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Osteoarthritis is the most common form of arthritis. Cartilage (connective tissue) between the bones gradually wastes away (degenerates), and this can lead to painful rubbing of bone on bone in the joints. It may also cause joints to fall out of their natural positions (misalignment). The most frequently affected joints are in the hands, spine, knees and hips.
Also known as inflammatory arthritis, rheumatoid arthritis is a more severe, but less common condition. The body's immune system attacks and destroys the joint, causing pain and swelling. It can lead to reduction of movement, and the breakdown of bone and cartilage.
There are over 200 forms of arthritis. More common forms include:
- Ankylosing spondylitis.
- Cervical spondylitis.
- Systemic lupus erythematosis (lupus).
- Psoriatic arthritis.
- Reiter's syndrome.
Arthritis is often associated with older people, but it can also affect children. About one in 1,000 children develop arthritis. Arthritis in children is often called juvenile idiopathic arthritis (JIA). The three main types of JIA are:
- Oligo-articular JIA is the most common form of JIA. It affects four or fewer joints in the body, most commonly the knees, ankles and wrists. This type has good recovery rates and the effects are rarely long term. However, there is a risk of developing eye problems, so children should have regular checks with an eye specialist (ophthalmologist).
- Polyarticular JIA (or polyarthritis) affects five or more joints, and the symptoms are very similar to adult rheumatoid arthritis. It can quickly spread from one joint to another and can develop at any age. It is often accompanied by a rash or fever.
- Systemic onset JIA begins with symptoms such as fever, rashes, lethargy and enlarged glands, and later develops into swollen and inflamed joints. It can also affect children of any age.
Symptoms of arthritis
The main symptoms of all forms of arthritis include:
- restricted movements of the joints,
- swelling, and
- warmth and redness of the skin over the joint.
Osteoarthritis often develops in people who are between 40-60 years of age. Osteoarthritis becomes more common with age with around 12% of people over 65 affected by the condition.
Osteoarthritis begins slowly with pain, stiffness and restricted movement in the affected joints. For some, slight stiffness is all that is experienced, but other people go on to have cracking or creaking joints (crepitation), knobbly bone growths (especially on the hands), and joints that move out of alignment. The pain and loss of movement tends to worsen as the day goes on, as the joints are used more.
Rheumatoid arthritis affects between 1-3% of the population, and often starts between 30-50 years of age. Women are three times more likely to be affected by rheumatoid arthritis than men.
Like osteoarthritis, rheumatoid arthritis begins gradually, with the first symptoms often being felt in small joints, such as fingers or toes. The condition can then progress to cause pain, swelling and stiffness of other joints, causing a lack of mobility. Cold and damp weather may aggravate the symptoms which are often worse in the morning. However, your symptoms may improve during the day as you start using and flexing your joints. Rheumatoid arthritis can also sometimes leave people feeling generally unwell and tired.
'I can feel a storm brewing!'
People with arthritis often say that they feel their joints aching before a storm. This could be linked to the increase in humidity and drop in air pressure that occurs just before a storm. Although there is very little evidence to support these claims, many people accurately predict the onset of a storm from their aching joints. Changing weather patterns will not cause arthritis, but they do seem to worsen the symptoms for some people with the condition.
Causes of arthritis
The cause of osteoarthritis is not fully known. One theory is that some people are genetically predisposed to developing the disease, but this has not yet been proven.
Factors that may contribute to the development of osteoarthritis include:
- obesity, which puts added strain on joints,
- jobs, or activities, that involve repetitive movements of a particular joint, or
- previous damage to the joint, such as from a sports injury.
Rheumatoid arthritis is caused by a fault in the immune system that makes the body to attack its own tissues. This may be inherited genetically (passed on from a family member).
Arthritis is usually diagnosed by the symptoms and a physical examination. In making a diagnosis, related factors, such as your occupation, activities that may strain joints (such as regular sporting activities), medical history, and any history of arthritis in your family, will be taken into account.
An X-Ray is particularly useful for identifying osteoarthritis, as it can highlight the narrowed space between the bones in a joint. It can also show whether there is any calcification, which is where calcium builds up in the body tissue, causing it to harden.
