritis can make joints look ‘knobbly’ as it progresses. There are many factors that contribute to the development of OA including age, weight, past injuries and even genetics.
Rheumatoid Arthritis (RA) is centred on inflammation. Normally in the body inflammation occurs in order to help healing, and when this has happened, it goes away. However, in RA, the inflammation remains or comes and goes (flares- up) at intervals, and over time it can cause damage. RA is what is known as an autoimmune disease, which is when the body’s immune system (natural defence system) has an abnormal response to a part of the body. In this case, the immune system attacks certain parts of the body instead of protecting it. This attack occurs mainly in the joints (sometimes other organs) and it is not known what causes the body to react this way.
Fibromyalgia affects the muscles, ligaments and tendons in the body rather than the joints. It can affect several different areas of the body. Like other types, it causes widespread and often severe pain and fatigue.
Psoriatic Arthritis is a type of arthritis that develops in some people suffering from the skin condition psoriasis. Again it consists of inflammation of the joints, mainly fingers and toes, and can cause problems with the nails also. This can often be accompanied by spondylitis, which is a stiff, painful back or neck caused by inflammation in the spine.
Gout comes under the heading arthritis as it again causes pain and inflammation in the joints. This is a very specific type, which is actually caused by the build-up of crystals of a substance called uric acid. These crystals build up in the joints, most commonly where the big toe meets the foot. When diagnosed and treated with the right medications, gout can usually be very well managed.
Juvenile Arthritis is the term used for the types of arthritis seen in children. In Ireland, 1 in every 1000 children has arthritis. Again this has symptoms of pain, inflammation and swelling in the joints. At present, doctors do not know what causes some children to develop this and not others. There are certain things that are thought to be a factor, such as genetics and infection/illness, however there is currently no clear evidence to back these theories up fully.
Symptoms and Diagnosis
If you experience any prolonged feelings of pain or inflammation in your joint then it is important that you visit your GP who will be able to test for arthritis. If your GP feels you should be tested for arthritis, he/she will do a physical exam of the joints/body parts to check for swellings, tenderness, restricted movement, muscle strength etc. They may also do blood tests and take X-rays.
If you are diagnosed with osteoarthritis, your GP can begin the treatment process, and they might also refer you to a physiotherapist, pain specialist or another relevant healthcare professional. A rheumatoid arthritis diagnosis means that your GP will refer you to others including a rheumatologist and physiotherapist.
Treatment options for arthritis fall into the categories of pharmacological (which means using medicines) and non-pharmacological (which is treatments other than medicines).
Depending on the type of arthritis diagnosed, there are different types of medications available. They can be split into two main categories:
- Medicines that control the symptoms of arthritis
- Medicines that affect the disease itself
Medicines that control the symptoms are generally used in all types of arthritis, and include different types of pain-killers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) or ‘anti-inflammatories’ for short. Certain medicines in this category are available to buy without a prescription, and then there are stronger ones of the same family that need to be prescribed by the doctor.
Drugs which affect the disease itself are often called disease modifying anti-rheumatic drugs (DMARDs). These medicines usually act to slow or halt the progression of the arthritis by suppressing the body’s immune system, which then slows/stops the attack on the joints. Examples of these medicines include methotrexate and corticosteroids. These are serious medicines which need to be prescribed under the care of your GP and usually a consultant. They are not suitable treatments for all types of arthritis.
It is important if you have arthritis and are taking medicines for it, that you feel that you understand your medicine and are in control of it. Talking to your pharmacist and doctor about any questions and concerns can help to achieve this.
If you are overweight, weight-loss can have some important benefits in arthritis. It reduces pressure on your joints, in particular the knees. It also can ease pain and inflammation and improve function. Fat is an active tissue in the body that actually produces chemicals that encourage inflammation, so a reduction in this can have multiple benefits. Weight loss advice can be sought from your doctor, pharmacist and physiotherapist.
Physiotherapy sessions can provide people with arthritis with improvement in strength, mobility, flexibility and function. In terms of Rheumatoid Arthritis, exercise programmes that include strengthening and aerobic exercises have been shown to improve exercise tolerance, muscle strength and level of function, and there is no evidence to suggest that it makes the condition worse.
Aids and Devices
Appropriate footwear, insoles and joint supports/braces are all part of the core treatment for various levels of arthritis. If necessary devices to assist with everyday life should be considered e.g. walking sticks, tap turners etc. More information and help with this type of thing can be sought from Occupational therapists.
