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Condition

What is arthritis?

What is arthritis?
This booklet provides
information and answers to your
questions about this condition.

Arthritis Research UK booklets


are produced and printed entirely
from charitable donations.
What is
arthritis?

Arthritis affects millions of people


worldwide and can have a huge
impact on the lives of those with
the condition. In this booklet we’ll
explain the main types of arthritis,
their causes and symptoms, as well
as looking at the various treatments
available. We’ll also suggest where
you can find out more about living
with arthritis.
At the back of this booklet you’ll find a brief glossary of
medical words - we’ve underlined these when they’re
first used.

www.arthritisresearchuk.org
Arthritis Research UK
What is arthritis?

What’s inside? 22 How can I help myself?


– Rest and exercise
– Healthy eating
2 Arthritis at a glance – Managing stress
5 What is arthritis? – Complementary medicine
– What are the main types of – Will moving to a warmer
musculoskeletal condition? climate help?
– Inflammatory arthritis
24 Research and new
– Degenerative or developments
mechanical arthritis
– Soft tissue musculoskeletal pain 26 Glossary
– Back pain 26 Where can I find out more?
– Connective tissue disease (CTD)
28 We’re here to help
– Other types of arthritis
8 What are the symptoms
of arthritis?
9 Who gets arthritis?
9 What causes arthritis?
10 What is the outlook?
12 How is arthritis diagnosed?
15 What treatments are there
for arthritis?
– Drugs
– Physical therapies
– Surgery
20 Who will be involved in
my treatment?
22 Support at work
At a glance
There are about 200 different
Two of the most
musculoskeletal conditions in all, common types
which fall into five main groups:
of arthritis are
• Inflammatory arthritis is a condition
where the body’s immune system
osteoarthritis
attacks the joints and causes them to and rheumatoid
become swollen. A common example
is rheumatoid arthritis, which affects
arthritis.
around 400,000 people in the UK.
• Degenerative or mechanical arthritis is
a group of conditions where the cartilage,
which covers the surface of the bones in
the joints, becomes damaged. Commonly
called osteoarthritis, it’s estimated that
this affects around 8.5 million people in
the UK.
Who gets it?
• Soft tissue musculoskeletal pain is
a term which covers pain felt in the Men, women and children of all ages can
muscles or soft tissues surrounding get arthritis; however, there are a number
joints. An example of this type of pain of factors which can make you more likely
is tennis elbow. to develop arthritis, including:
• Connective tissue disease (CTD) • genetics – many forms of arthritis run
affects the tissues that support or bind in families, although this isn’t always
other body tissues and organs. This may the case
affect the joints, but muscles, lungs, • lifestyle – physically demanding jobs
skin and kidneys may also be affected. and injuries can sometimes lead to
• Back pain is a common complaint that osteoarthritis
affects four out of five people at some • trigger factors – short-lived arthritis
time during their lives. It isn’t usually a can be triggered by some infections
sign of arthritis and is often a short-term
problem, although long-term back pain • gender – might increase your risk of
may have a more complex cause. It can developing a certain condition, for
be as a result of any of the four above example more men develop ankylosing
groups of conditions. spondylitis and more women develop
rheumatoid arthritis.
This isn’t a definitive list as there are
many varied reasons why people develop
arthritic conditions. For many conditions
there’s a strong element of chance.

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Arthritis Research UK
What is arthritis?

What are the symptoms? to your condition, which may include


hydrotherapy (exercises in a warm-water
As there are many forms of arthritis, the pool). Physiotherapy can also include
symptoms are varied. These can range things like massage and pain relief
from stiff, swollen, painful joints to less
obvious symptoms such as tiredness,
• occupational therapy – where you
can get help and advice about any
weight loss and skin rashes. Seek advice if:
difficulties with everyday activities.
• you feel aches and pains in your joints
or other tissues which aren’t related to Surgery includes:
an injury, or if the pain from an injury • joint replacements for severe cases
won’t subside • other pain-relieving or
• a joint becomes swollen, particularly if reconstructive operations.
not linked to injury
• you’re unable to perform your daily How can I help myself?
tasks because of muscle or joint pains.
Simple tips for self-help and daily living
that can make your arthritis more bearable
What treatments are there? include:
Treatments for arthritis are varied but • an exercise regime that suits your
could include drug treatments, physical fitness levels and keeps your joints
therapies and surgery. moving, but gives you a healthy balance
between exercise and rest
Drug treatments include:
• a healthy diet
• drugs that treat the symptoms of
arthritis, such as painkillers and • stress management
anti-inflammatory drugs (NSAIDs) • complementary therapies, such as
• drugs that suppress the disease itself, osteopathy, chiropractic treatments
such as steroids, biological therapies and acupuncture
and disease-modifying anti-rheumatic • homeopathy, herbalism and food
drugs (DMARDs). supplements.

Physical therapies include:


• physiotherapy – where you’ll be given
advice on things like exercises specific
3
There are now very effective
treatments for many forms of
arthritis.
Regular exercise is very
important if you have arthritis
as it can reduce pain and keep
you healthy and independent.

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Arthritis Research UK
What is arthritis?

