“So, it’s just like sore knees and stuff, right?”
There are many myths and misconceptions about arthritis and, particularly, rheumatoid arthritis. Categorised as an autoimmune disease, rheumatoid arthritis (RA) can affect anyone at any age. In the UK, around 10 million people suffer with arthritis.
“So, it’s a disease that old people get?”
RA, meanwhile, affects more than 400,000 people with the usual age of onset of between 40 and 50 years old. In the US, arthritis affects around 52 million people alone. Women are three times more likely to be affected by arthritis than men.
I’m not going to lie, I, too, was a little ignorant in my views on arthritis. I know that my mum has it, my grandma had it and I know my dog has it (he’s 16). But I don’t know anybody my age that has it so, naturally, I thought it was something I might be affected with with when I’m older.
Actually, arthritis can affect anyone. At any age.
It causes inflammation in the joints and can cause painful deformities and immobility, particularly in the wrists, fingers, feet, and ankles. RA can also affect other organs such as the lungs, the heart and the eyes, which is evident in more than 15-25% of those with the disease. In rare instances, it can even tighten vocal cords which can cause the voice to change and become hoarse.
“Isn’t all arthritis the same?”
No. There are around 200 types of arthritis. The most common is osteoarthritis. Osteoarthritis is the most common form of joint disease. It’s caused by degeneration of the joint cartilage and underlying bone, basically it’s the wear and tear on aging joints whereas RA damage is caused by an autoimmune process. There is no known cause for RA. Viruses and bacteria have historically been suspected however this has not been proven. Additionally, it has been observed that multiple members of the same family have been affected suggesting a genetic cause. Some have even suggested that dehydration may be a trigger for the onset of RA but this is, as yet, untested.
There is also no cure for rheumatoid arthritis but there are a number of treatments available to help make day-to-day life easier including drugs, surgery and physical therapies such as hydrotherapy. Vaccine style drugs have also been trialled in the hope that the treatment re-educates the body’s immune system.
Q: How does arthritis affect people day-to-day?
A: Depending on how advanced the arthritis is and the functional status of the person, in terms of co-existence of other medical problems, people can experience difficulty with ambulation, dressing themselves, grooming, cooking, driving and other activities of daily living because of the pain and stiffness that occurs in their joints.
Q: What symptoms are there? What should someone do if they believe they could be suffering from RA?
A: The main symptoms of arthritis consist of pain, stiffness and swelling of one or multiple joints. There are two types of arthritis: inflammatory arthritis, which can cause severe deformities in the joints in a short period of time that without treatment can lead to disability and is associated with prolonged periods of stiffness and pain – especially in the mornings and involve multiple joints at a time. An example of inflammatory arthritis is rheumatoid arthritis. Inflammatory arthritis is more aggressive, and individuals with this diagnosis need to be treated very early in the onset of the symptoms to avoid damage to the joints.
The other type of arthritis is degenerative arthritis and one example of this is osteoarthritis (OA). OA can cause impairment on the person’s life, but usually over a long period of time. In this type of arthritis the individuals may have involvement or pain of only one joint (e.g. one knee, one hip). It is associated with a history of previous repetitive activity of a particular joint over a long period of time (e.g. hammering as part of construction work, hand labour) or previous injuries (torn ligament, tendon or cartilage of any joint). With OA, the pain is better with rest and worse with physical activity or towards the end of the day, and inflammation of the joint is not as pronounced or severe as it is in the case of inflammatory arthritis.
Patients experiencing these symptoms should be evaluated by a health professional. Usually a general internal medicine doctor is the first one to evaluate these symptoms by performing an initial assessment with X-rays and laboratories. If needed, patients are referred to a specialist (rheumatologist). This is very important, since characterizing if the arthritis as inflammatory or not is critical to determine the definite treatment of the joint symptoms.
Q: What medical treatments are there?
A: The treatment of arthritis will be based on the kind of arthritis. One of the most successful stories in rheumatology was the advent of newer therapies, known as disease-modifying anti-rheumatic drugs (DMARDs) and biologics, since these have changed the natural course of RA and other inflammatory arthritides. These inflammatory arthritides can be very debilitating without treatment and carry significant amount of disability in a very short period of time.
These medications, however, can’t be used to treat osteoarthritis or degenerative arthritis. Similarly, the goal of treatment of gout is to prevent the frequency of gout attacks by decreasing the serum levels of uric acid. In general, anti-inflammatory medications known as NSAIDs can certainly serve the purpose of first line treatment for arthritis but for a short period of time in most arthritides except in osteoarthritis, where NSAIDs are the main treatment to control joint pain.