Occasionally, a computerised tomography scan (CT scan) or magnetic resonance imaging scan (MRI scan) is used to identify arthritis.
As everyone experiences arthritis in a different way, individual treatment and management advice is usually given. It is important to start treatment as early as possible after symptoms begin in order to reduce further damage to joints and improve quality of life.
The treatment of arthritis usually involves a range of healthcare professionals. These may include:
- your GP,
- arthritis specialist (rheumatologist),
- occupational therapist,
- nurse specialist,
- pharmacist, and
- social worker.
Treatments for osteoarthritis
The medicines prescribed for osteoarthritis tend to fall into three groups:
- analgesics - such as paracetamol. They help to relieve pain.
- non-steroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen and aspirin. However, when taken over long periods, or in high doses, these medicines can lead to digestive problems and bleeding in the stomach. Aspirin should not be given to children under 16 years of age. Cox-2 selective inhibitors are a type of NSAID which are designed to be less harmful to the stomach. However, research has linked the use of Cox-2 inhibitors to an increased risk of strokes, raised blood pressure, heart disease and hear attacks, so it is important to make your GP aware if you have a history of high blood pressure or high cholesterol, or if you smoke.
- corticosteroids - these are injected directly into the affected joint. However, this is not recommended on a long term basis because of serious side effects, such as wasting away of tissue surrounding the joint.
Sometimes, surgery (arthroplasty) may be used to treat severe cases of osteoarthritis. Arthroplasty involves either reconstructing, or replacing, a diseased joint. For arthritis patients it can help restore movement and function to the joint. However, not all joints can be artificially replaced. Other possible procedures might include realignment of the joint (osteotomy).
Treatments for rheumatoid arthritis
The main objective for the treatment of rheumatoid arthritis is to reduce the damaging inflammation. Some of the main treatments are outlined below.
- Disease modifying anti-rheumatic drugs (DMARDs) can help stop the progress of rheumatoid arthritis. Therefore, the earlier these are prescribed, the more effective they are. DMARDs are thought to have fewer side effects than long-term use of drugs, such as paracetamol. However, there are some associated risks including diarrhoea, nausea, skin rash and hair-loss. DMARDs are often used in conjunction with NSAIDs
- Relaxation techniques and physiotherapy can be effective in treating some types of arthritis, particularly those that involve swelling of the joints.
- Some alternative techniques include low-level laser therapy (LLLT), and low doses of orally administered corticosteroids, although the evidence of these treatments being beneficial is limited.
- New medicines, such as tumour necrosis factor (TNF ) blockers, are in development and are showing very promising results. However, this type of medicine is not appropriate for everyone with arthritis.
There are a number of other therapies that have been used to treat arthritis. However, not all of them have been clinically proven to be effective. These therapies include:
- acupuncture - the insertion of fine needles at chosen points on the skin,
- osteopathy - a mixture of gentle and forceful massage techniques aimed to reduce pain and swelling,
- chiropractics - involves careful manipulation of the joints, muscles and tendons to provide pain relief,
- hydrotherapy - exercise programmes in either a warm shallow swimming pool or a special hydrotherapy bath,
- electrotherapy - uses electrical impulses (tiny electrical shocks) to stimulate the nervous system, and
- nutritional supplements - such as glucosamine sulphate, chondroitin and fish oil.
Side effects of treatment
Some treatments for arthritis have side effects that may cause additional problems. NSAIDs may damage the stomach and digestive system and are also associated with kidney problems in some people.
Corticosteroids can cause reduction in bone density (osteoporosis), leading to increased risk of fractures, and may also lead to the development of shingles, cataracts, and diabetes.
Other side effects can include high blood pressure, weight gain and mood swings. Your doctor will treat you with the lowest possible effective dose in order to minimise the risk of complications and may suggest additional treatment to protect your bones.
Is hydrotherapy good for arthritis?