What is arthritis? pain and stiffness. Inflammation may


also affect the tendons and ligaments
Arthritis is a term used by doctors to
surrounding the joint.
describe inflammation within a joint,
although there are several forms of the Inflammatory types of arthritis often
condition and each has a specific medical affect several joints. Rheumatoid arthritis,
name. Rheumatism is a more general which is a common example, is a systemic
term that’s used to describe aches and illness that mainly affects the joints. As
pains in or around the joints. Because well as joint pain and swelling, other
there are many possible causes of these symptoms of rheumatoid arthritis can
pains, doctors don’t often use the term include tiredness, depression, irritability
‘rheumatism’ and will usually refer to and flu-like symptoms.
these problems either by a specific There are many other forms of
diagnosis or according to the part of the inflammatory arthritis, including:
body affected. Doctors sometimes use
the terms ‘musculoskeletal conditions’ or • ankylosing spondylitis
‘rheumatic diseases’ to refer to a whole • psoriatic arthritis
range of conditions that affect
• reactive arthritis.
the joints.

What are the main types of See Arthritis Research UK booklets


Ankylosing spondylitis; Psoriatic arthritis;
musculoskeletal condition?
Reactive arthritis; Rheumatoid arthritis.
There are about 200 different
musculoskeletal conditions, which fall
into five main groups: Degenerative or mechanical arthritis
This is a group of conditions where the
Inflammatory arthritis main problem is damage to the cartilage
Arthritis literally means inflammation which covers the ends of the bones.
within the joint itself. Inflammation is part Normally the smooth, slippery cartilage
of your body’s healing process. It normally helps the joint to move smoothly. In this
occurs as a defence against viruses and type of arthritis the cartilage becomes
bacteria or as a reaction to injuries such thinner and rougher, and the bone
as a burn. But in people with this type of underneath then tries to repair this damage
arthritis, inflammation often occurs for but sometimes overgrows, altering
no obvious reason. This is referred to as the shape of the joint. This is known as
an autoimmune condition and means osteoarthritis. It’s more common in older
that the immune system is attacking the people and particularly affects the joints
body’s own joints. Instead of helping to that get heavy use (like hips and knees),
repair the body, inflammation can cause and also often the base of the thumb and
damage to the affected joint and cause big toe joint. Osteoarthritis can result from

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damage to the joint, for example a fracture Sometimes back pain may be caused
or previous inflammation in that joint (see by a slipped disc (the disc itself doesn’t
Figure 1). really slip; the central part of the disc
bulges through the outer ring) but this
See Arthritis Research UK booklets more commonly causes pain in a limb.
Osteoarthritis; Osteoarthritis Osteoporosis (thinning of the bones)
of the knee. can cause sudden back pain if one of
the bones in the spine crunches down.
In the majority of cases it isn’t possible
Soft tissue musculoskeletal pain to identify the exact cause of the pain,
Soft tissue musculoskeletal pain is often and doctors often describe this as non-
felt in tissues other than your bones and specific or simple back pain.
joints. Typically it’ll come from the muscles
or soft tissues supporting the joints, See Arthritis Research UK booklets
including the bursa which can sometimes Back pain; Osteoporosis.
become inflamed. You may find this type
of pain is localised to one particular part
of the body following an injury or overuse. Connective tissue disease (CTD)
You might find that the pain is more Connective tissues support, bind together
widespread and, if associated with other or separate other body tissues and organs.
symptoms, a diagnosis of fibromyalgia They include tendons, ligaments and
may be made. Often the causes of these cartilage. Joints are usually involved in
symptoms are not fully understood. CTD, but there may also be inflammation
in other tissues such as your skin, muscles,
See Arthritis Research UK booklets lungs and kidneys, so you may feel a range
Elbow pain; Fibromyalgia; Hip pain; of other symptoms besides painful joints.
Neck pain; Shoulder pain; Work-related Examples of this type of disease include
joint disorders. systemic lupus erythematosus (SLE or
lupus), scleroderma and dermatomyositis.
Your healthcare team will often include
Back pain different specialists along with your GP
Back pain is a very common problem because these diseases often affect many
that has a number of different causes. organs.
Pain can arise from muscles, discs,
ligaments, bones and joints. It may See Arthritis Research UK booklets
even be caused by problems with other Lupus (SLE); Polymyositis and
organs inside the body (this is known dermatomyositis; Scleroderma.
as ‘referred pain’). Sometimes there’s a
specific cause such as the degenerative
condition osteoarthritis, (often known as
spondylosis when it occurs in the spine).
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Arthritis Research UK
What is arthritis?

(a) A normal joint Figure 1


Synovium Normal and
(fatty packing arthritic joints
tissue) Cartilage
(weight-
Bone bearing
surface)
Muscle
Ligament
Film of
lubricating fluid

(b) A joint affected by rheumatoid arthritis


Synovium
Bone being
spreading
eroded
over damaged
cartilage
Bone

Excess fluid
(effusion)

(c) A joint affected by osteoarthritis


Painful
friction point Scarred synovium
Cartilage being
worn down
Bone
Excess fluid
Bony (effusion)
outgrowths

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Other types of arthritis What are the symptoms
Joint inflammation and pain can also
be due to infection within the joint of arthritis?
itself (septic arthritis) or because of the As there are many types of arthritis,
formation of crystals within the joint, there’s also a wide range of symptoms.
for example gout. Septic arthritis can be With inflammatory arthritis there’s likely
a serious condition, and treatment usually to be more swelling of the joints and
requires long courses of antibiotics. more variation in the pain (which can’t be
Gout can be extremely painful and explained simply by the level of physical
most often affects the joint at the base activity). Other common symptoms
of the big toe. It can usually be treated include early morning joint stiffness,
effectively with medication which prevents tiredness, a general feeling of being
the acute attacks. unwell, weight loss, mild fevers or night
sweats, and skin rashes. But remember
See Arthritis Research UK booklets these symptoms aren’t specific to arthritis
Calcium crystal diseases including acute and can be caused by other illnesses.
CPP crystal arthritis (pseudogout) and
acute calcific tendinitis; Gout.

