WHAT IS ARTHRITIS?
As is often the case there are a number of different joint disease which are called arthritis, even by the medical profession. The two most common types are rheumatoid arthritis and osteoarthritis.
Rheumatoid arthritis is an inflammatory disease of unknown origin. The inflammation is not caused by infection, but it is a similar reaction that you see around an infected cut or tooth. The inflammation results from a destruction of joint tissue. It may be that the body mistakenly starts attacking its own tissues with the immune system, which usually protects us from infection, in this case turning against the body’s own tissues with the same power it uses to destroy bacteria. Usually rheumatoid arthritis affects the small joints of the hands first, but it can affect other joints in the body. It is often accompanied by weakness or tiredness as well as the pain and stiffness in affected joints.
Osteoarthritis is a different disorder. Although the term arthritis is used it is not an inflammation in the way that rheumatoid arthritis is. It is more due to wear and tear usually of one joint, one hip or one knee or one shoulder, but it can occur in more than one joint, for example in more than one joint of the spinal column or in more than one knee or hip. It is not simply accelerated ageing although it does come as a result of living longer particularly if one lives longer very overweight and perhaps with some imbalance in the body, for example the imbalance that comes from having one leg one centimetre longer than other. It is not uncommon to have osteoarthritis in a number of joints but usually one causes most problems.
The effects of both types of arthritis are often complicated by loss of fitness. Have a good look at a joint next time you have a leg of lamb or chicken. You can see the surface of the joint being white, hard and shiny, that is the tissue called cartilage which has a very low friction. The bone itself is not so smooth principally because blood vessels enter the bone through lots of tiny holes. What you can also see around joints are white fibrous tissues. These are two; sorts there are ligaments joining one bone to another and there are tendons joining a muscle to a bone. When joints are affected by arthritis they get used less and
Why are the two types of arthritis important?
Arthritis is important not only for the pain it causes but because it is a very common cause of loss of ability. The ability may be relatively minor, for example difficulty turning a screw to fix a fuse, but it can also be more general and severe, for example a reduction in the ability to get out and about leaving the person isolated and housebound and therefore at greater risk of depression and dementia. Because they are so common these diseases of the joints with the subsequent pain and loss of ability are among the most common cause of disability.
Why is it important to understand the conditions?
It is important to understand that rheumatoid arthritis is a disease that needs accurate diagnosis and effective treatment, not just drug treatment but different types of help so that the person feels less depressed.
It is also important to understand that osteoarthritis is not accelerated normal ageing and is therefore preventable and treatable
In both these types of arthritis they may be secondary loss of fitness resulting from the immobility and reduction in movement in the muscles either side of the movement. This may be aggravated by the well-meaning attempts of friends and family to reduce the demands on those muscles and joints by doing things for people instead of helping them recover the ability to do things for themselves.
Can progression be slowed, reduced or reversed?
One of the miracles of modern medicine is the development of effective drugs for treating rheumatoid arthritis. There is no doubt that the progression of rheumatoid arthritis can be slowed by effective treatment. This may be done by the general practitioner but usually referral to a rheumatologist is necessary to make sure the right drug is chosen at the right dose. Even when effective treatment has been prescribed at high quality it is also important for the person to increase the level of activity and try to become fitter. Obviously, there are limitations resulting from the development of rheumatoid arthritis but of the four aspects of physical fitness – strength, stamina, suppleness and skill it is suppleness that is the key dimension that is most important with arthritis and therefore activities such as tai chi, yoga or the Alexander technique are very effective as is swimming.
For osteo arthritis the first line of treatment is also to focus on suppleness although there may need to be good medication for pain control. Tai chi, yoga, the Alexandre technique all increase suppleness and it is safe to go directly to a class or find a trainer. When osteoarthritis becomes more severe it maybe helpful to have assessment by a physiotherapist with a special interest in arthritis but again the message is the same – increase suppleness and also increase strength of the muscles on either side of the affected joint. What happens following the onset of osteoarthritis is that the affected person may try to “spare” that joint by using it less, this reduces the muscle strength on either side of the joint, makes the joint less stable and may aggravate the problem. For osteoarthritis there is also one of the wonders of the last fifty years – joint replacement.
It is however important to be careful about joint replacement. Even in the best of hands this wonderful technology may go wrong or not have the result expected. It is therefore vitally important for someone with osteoarthritis to ask themselves
LINK TO DECSION AID
What can be done?
Osteorthritis is so common that the general practitioner is the key person for the medical treatment of the condition. Not every general practice has direct access to a physiotherapist so either a referral to NHS physiotherapist or a private physiotherapist may have to be organised by a general practitioner. For osteoarthritis the referral should first be to a skilled physiotherapist because skilled physiotherapists can make a big difference to somebody, often working with trainers in gyms and fitness centres rather than simply referring the person
For rheumatoid arthritis the referral is to a rheumatologist, a specialist physician whose practice focuses on rheumatoid arthritis and a number of other less common joint diseases.