Hydrotherapy improves muscle and tendon strength, and helps to keep joints aligned. It's different from swimming in that it involves special exercises that are performed in a warm water pool (usually at temperatures of 33-37ºC). There are classes offered by physiotherapists and some local swimming baths have hydrotherapy pools. Hydrotherapy is extremely useful for patients with arthritis because it allows them to exercise their joints without having to bear their full weight.
Complications of arthritis
Some treatments for arthritis have side effects that may cause additional problems. NSAIDs may damage the stomach and digestive system and are also associated with kidney problems in some people. Corticosteroids can cause reduction in bone density (osteoporosis) leading to increased risk of fractures and may also lead to the development of shingles, cataracts, and diabetes.
In the long term, arthritis can produce worsening pain, loss of mobility, and sometimes make walking difficult, or impossible. As a result, depression may accompany this condition.
General effects of rheumatoid arthritis may include:
- loss of appetite and weight,
- muscle pain,
- lumps (nodules) under the skin,
- inflammation of tendons,
- sight problems,
- anaemia (blood disorder), and
- vasculitis (inflammation of the blood vessels)
Controlling your weight may help to ease pressure on your joints. Weight control can also help avoid stress, or injury, to your joints and can prevent, or reduce, the severity of osteoarthritis.
It is not true that avoiding exercise will help reduce joint problems in later life. Weight-bearing exercises, such as walking, will help to prevent osteoarthritis by increasing the strength of the muscles that support your joints. Good posture can assist the strengthening of healthy joint structures.
Having physiotherapy, and using a walking stick, can help prevent existing osteoarthritis from becoming worse. There is no known way to prevent rheumatoid arthritis.
Arthritis expert Professor David Blake on the questions to ask
Arthritis is a musculoskeletal condition that affects one in five people in the UK. An estimated 70% of all 70-year-olds have arthritis, but the condition can affect people of all ages. There are more than 200 types of arthritis; the most common is osteoarthritis, which occurs when your joints wear out. Although arthritis is incurable, it's possible to slow down the progression of the condition and manage the pain it causes.
We asked Professor David Blake, consultant physician and rheumatologist at the Royal National Hospital for Rheumatic Diseases (RNHRD) in Bath, what he would want to know if he was diagnosed with arthritis.
Could the pain in my joints be a sign of something more serious?
Joint pains are very common and short-lived joint pains are usually of no concern. However, joint pains that last for more than a few days and are associated with swelling or throbbing pain need urgent medical attention. If one of your joints is hot, swollen, red and throbbing, then you should visit your doctor quickly. In an elderly person, this may be gout. However, it could also be an infection which demands very prompt treatment to stop the joint being damaged.
Do I need to take medication?
Drugs are essential, and sometimes life saving, for serious inflammatory forms of arthritis, caused by alterations in the immune system. These drugs must be taken conscientiously and regularly, and you'll need to be monitored at specific intervals. Drugs are also prescribed to help ease the symptoms of arthritis. It's perfectly sensible to take these drugs only as and when required. This will reduce the incidence of side effects. Make sure you know why you're taking medication and how often you should take it.
Can complementary therapies help?
Any complementary medicines/therapies that are proven to work can be prescribed by your doctor on the NHS. If they aren't proven to work, they will not be approved. If you want to do something to help yourself, try exercise and relaxation programmes rather than unproven herbal or other remedies. No diet or food supplement has any proven influence on arthritis. However, some types of arthritis are associated with an increased risk of heart disease, so it’s important to eat a properly balanced diet that's low in fat and includes plenty of vegetables.
Should I continue to exercise?
Yes. If you exercise regularly, your tendons and muscles will stay supple and be less susceptible to injury. Keep as fit and active as possible and get professional support to help you if you're finding this difficult. Joints, as well as hearts, struggle if you're overweight. Your spine struggles if you repeatedly carry asymmetrical weights, such as a heavy handbag over your shoulder. Heavy handbags worn in this fashion will wear out your neck (cervical vertebrae).
Why am I feeling tired and depressed?
Fatigue and depression commonly accompany poorly treated inflammatory arthritis and are a sign that your treatment programme needs reassessing. Keep a positive attitude. Your grandmother was right when she said that the brain had powerful influences on your immune system and your health. Get help if you're struggling.