Figure 2  Factors you should consider before seeing a healthcare professional

Persistence Swelling of joints Effects on your


of symptoms • If a joint becomes daily life
• How and when did swollen, and isn’t linked • Seek advice if
the pain start? to an injury, seek advice. you’re unable to do
• If the pain • This is particularly true everyday tasks
developed after if you’re unwell or have due to joint or
unusual exercise a fever. muscle pain.
or activity you may • If you’ve lifted
have just overdone something heavy
it a bit, and the pain and hurt your
should ease within back, for example,
a few days. then take some
• Seek advice if the painkillers, apply
pain isn’t linked to some heat and try
an injury or if the to stay active. If the
pain persists. Consult a pain doesn’t ease
healthcare after a day or so,
professional seek advice.

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Arthritis Research UK
What is arthritis?

It’s common to experience aches and adolescents will suffer from juvenile forms
pains in your muscles and joints from time of arthritis (see Figure 3).
to time, particularly if you take part in
unusual or strenuous physical activities. Figure 3  Approximate numbers of
people affected by some of the rheumatic
So how can you distinguish the early signs diseases in the UK. This is based on those
of arthritis from normal pain and stiffness? seeking treatment from their doctor.
And how do you know when you should
Rheumatic disease People affected
see your doctor about your symptoms?
(see Figure 2). Osteoarthritis 8.5 million (estimate)

If you experience swelling or stiffness, Rheumatoid arthritis over 400,000


or if it becomes painful to squeeze Gout 250,000
your joints, you need to consult your Ankylosing spondylitis 30,000
doctor. The earlier you get diagnosed
the better the outcome. Juvenile idiopathic 16,000
arthritis
Systemic lupus 10,000
Who gets arthritis? erythematosus
Arthritis and other types of musculoskeletal
pain are common, worldwide problems.
They affect people regardless of age, sex, What causes arthritis?
race, class or country. There isn’t a single answer to this
question, as there are many different
Millions of people in the UK alone will
forms of arthritis to be considered.
experience some form of muscle or
joint pain during the course of a year, Most types of arthritis are caused by
although many people won’t have several factors acting together. You may
persistent or severe symptoms. be naturally more likely to develop certain
disorders as a result of your genetic
Around 10 million people will seek help
make-up (see section ‘Genetics and family
from their family doctor each year with
risks’) and a variety of external factors
arthritis or related conditions. There are
may increase the risk further if you’re
around 400,000 people in the UK with
susceptible to the condition in question.
rheumatoid arthritis and around 20,000
These include environmental factors –
new cases each year. It’s estimated that
for example previous injury, infection,
around 8.5 million people in the UK
smoking, and occupations which are
have osteoarthritis and the numbers are
very physically demanding (see section
increasing with the aging population.
‘Lifestyle and trigger factors’). For many
Others will have localised musculoskeletal
conditions there’s also a major element
pain, back pain or osteoporosis. Some
of chance.
people will have one of the less common
conditions and about 16,000 children and
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Genetics and family risks What is the outlook?
Many forms of arthritis run in families
The symptoms of musculoskeletal
to a degree, and some conditions have
problems tend to vary from day to
a stronger tendency to be passed on
day and from week to week. Many
through genetics. The way your body
problems will get better by themselves,
is made (based on the genes passed
including such things as sprains.
on from your parents) makes you more
Episodes of backache or painful flare-ups
or less likely to develop the disease in
of rheumatoid arthritis are also often
question. Arthritis Research UK supports
short-lived even though the underlying
research that’s looking at the genetic
cause hasn’t changed. Other conditions,
side of arthritis. We believe this could
including gout, can often be controlled
lead to the ability to prevent some
by treatment.
forms of arthritis.
Many types of arthritis, including
Lifestyle and trigger factors rheumatoid arthritis and osteoarthritis,
Arthritis can start suddenly without are long-term conditions, where the
any obvious cause, and at any age. disease can’t be cured. The symptoms
Sometimes something in your lifestyle of these conditions tend to vary
or medical history – or a combination over time. Often your symptoms may
of these – could be responsible. go into remission for quite some time,
For example, if you have a physically but then there will be periods where your
demanding job you may be at greater risk symptoms become worse for a while.
of developing osteoarthritis, particularly Although these flare-ups may be related
if the job involves heavy repetitive to things like viral infections, they’ll often
activity. Also, a previous injury can happen for no apparent reason. The aim
increase the likelihood of osteoarthritis. of treatment is to keep you in remission
Infections can cause short-lived for as much of the time as possible, so
arthritis. One theory about the cause that you can get on with your life as
of rheumatoid arthritis is that it may be normally as you can, while minimising any
triggered by infections, but there’s progression of the disease.
no direct evidence for this. However, Arthritis can affect people in different
we do know that rheumatoid arthritis is ways and this makes it difficult for
more common and can be more severe doctors to predict a clear outcome for
in people who smoke. For some people, any one patient. However, most people
stopping smoking might reduce the risk with arthritis don’t have major mobility
of developing arthritis in the future. Some problems, and effective treatment will
foods may appear to make your arthritis help reduce the risk of disability or joint
worse, but diet and food intolerance are damage, even in more severe cases.
unlikely to cause long-term arthritis.