As is often the case there are a number of different joint disease which are called arthritis, even by the medical profession. The two most common types are rheumatoid arthritis and osteoarthritis.
Rheumatoid arthritis is an inflammatory disease of unknown origin. The inflammation is not caused by infection, but it is a similar reaction that you see around an infected cut or tooth. The inflammation results from a destruction of joint tissue. It may be that the body mistakenly starts attacking its own tissues with the immune system, which usually protects us from infection, in this case turning against the body’s own tissues with the same power it uses to destroy bacteria. Usually rheumatoid arthritis affects the small joints of the hands first, but it can affect other joints in the body. It is often accompanied by weakness or tiredness as well as the pain and stiffness in affected joints.
Osteoarthritis is a different disorder. Although the term arthritis is used it is not an inflammation in the way that rheumatoid arthritis is. It is more due to wear and tear usually of one joint, one hip or one knee or one shoulder, but it can occur in more than one joint, for example in more than one joint of the spinal column or in more than one knee or hip. It is not simply accelerated ageing although it does come as a result of living longer particularly if one lives longer very overweight and perhaps with some imbalance in the body, for example the imbalance that comes from having one leg one centimetre longer than other. It is not uncommon to have osteoarthritis in a number of joints but usually one causes most problems.
The effects of both types of arthritis are often complicated by loss of fitness. Have a good look at a joint next time you have a leg of lamb or chicken. You can see the surface of the joint being white, hard and shiny, that is the tissue called cartilage which has a very low friction. The bone itself is not so smooth principally because blood vessels enter the bone through lots of tiny holes. What you can also see around joints are white fibrous tissues. These are two; sorts there are ligaments joining one bone to another and there are tendons joining a muscle to a bone. When joints are affected by arthritis they get used less and
- The muscles become weaker and
- The ligaments and tendons become less elastic and supple
Why are the two types of arthritis important?
Arthritis is important not only for the pain it causes but because it is a very common cause of loss of ability. The ability may be relatively minor, for example difficulty turning a screw to fix a fuse, but it can also be more general and severe, for example a reduction in the ability to get out and about leaving the person isolated and housebound and therefore at greater risk of depression and dementia. Because they are so common these diseases of the joints with the subsequent pain and loss of ability are among the most common cause of disability.
Why is it important to understand the conditions?
It is important to understand that rheumatoid arthritis is a disease that needs accurate diagnosis and effective treatment, not just drug treatment but different types of help so that the person feels less depressed.
It is also important to understand that osteoarthritis is not accelerated normal ageing and is therefore preventable and treatable
In both these types of arthritis they may be secondary loss of fitness resulting from the immobility and reduction in movement in the muscles either side of the movement. This may be aggravated by the well-meaning attempts of friends and family to reduce the demands on those muscles and joints by doing things for people instead of helping them recover the ability to do things for themselves.
Can progression be slowed, reduced or reversed?
One of the miracles of modern medicine is the development of effective drugs for treating rheumatoid arthritis. There is no doubt that the progression of rheumatoid arthritis can be slowed by effective treatment. This may be done by the general practitioner but usually referral to a rheumatologist is necessary to make sure the right drug is chosen at the right dose. Even when effective treatment has been prescribed at high quality it is also important for the person to increase the level of activity and try to become fitter. Obviously, there are limitations resulting from the development of rheumatoid arthritis but of the four aspects of physical fitness – strength, stamina, suppleness and skill it is suppleness that is the key dimension that is most important with arthritis and therefore activities such as tai chi, yoga or the Alexander technique are very effective as is swimming.
For osteo arthritis the first line of treatment is also to focus on suppleness although there may need to be good medication for pain control. Tai chi, yoga, the Alexandre technique all increase suppleness and it is safe to go directly to a class or find a trainer. When osteoarthritis becomes more severe it maybe helpful to have assessment by a physiotherapist with a special interest in arthritis but again the message is the same – increase suppleness and also increase strength of the muscles on either side of the affected joint. What happens following the onset of osteoarthritis is that the affected person may try to “spare” that joint by using it less, this reduces the muscle strength on either side of the joint, makes the joint less stable and may aggravate the problem. For osteoarthritis there is also one of the wonders of the last fifty years – joint replacement.
It is however important to be careful about joint replacement. Even in the best of hands this wonderful technology may go wrong or not have the result expected. It is therefore vitally important for someone with osteoarthritis to ask themselves
- what is really bothering me most?
LINK TO DECSION AID
What can be done?
Osteorthritis is so common that the general practitioner is the key person for the medical treatment of the condition. Not every general practice has direct access to a physiotherapist so either a referral to NHS physiotherapist or a private physiotherapist may have to be organised by a general practitioner. For osteoarthritis the referral should first be to a skilled physiotherapist because skilled physiotherapists can make a big difference to somebody, often working with trainers in gyms and fitness centres rather than simply referring the person
For rheumatoid arthritis the referral is to a rheumatologist, a specialist physician whose practice focuses on rheumatoid arthritis and a number of other less common joint diseases.