Acetaminophen can be used as an alternative among patients that have a contraindication to the use of NSAIDs. In some instances, steroid injections inside of the affected joint(s) can be performed to control the inflammation and pain in most of the aforementioned arthritides. For that reason, I cannot emphasise more the importance of obtaining a health professional assessment of the joint symptoms in a way that treatment can be tailored to the specific type of arthritis that a patient may be suffering.
Q: And what is hydrotherapy? How does it work?
A: Hydrotherapy was designed to increase joint range of motion, muscle strength and physical fitness. Patients perform a series of slow controlled movements in a warm pool targeted to increase muscle strength and flexibility. Due to the buoyancy of the water, there is lower impact on the joints so than an arthritic joint is under less stress during the exercise session and, at the same time, the muscles around the joints can achieve increase in strength and flexibility. These two aspects allow patients to experience an increase in range of motion of their joints better than land-based training programs, as demonstrated in clinical trials of arthritis patients and in trials of patients with chronic low back pain or back pain and associated leg pain. The evidence of efficacy of hydrotherapy is also supported by a systematic review.
Q: How is it different to bathing or swimming?
A: Hydrotherapy is different from swimming because of the set of exercises that are performed. Swimming requires a set of movement and a level of flexibility in the joints that patients with arthritis may not have and these are more intense than those performed during hydrotherapy.
While bathing or soaking has also been beneficial for joint pain, in these techniques neither stretching nor strengthening movements/exercises are performed as during a hydrotherapy session.
Q: In what ways can people ease the pain of arthritis at home?
A: It is very important that patients are compliant with the medical treatment that their health professional is recommending them. But there are other remedies and practices that patients should certainly do at home to complement the effect of the medications prescribed by their doctors. Some of these consist of lifestyle modifications such as smoking cessation, limited consumption of alcohol and avoiding binge alcohol drinking, and keeping an ideal body weight and muscle tone by performing an exercise routine tailored to the patient’s ability.
In the case of gout, another inflammatory arthritis, diet modification is very critical since the consumption of red meat, shell fish, and alcohol in large quantities can trigger gout attacks. Wearing adequate footwear is important to control symptoms related to arthritis of the knee. Stress releasing techniques such as meditation or yoga, which I would recommend for anybody regardless if they have arthritis or not, are another non-medical treatment option that can be done at home. Certainly, hydrotherapy is another option of treatment that patients can do to help relieve the arthritis pain.
Nowadays there are multiple resources online that help patients track their symptoms so that they can have more of an insight regarding what may or may not be working for them. One of the most innovative resources available for this is Arthritis Power, an online disease management and research tool offered by CreakyJoints, the online arthritis patient community supporting more than 80,000 members. Arthritis patients should making joining Arthritis Power (free membership) a priority because through this tool they can track, share, and send their own symptoms (e.g. pain) and treatment data with their provider team. In this way, patients can figure out what works for them with real data over time, how they feel in relation to what treatments that they are taking, or therapies that they may just be trying out such as those that we just described.
Q: Can dehydration trigger the onset of arthritis?
A: The cause of arthritis remains unknown. There are well described risk factors for the development of different kinds of arthritis such as smoking, genetic factors, age and obesity. At the same time it is important to mention that none of these cause arthritis, but are associated with an increased risk of developing arthritis. In the case of the relationship between dehydration and arthritis, we know that water is very important for overall health. This one also allowed the medications that patients take to work better if the patients are well hydrated but that does not mean that because of dehydration a patient may be developing arthritis. Even if dehydration is associated or not with the development of arthritis, I would always recommend patients to be generous with the amount of water they consume given its multiple health benefits. At the end of the day, water is what Mother Nature has given to all of us to drink.
I think that I, like many, didn’t know serious it could be. There’s a huge misconception about RA and it can really threaten someone’s independence and health – with some putting off going to see a doctor for months. I didn’t know enough about my own family’s arthritis so if you suspect you may have RA or any form of arthritis it is essential to go and seek treatment straight away.
Many people who suffer with arthritis lead happy and fruitful lives and for family member’s concerned about the wellbeing of someone close to you – show them this article, share it and show them the Arthritis Power site. It’s for anyone living with arthritis and other related conditions of the joints and will ensure that more research can be done to better understand how to fight these diseases and ultimately, find cures.