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Arthritis Research UK
What is arthritis?
How is arthritis diagnosed?
Your doctor will diagnose
your arthritis by asking you
about your symptoms and how
they’ve developed (your history);
examining you (physical
examination); and possibly
arranging for tests to be done
(investigations).

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Arthritis Research UK
What is arthritis?
1. Symptoms
• Your doctor will need to know the about any swelling in or around your
site of your pain (whether in the joints, including any warmth, redness
joint or between the joints) and and tenderness
which joints are involved • Arthritic conditions can affect
• Separating inflammatory arthritis other organs in your body, so your
from degenerative is important. doctor will ask about other aspects
To do so your doctor will ask you of your health.

2. Examination
Your doctor will be able to tell a lot • Soft tissue disease will usually
from examining you. For example: cause tenderness and pain in
these tissues
• Inflammatory arthritis is likely
to cause swelling in the joints • Because some forms of arthritis
have other signs and symptoms
• Degenerative arthritis will usually
(for example a rash or mouth ulcers),
cause pain and restricted movement,
your doctor may need to examine
but with less swelling, and often
other parts of your body.
a grating feeling (crepitus)

3. Tests
Tests may be carried out to help • Synovial fluid analysis looks at the
confirm the diagnosis, to rule out other lubricating fluid from joints. It can
possible causes or assess the severity help to diagnose inflammation,
of your condition: infection and gout
• Blood tests help make a diagnosis, • A biopsy is when a small amount
and monitor your condition or of tissue is removed and analysed.
drug treatments It’s only done when absolutely
• X-rays show bone abnormalities or necessary
damage but aren’t very good for • Urine tests help with a diagnosis
detecting early signs of arthritis and monitor drug treatments.
• MRI scans, computerised
tomography (CT) and ultrasound
record ‘slices’ of the body to give
detailed pictures of the skeleton
and other tissues to detect early
problems and show inflammation

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Figure 4  Some drugs are used in all types of arthritis, while others are only used in certain
types of disease. Many people may benefit from a combination of drug treatments.
Drugs that treat the symptoms
Type Examples Used for
Analgesics • paracetamol all types of arthritis
• co-codamol
• tramadol
Non-steroidal Standard NSAIDs: all types of arthritis (including
anti-inflammatory • aspirin osteoarthritis if there’s
drugs (NSAIDs) • ibuprofen inflammation)
• naproxen
• diclofenac
COX-2 NSAIDs:
• celecoxib
• etoricoxib
Steroids • prednisolone, tablets or given as tablets in inflammatory
injections arthritis or connective tissue
disease; may be given
as an injection into any swollen,
painful joint

Drugs that suppress the disease


Type Examples Used for
Disease-modifying • methotrexate inflammatory arthritis, some
anti-rheumatic • sulfasalazine connective tissue diseases
drugs (DMARDs) • leflunomide
• hydroxychloroquine
• azathioprine
Biological anti-TNF: rheumatoid arthritis, psoriatic
therapies • etanercept arthritis, ankylosing spondylitis
• infliximab
• adalimumab
• certolizumab pegol
• golimumab
Others: severe rheumatoid arthritis
• abatacept
• tocilizumab
• rituximab

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Arthritis Research UK
What is arthritis?