Are there specialists that can help?
Rheumatology and orthopaedics are the medical and surgical specialties that deal with complex arthritis and rheumatism. Physiotherapists, occupational therapists, nurses, orthotists, chiropodists and podiatrists help with exercise regimes, pain control, monitoring, education and foot care. Don’t delay in seeking specialised advice. Advances in treatment can have a big impact on the more serious forms of arthritis and early treatment is essential.
What should I tell my family and friends?
Make sure your friends and family understand your problems. Remember that family members or friends can come with you to your clinic appointment. Your arthritis may have a big impact on your life, but it can also have a big impact on those around you. Make sure they also know enough to help you in the right way.
Living with arthritis
There are things that you can do to manage your condition, ease your symptoms and improve your quality of life. For example:
- Controlling your weight can help to ease pressure on joints.
- Avoiding stress or injury to your joints can help to prevent or reduce the severity of osteoarthritis.
- Good posture can strengthen healthy joint structure.
- Physiotherapy and use of a walking stick or cane can help prevent worsening of existing conditions.
- Weight-bearing exercise, such as walking, will help to prevent osteoarthritis by increasing the strength of muscles that support your joints. It's not true that avoiding exercise will help reduce joint problems in later life.
Your GP can refer you to an occupational therapist that will be able to advise you on the equipment you may need to assist your independent living. They can also write supporting letters to your local social services department. If you need to adapt your home, there are a number of services and merchandise available, so it's important to shop around.
Arthritis can sometimes make you less flexible and mobile. This can increase your risk of having an accident. There are a number of measures you can take to limit this risk.
- Eliminate home hazards. Always keep your home well lit and remove all loose wires and cords that you may trip over. Make sure treads, rugs and carpets are secure. Keep rubber mats by the sink and in the bath to prevent slipping, and always clean up spills immediately. Install grab rails in the bathroom and toilet to help you stand up without falling. Your GP or local authority may be able to give you support or advice about safety in the home.
- Get the balance right. Exercise that helps improve your balance can prevent a fall. Being physically active can prevent up to 25% of falls. Ideal forms of exercise for improving balance include t'ai chi, yoga and dance.
- Exchange the highs for the flats. High-heels are bad for your posture and make you more prone to take a fall, so try to wear flat, comfortable footwear.
- Don’t drink too much. Alcohol can disturb your ability to balance, making you more likely to take a knock or a fall. Try to keep within the government recommended daily amounts of alcohol of no more than two to three units for women and three to four for men. A unit of alcohol is half a pint of normal strength lager or beer, one pub measure of a spirit or one small glass of wine.
- Check your sight. As we get older, most of us will experience some deterioration in our eyesight. It's important to get your sight checked regularly by a qualified optician. Poor eyesight can increase your risk of accident and injury.
- Ask for help. If you know you have arthritis, avoid standing on chairs to reach high cupboards or change a light bulb. Also, try to avoid chores that you know lead to more pain. Write a list of the jobs that need doing around the house and save it for the next time you have a visit from friends or family.
- The Royal Society for the Prevention of Accidents offers more information about safety in the home.
Will I lose my driving licence?
You will need to contact the DVLA and inform them of your condition. It's unlikely that you'll have to re-take your driving test, unless you have severe mobility problems. You can call the DVLA for further advice about the safety of driving with arthritis on 0870 600 0301.
Food for thought
There are many food myths surrounding arthritis. Some people say that dairy products cause arthritis, that cider vinegar and honey will cure arthritis, and acidic fruits (such as lemons, oranges and grapefruit) and night shade vegetables (such as potatoes, aubergines and peppers) can make symptoms worse. Many people living with arthritis, especially rheumatoid arthritis, also say there's a link between certain foods and the flare-ups they experience.
There's little evidence to support these claims, but some studies suggest that certain foods may help reduce pain, inflammation and slow the progression of arthritis. These foods all contribute to a healthy balanced diet, which will not only help with the arthritis, but can also reduce your risk of developing other health complications, such as heart disease, osteoporosis and obesity.