This may be necessary for some people who have arthritis, and many say that it brings about a large reduction in their pain and likewise a large increase in their level of mobility, and quality of life. Surgeries can be small procedures, or more major ones such as hip and knee replacements. Surgical procedures are always improving and the age of people undergoing joint replacements is getting younger and younger. There are some other non-prescription items that can be helpful in the everyday management of arthritis, including:
Gels and Rubs:
Flexiseq and Flexiseq Sport
Flexiseq has been clinically proven to relieve the pain of osteoarthritis, reduce stiffness, improve joint function and protection, and it is drug-free. Flexiseq Sport has the same features, but with the added bonus that it is batch-tested for banned substances, so that it can be safely used by competitive athletes also.
Voltarol and Diclac Gels
These gels contain an anti-inflammatory medicine called diclofenac. The gel formulation means that you can apply the medicine straight onto the joint or muscle that is aching, which in turn means you can avoid the side effects of taking this medicine in an oral form, including stomach upset.
This is a traditional remedy for joint and muscle pain. It contains natural products that are thought to ease this type of pain, and many people find it very effective. There are also supplements thought to be of benefit to the health of joints for all people, including those with certain types of arthritis, namely supplements that contain glucosamine, chondroitin, omegas and fish oils. One example is Jointace, by Vitabiotics, available in Grants Pharmacy:
This is a supplement aimed at those looking to maintain an active lifestyle, particularly into older age. It provides a unique combination of minerals, vitamins and other nutrients that helps to maintain cartilage and bone health. It also contains pure cod liver oil and omega-3 fish oil.
- Copper contributes to the maintenance of normal connective tissues and therefore can be beneficial to cartilage (as cartilage is made up of connective tissues).
- Vitamin D, zinc and manganese all help to maintain normal bone. Vitamin D3 is provided in its Cholecalciferol form as naturally produced by the body on exposure to sunlight.
- Vitamin C contributes to normal collagen formation for the normal function of bones and cartilage.
- Glucosamine is found naturally in the body and is involved in building tendons, ligaments, cartilage, and the thick fluid that surrounds joints.
Living with Arthritis
Many people assume that their symptoms are due to only one cause – arthritis. While it can certainly cause pain and fatigue, it is not the only cause. Each of these symptoms can actually contribute to the other symptoms, and all can make pain and fatigue worse.
Moreover, these symptoms can feed on each other. For example, inflammation from the arthritis can cause pain, which causes stress and anxiety, which can cause poor sleep. Poor sleep can cause depression and depression can sometimes make it hard to take medications as we should, and these can lead to more pain or fatigue, and so on. The interactions of these symptoms, in turn, make our arthritis or fibromyalgia seem worse. It becomes a vicious cycle that only gets worse unless we find a way to break the cycle. This is called the Pain/Fatigue Cycle.
By understanding the Pain/Fatigue Cycle and how each symptom contributes to increase others, we can learn techniques that help break the cycle at these various points. There are a few key principles for pain management:
- Treating pain earlier is more effective than if you wait until it gets bad. Don’t wait to see if it’s going to get worse. Treat pain when you first notice it.
- Small changes in pain can make a huge difference. You do not have to be pain free to do what you want and like. Sometimes just taking the edge off the pain can make a great difference.
- Self-management activities such as exercise are not usually pain free. However, you can use pain as a way to judge when you have done too much or when you should be doing more.
Arthritis Ireland outlines three steps for self-management when it comes to arthritis. The aim of this is to put these small steps into practice in order to make a big difference to your overall quality of life when living with arthritis.
- Take care of your health problems: This basically means going to your doctor and health care providers, taking any medicines you are prescribed, exercising as advised etc. It is very important to seek information about your condition and to take part in the planning of a treatment program.
- Carry out your normal activities: Keep doing the normal things that matter to you, in the best way you can. Find ways to adjust the way you do these things if necessary.
- Manage your emotional changes: Acknowledging that there will be changes in emotions from time to time as a result of your condition, such as anger, uncertainty, depression, as well as changes in relationships with loved ones. The important thing is to know that these are natural ‘ups and downs’ and not to let the ‘downs’ get the better of you.
Visit us in Grant’s Pharmacy to identify the best products for your arthritis. Grant’s pharmacy is open 6 days a week for any queries on the above or any other worry you may have. Leonie, Lorna or any Pharmacist in Grant’s Pharmacy can tell you more about the products used to treat arthritis, in private and in confidence. Every Grant’s Pharmacy has a private consultation room where you can discuss any personal ailments discreetly and without embarrassment. Pop in and experience a fast, friendly and informed service. We will be happy to advise you on your best course of treatment. Grant’s Pharmacy is located in Wexford town, in Enniscorthy town, in Arklow town – all beside Pettitts and in Gorey town opposite the GPO. Find us on Facebook.