What treatments are there It’s important to understand that


there’s no effective treatment that
for arthritis? doesn’t occasionally cause side-effects.
Just as there’s no simple answer to the Minor side-effects aren’t uncommon,
cause of most forms of arthritis, there is – but fortunately serious side-effects are
as yet – no single cure for most rheumatic rare. These problems can be minimised
diseases. For some diseases there are drugs by following your doctor’s advice.
that will correct the problem, but for most
rheumatic diseases this isn’t the case. But Drugs that treat the symptoms
with modern treatment the symptoms can Analgesics (painkillers), such as
be effectively controlled. Research has led paracetamol, reduce pain. These can be
to great improvements in this area. used for all types of arthritis. It’s best to
take them before an activity that’s likely
Treatment has to be tailored to the needs
to aggravate the pain rather than wait
of each individual, because the severity,
until your pain is very bad. They’re also
impact and type of arthritis is different
more effective if you take them regularly
from person to person. You and your
during a flare-up of pain.
healthcare professionals will need to
balance the risks and benefits of each While some painkillers are available
treatment, based on your personal needs over the counter, if you’re using these
and circumstances. frequently or they aren’t working, your
doctor will be able to advise you about
Drugs alternatives.
In the case of inflammatory arthritis, the Anti-inflammatory drugs (NSAIDs)
sooner drug therapies are begun the reduce stiffness and swelling, as well as
more effective they’re likely to be. This relieving pain. They reduce inflammation,
can reduce the risk of long-term damage but they can also be helpful in types
to joints and bones. (see Figure 4). of arthritis where inflammation isn’t
Drug therapy can be divided into two the main problem (for example
main groups: osteoarthritis). They can be used for short
spells when your symptoms flare up, and
• drugs that treat the symptoms of arthritis in combination with analgesics if you
(for example pain and stiffness) need extra pain relief. You should take
• treatments that suppress inflammatory the lowest dose of anti-inflammatory
disease and may improve the outcome. that controls your symptoms, and for the
shortest possible time. Your doctor may
Drugs may be available under different
advise you to use them for short spells
names. Each drug will have an approved
rather than taking them all the time.
(scientific) name – these are the names
Sometimes you may be given an NSAID
used in this booklet. But different
cream to rub on the affected joint – this
manufacturers may give their own
reduces the risk of side-effects.
brand name or trade name to a drug –
for example, Voltarol is a brand name
for diclofenac.
15
Many people with
arthritis may benefit commonly used to treat inflammatory
arthritis and connective tissue diseases, but
from a combination they’re occasionally used for the short-term
of drug treatments. treatment of osteoarthritis. This is usually
done as a joint injection to ease a flare-up
in a single joint, or in inflammatory arthritis
you may be given a steroid injection
into the muscle which works throughout
your body.
Steroids can have side-effects –
especially if used for a long time
– as well as great benefits. One of
Like all drugs, NSAIDs can sometimes the possible side-effects of steroid
have side-effects, but your doctor treatment is osteoporosis. Because
will take precautions to reduce the risk of this, steroids are commonly used
of these side-effects – for example, only for short periods. If you do need
by prescribing the lowest effective dose steroid treatment on a long-term basis
for the shortest possible period of time. you may be given other tablets with
NSAIDs can cause digestive problems them to protect against osteoporosis.
(stomach upsets, indigestion or If you wish to stop using steroids
damage to the lining of the stomach) you should discuss this with your
so in most cases NSAIDs will be doctor as you will need to reduce the
prescribed along with a drug called a dose gradually.
proton pump inhibitor (PPI), which will
help to protect the stomach. Drugs that suppress inflammatory
NSAIDs also carry an increased risk of disease
heart attack or stroke. Different forms Disease-modifying anti-rheumatic
of NSAIDs carry a varying degree of drugs (DMARDs) suppress inflammation
risk. Although the increased risk is and treat the underlying disease. These
small, your doctor will be cautious drugs are used to treat inflammatory
about prescribing NSAIDs if there are types of arthritis and occasionally some
other factors that may increase your types of connective tissue disease. It
overall risk – for example, smoking, may be several weeks before they have
circulation problems, high blood any effect so anti-inflammatory drugs
pressure, high cholesterol or diabetes. are often used alongside them. It’s usual
to have regular blood tests while you’re
Steroids are powerful, natural anti- on disease-modifying drugs, and your
inflammatory agents. They can be injected blood pressure, urine and eyes should
into painful joints or into the muscles, also be checked regularly. These drugs
and can also be used in tablet form. They can be stopped for short periods without
may also have some effect on the way harm, for example if you’re on a course of
the disease progresses. Steroids are most antibiotics for an infection (see Figure 4).
16
Arthritis Research UK
What is arthritis?
Figure 5
An artificial
knee joint in
place

Patella (knee cap)

Femur (thigh bone)

Femoral component

Tibial component

Tibia (shin bone)

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Arthritis Research UK
What is arthritis?

Biological therapies are a newer class Hydrotherapy involves special exercises


of drug. They’re used in the treatment of that take place in a warm-water pool,
inflammatory arthritis when other types usually within a hospital physiotherapy
of disease-modifying drugs haven’t been department. If you have arthritis in several
effective. They’re unique in the way they joints then hydrotherapy may benefit
work, as they were made specifically to you. This is because all your joints can
block messages between the white blood be easily exercised in the warm water,
cells that cause inflammation. which supports your weight and puts
less pressure on your muscles and skeleton.
Drugs are often beneficial, but
Occupational therapy will help if you
they need to be used carefully,
have difficulty with everyday activities
according to your doctor’s
due to your arthritis. Your occupational
instructions. If you’re worried, or
therapist will assess your condition and
think that they may be causing
work with you to identify your own goals.
side-effects, consult your doctor.
By analysing how you go about your
day-to-day tasks, your therapist may be
See Arthritis Research UK individual able to suggest ways of making them
drug leaflets. more manageable.

Surgery
Physical therapies Surgery may be necessary and advisable
Often your doctor will recommend a
if the damage to a joint is severe enough
course of physical therapies to help you to cause difficulties with everyday life,
overcome some of the symptoms of and when other treatment isn’t reducing
your arthritis. the pain. Joint replacements are now
very sophisticated and successful.
See Arthritis Research UK booklets Many different joints, including hips,
Hydrotherapy and arthritis; knees, shoulder and elbow joints,
Occupational therapy and arthritis; are routinely replaced in people with
Physiotherapy and arthritis. advanced arthritis (see Figure 5). There
are also a number of other pain-relieving
Physiotherapy helps to improve your or reconstructive operations which are
general fitness and muscle strength, helps sometimes helpful. Some surgery can be
to manage your pain and restore the performed with needles and implements
function of parts of your body affected without fully opening the joint up.
by arthritis. A course of physiotherapy will This is called arthroscopy or is sometimes
referred to as keyhole surgery. The
include a detailed assessment, following
surgeon will make small (less than
which you’ll be given specific exercises
1 cm) incisions to allow a special light
tailored to your needs.
and camera to look at the inside of a

19
joint. This can be seen by the surgeon on Hospital doctors
a television screen. Arthroscopy can be • Consultant rheumatologists may be
used to help with diagnosis or can form supported by specialist registrars and
part of treatment. junior doctors.

See Arthritis Research UK booklets Specialist rheumatology nurses:


Foot and ankle surgery; Hand and wrist • provide you with information about
surgery; Hip replacement surgery; Knee your condition and its treatment
replacement surgery; Shoulder and elbow • provide you with advice about any
joint replacement. changes to your lifestyle
• will help to monitor the safety and
effectiveness of your drugs
Who will be involved • often have a telephone number you can
in my treatment? call for advice.
Go to your own doctor’s surgery first.
They can often provide all the help you’ll Physiotherapists:
need. If necessary you may be referred • will teach you exercises to help improve
to hospital to see a specialist such as your movement and reduce pain
a rheumatologist or an orthopaedic
surgeon. Your doctor or specialist may • help you improve your fitness
suggest you see other professionals such • can help with pain relief through
as specialist nurses, physiotherapists, massage or splints
occupational therapists or podiatrists. • help with choosing things like
walking aids.
GPs:
• will treat many forms of arthritis and Occupational therapists:
refer you to your local rheumatology • can advise you on how to protect and
department if a rheumatological
reduce the strain on painful joints
disease is suspected
• will be involved in prescribing repeat • help you find ways of carrying out
prescriptions for medications everyday tasks
• may be involved in blood tests for • can advise you on personal or
monitoring. sensitive activities or concerns such
as hygiene needs or relationship issues
Consultant rheumatologists: • can advise you or your employer on your
• will usually determine your diagnosis needs to remain in or return to work.
• will provide you with advice about
the likely effects of a condition and Podiatrists:
prescribe the relevant treatments • correct common biomechanical
• will monitor your condition and oversee problems in the feet
your treatment • offer expert advice on feet and footwear
• work closely with orthopaedic surgeons • can also help with foot or nail care if
if you require surgery. your arthritis makes this difficult.

20
Orthotists: with your employer to ensure a smooth
• specialise in the use of appliances to transition back into the workplace.
support weakened joints A Disability Employment Adviser (DEA) at
• will recommend specialist shoes or your local JobCentre Plus can help you find
insoles for problems in the feet or legs, a job or gain new skills and tell you about
and splints for hands and wrists disability friendly employers in your area.
• specialist orthotists can assist with At a JobCentre Plus you can enquire
custom-made devices. about the Access to Work grant, which
Help is also available from a variety of can pay for practical support if you have
other sources, for example, pain clinics, a disability. The grant is aimed at helping
social services and voluntary sector people to start work, stay in work, move
organisations such as Arthritis Care. into self-employment or start a business.
It can pay for special equipment and fares
See Arthritis Research UK booklets to work if you can’t use public transport.
Caring for a person with arthritis; You could also contact your local branch
Feet, footwear and arthritis; Looking of the Employment Medical Advisory
after your joints when you have arthritis; Service (EMAS), which is part of the Health
Meet the rheumatology team; Sex and and Safety Executive (HSE) and is staffed
arthritis; Work and arthritis. by doctors and nurses who offer advice
on health matters relating to work.
There are many treatments and
therapies available which can help
with your arthritis. Make sure you seek
How can I help myself?
professional advice and be prepared There are many ways that you can help
to follow it. yourself if you have arthritis. Some of
these are described below, and further
information can be found in the Arthritis
Research UK booklets and leaflets
Support at work referred to.
Work is good for you. It helps your
physical and mental wellbeing by giving Rest and exercise
you a sense of worth. If you’re off work, it It’s important to keep your joints moving
can be hard to return, especially if you’re and your muscles strong – whether
absent for a long period of time. you have arthritis or not. Generally the
Occupational therapists are health and stronger the muscles which support a
social care professionals who can improve joint, the less pain you’ll have in that joint.
your capabilities in the workplace, by If a joint is very inflamed, a short period of
helping you deal with issues related to rest may help the swelling to settle down.
your condition and its impact on your You should protect inflamed or damaged
work. Occupational therapists will work joints. It’s better to use them little but

22
Arthritis Research UK
What is arthritis?

often rather than persisting with activities group gives them extra motivation, and
that cause lasting pain. It’s also important it can be a good way to meet people with
not to rest the joints too much. the same interests.
Try to put your joints through a full range Swimming is an excellent all-round form of
of motion at least once a day, to prevent exercise for people with arthritis because
them stiffening up. Your body is designed the joints are supported in the water,
to move, and not doing so is harmful to which makes it easier to move them.
the tissues in and around the joints. To Cycling is good for strengthening your
increase the life of your joints, you should knees and for general fitness. You can use
stay active. Keeping active is good for your a static exercise bike at home or in a gym,
cardiovascular system (heart and lungs) or there are many traffic-free cycle paths
and for your general health. if you want to go outside. If you get a lot
If you have a flare-up of your arthritis, of knee pain you may have to take it very
which may occur as a result of overdoing gently to start off with, and stop if your
it, applying ice to the painful joints may pain gets worse after cycling.
help reduce the inflammation (make sure In terms of amount of exercise, little and
the ice pack is wrapped in a damp towel often is the right approach. You could
to protect your skin). Packs to warm in the build exercises into your daily routine. For
microwave are available and may ease example, every time you wash your hands,
aching joints. take a few minutes to do some simple
Exercise doesn’t need to involve exercises. It may sound silly, but it’ll help
equipment, and often the simplest you remember.
exercises are the best. A physiotherapist will be able to advise you
Stretching exercises help ease aches and further about specific exercises which will
pains and get the best movement from help you more.
your joints.
Strengthening exercises are important
as we rely on our muscles to support See Arthritis Research UK booklets
our joints and keep them in the right Keep moving; Physiotherapy
position when we move. If muscles are and arthritis.
weak, joints can become unstable and
this can be painful.
Healthy eating
Fitness exercises, which can be as simple
If you have arthritis it’s important to
as walking a bit further or faster than you
avoid being overweight, as this puts extra
normally would, are very important to
strain on the joints. If you’re overweight,
keep your heart healthy. You might like
losing two stone (about 13 kg) can reduce
to join a sports team or a leisure centre
pain in the knee by 50 per cent and even
so you can exercise with other people.
a little weight loss can reduce pain. A
Some people find doing exercise in a
healthy, balanced, low-fat and nutritional

23
diet with plenty of fruit, vegetables and on whether you notice any improvement.
fibre is good for your general health. You may find that changing only one
Avoiding too much meat or animal fat is thing at a time helps you to tell which
a good idea. therapies are having an effect.
If you’re on drugs for arthritis you may
need to avoid alcohol or limit the amount See Arthritis Research UK booklet
you drink. If you’re in doubt, check with and special reports Complementary
your doctor. and alternative medicine for arthritis;
Complementary and alternative
Beware of books, articles and advice medicine for the treatment of rheumatoid
about diets that claim to cure arthritis. arthritis, osteoarthritis and fibromyalgia;
Many of them recommend quite different Practitioner-based complementary and
things, and most people do not benefit alternative therapies for the treatment
from them. An unusual diet can do more of rheumatoid arthritis, osteoarthritis,
harm than good. fibromyalgia and low back pain.
Managing Stress
Chronic arthritis can get you down, and Will moving to a warmer
constant pain may lead to anxiety and climate help?
depression. Counselling from your doctor, Many people with arthritis feel changes in
or from someone they recommend, the weather affect the level of pain they
may help. You may find that sharing the feel. Most people prefer hot, dry climates,
problem with friends and others who but some people feel better in the cold
are affected can also be helpful. You may and damp. The weather will probably
be able to learn relaxation techniques make a difference to how you feel –
with the help of a physiotherapist or warmth and sunshine tend to lift your
occupational therapist. Support groups spirits. However, although the weather
and telephone support lines allow you to may affect the symptoms of your arthritis
talk to others with similar issues. or the way you feel, it won’t cause the
condition or affect the way it develops.
Complementary medicine
Complementary therapies such as
osteopathy and chiropractic can help Research and new
in some arthritic conditions, especially
back pain. There’s a huge range of other
developments
Arthritis Research UK aims to be at the
therapies, for example homeopathy
forefront of international efforts to
and herbalism, and a range of food
develop new treatments for arthritis.
supplements you may be tempted to try.
By funding world-class research into
Most of these are harmless, but if in doubt
developing treatments that accurately
you should ask your doctor. If you decide
target arthritis, patients should be able
to try therapies or supplements, you
to experience reduced pain, increased
should be critical of what they’re doing for
mobility and a normal quality of life.
you, and base your decision to continue

24
Arthritis Research UK
What is arthritis?

Even though there isn’t


yet a cure for arthritis,
there’s still a great deal that
can be done to relieve the
symptoms and help you to get
on with your life. In most cases,
the sooner the treatment
begins the more effective it’ll
be, so don’t hesitate to consult
your doctor if your symptoms
persist for more than a few days.

25
Glossary in all of us as we get older, often without
causing any symptoms.
Bursa – a small pouch of fibrous tissue
lined (like a joint) with a synovial Tendons – strong fibrous cords that
membrane. Bursae help to reduce friction; connect muscles to bones.
they occur where parts move over one Ultrasound – a type of scan which uses
another, for example where tendons high-frequency sound waves to build up
or ligaments pass over bones. Others, pictures of the inside of the body.
however, form in response to unusual
pressure or friction.
Cartilage – a tough, slippery tissue which Where can I find out more?
covers the bone ends. It acts as a shock You can download all of our booklets
absorber and allows smooth movement and leaflets from our website or order
between bones. them by contacting:
Computerised tomography (CT) Arthritis Research UK
scan – a type of scan that records Copeman House
images of sections or ‘slices’ of the body St Mary’s Court
using x-rays. These images are then St Mary’s Gate
transformed by a computer into cross- Chesterfield
sectional pictures. Derbyshire S41 7TD
Phone: 0300 790 0400
Ligaments – tough, fibrous bands which
www.arthritisresearchuk.org
hold two bones together in a joint.
MRI (Magnetic Resonance Imaging) Related organisations
– a type of scan which uses radio waves The following organisations may
in a strong magnetic field to build up be able to provide additional advice
pictures of the inside of the body. It works and information:
by detecting water molecules in the body
tissues which give out a particular signal Arthritis Care
in the magnetic field. Floor 4, Linen Court
10 East Road
Osteoporosis – a condition where bones London N1 6AD
become less dense and more fragile, Phone: 020 7380 6500
which means they break or fracture Helpline: 0808 800 4050
more easily. Email: info@arthritiscare.org.uk
Spondylosis – the term used to describe www.arthritiscare.org.uk
the x-ray appearance of mechanical or
degenerative changes of the small joints
in the neck and back, commonly present

26
Arthritis Research UK
What is arthritis?

DIAL Network National Rheumatoid


(formerly Disability Information Arthritis Society (NRAS)
and Advice Line or Dial UK) The Switchback, Gardner Road,
Phone: 01302 310 123 Maidenhead SL6 7RJ
www.scope.org.uk/dial Phone: 0845 458 3969
An independent network of local Helpline: 0800 298 7650
disability information and advice Email: helpline@nras.org.uk
services run by and for disabled people, www.nras.org.uk
part of Scope. Disability Rights UK (formerly Disability
Disabled Living Alliance, RADAR and the National
Foundation (DLF) Centre for Independent Living)
Ground, Landmark House, Ground Floor, CAN Mezzanine,
Hammersmith Bridge Road, 49-51 East Road, London N1 6AH
London W6 9EJ Phone: 020 7250 8181
Phone: 020 7289 6111 Email: enquiries@disabilityrightsuk.org
Helpline: 0845 130 9177 www.disabilityrightsuk.org
Email: info@dlf.org.uk Relate
www.dlf.org.uk See the telephone directory under
Employment/benefits ‘Relate’ or the Yellow Pages under
Your Jobcentre Plus office can put ‘Counselling and Advice’ for your local
you in touch with your local Disability Relate centre. Or Relate Head Office
Employment Advisor. For information can be contacted at:
on benefits you can contact the Benefit Premier House
Enquiry Line on 0800 882200. Carolina Court
Employment Medical Advisory Lakeside
Service (EMAS) Doncaster DN4 5RA
To find your local office, see the Phone: 0300 100 1234
telephone directory under ‘Health & www.relate.org.uk
Safety Executive’. The address and phone
number should also be available in all
workplaces. Alternatively, you can get this Links to sites and resources provided by third
information from: parties are provided for your general information
only. We have no control over the contents of those
www.hse.gov.uk/forms/health/ sites or resources and we give no warranty about
emasoffices.htm their accuracy or suitability. You should always
consult with your GP or other medical professional.

27
We’re here to help
Arthritis Research UK is the charity funding and giving insight into the latest
leading the fight against arthritis. treatment and self-help available.
We fund scientific and medical We often feature case studies and
research into all types of arthritis and have regular columns for questions
musculoskeletal conditions. and answers, as well as readers’ hints
We’re working to take the pain away and tips for managing arthritis.
for sufferers with all forms of arthritis
and helping people to remain active.
Tell us what you think
We’ll do this by funding high-quality
research, providing information
of our booklet
and campaigning. Please send your views to:
feedback@arthritisresearchuk.org
Everything we do is underpinned
or write to us at:
by research.
Arthritis Research UK, Copeman
We publish over 60 information booklets House, St Mary’s Court, St Mary’s Gate,
which help people affected by arthritis Chesterfield, Derbyshire S41 7TD.
to understand more about the condition,
its treatment, therapies and how
to help themselves. A team of people contributed to this booklet.
The original text was written by Dr David
We also produce a range of separate
Walker, who has expertise in the subject. It was
leaflets on many of the drugs used
assessed at draft stage by physiotherapists
for arthritis and related conditions.
Colin Waldock and Angela Reilly, general
We recommend that you read the
practitioner Dr Lisa le Roux and occupational
relevant leaflet for more detailed therapist Dr Elizabeth White. An Arthritis
information about your medication. Research UK editor revised the text to make
Please also let us know if you’d like it easy to read, and a non-medical panel,
to receive an email alert about our including interested societies, checked
online quarterly magazine, Arthritis it for understanding. An Arthritis Research
Today, which keeps you up to date with UK medical advisor, Dr Ben Thompson, is
current research and education news, responsible for the content overall.
highlighting key projects that we’re

28
Get involved
You can help to take the pain away
from millions of people in the UK by:

• volunteering
• supporting our campaigns
• taking part in a fundraising event
• making a donation
• asking your company to support us
• buying products from our online and
high-street shops.

To get more actively involved, please


call us on 0300 790 0400, email us at
enquiries@arthritisresearchuk.org
or go to
www.arthritisresearchuk.org
Arthritis Research UK
Copeman House
St Mary’s Court
St Mary’s Gate
Chesterfield
Derbyshire S41 7TD

Tel 0300 790 0400


calls charged at standard rate

www.arthritisresearchuk.org

Registered Charity England and Wales No. 207711, Scotland No. SC041156
© Arthritis Research UK 2012
Published May 2015  2020/INTRO/15-1

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