- People taking steroids over a long period of time are more likely to develop osteoporosis. You can reduce your risk of this by eating foods that are rich in calcium and vitamin D. Calcium-rich foods include dairy products (milk, cheese and yoghurt), nuts and seeds (especially sesame seeds) and fish such as sardines or whitebait (especially if you eat the bones). The sun on our skin is our main source of vitamin D. However, vitamin D can also be found in fortified foods, such as cereals and margarines, and oily fish.
- Certain foods, such as ptés, uncooked meats and unpasteurised dairy products, can increase the risk of developing food poisoning. People taking immunosuppressant drugs best avoid them.
- There is increasing evidence that the Mediterranean diet is good for arthritis and a number of other conditions. This diet includes lots of fruit, vegetables, fish, grains and pulses, with a moderate intake of red meat. Foods rich in omega-3 are believed to have an anti-inflammatory effect, which may reduce the pain associated with inflamed joints. Omega-3 is found in oily fish, such as sardines, mackerel and salmon. Try to eat at least two portions of oily fish a week. Omega-3 is also found in nuts and seeds (especially linseed or flax seed) and is regularly used to fortify margarines, cereals and bio-live yogurt drinks.
Foods that may help with rheumatoid arthritis
Exercising with arthritis
Finding the right sort of exercise is important for people with arthritis. Regular exercise can make an enormous contribution towards the self-management of the disease. It can help you keep in a healthy weight range, improve your posture, and reduce your chance of getting osteoporosis. A survey by Arthritis Care found that 57% of people with arthritis find exercise effective for managing their symptoms.
Three types of exercise combine to make up a good exercise regime:
- Range of movement. This helps strength, flexibility and promotes good posture. Try swimming, t'ai chi and golf.
- Strengthening. This will help build the muscles, which in turn provide better support for your joints. Try weight training.
- Aerobic. This raises your heartbeat, which helps with your level of fitness by strengthening your heart. Some of the best forms of aerobic exercise include brisk walking, cycling and tennis.
Remaining physically active gives you the best possible chance of managing the symptoms of arthritis effectively. It's also essential for minimising your risk of experiencing a number of other health problems. Maintaining an appropriate level of physical activity is key to reaping the health benefits of exercise. Try to be realistic about the amount of exercise that you're able to do and choose a form of activity that you enjoy.
When you first start your exercise programme you may experience some pain. This is often due to new muscles being used. However, if you feel pain for longer than two hours after the exercise or any pain in the joints, you must consult your GP or physiotherapist before performing that exercise again.
Tips for exercising with osteoarthritis
- Regular exercise can be the best way to help reduce the symptoms of osteoarthritis. By keeping active you will strengthen the muscles surrounding the joints, which in turn reduces further joint deterioration.
- Exercise helps you maintain a healthy weight, thus putting less strain on your joints.
- A moderate exercise programme is far more beneficial than a strenuous programme. Too much exercise can cause further pain and joint degeneration.
- Try to do small exercises everyday that improve your range of movement. Arthritis Care provides a very comprehensive list of exercises for you to try.
- Never force a painful joint.
Tips for exercising with rheumatoid arthritis
- It's very important for people with rheumatoid arthritis to get the right balance between rest and activity.
- You can still exercise during a flare-up, but you should reduce the intensity of your workout.
- Exercise when you're least tired.
- Try to do small exercises everyday that improve your range of movement.
- Exercising in the morning can help reduce morning stiffness.
- Exercises that build and strengthen muscles can help protect and support your joints.
- Swimming, cycling and brisk walking are known as low impact exercises. They're particularly good for people with rheumatoid arthritis.
- Concentrate on having good posture at all times.
Caring for someone with arthritis
There are six million people in the UK who look after an ill or disabled partner, child, relative or friend. Caring for someone with arthritis can be a varied and demanding job. This is because of the broad range of medical, personal and emotional needs that a person with arthrtitis can have.
If you're caring for a family member, you may not consider yourself a carer because you're just doing what needs to be done. You might feel that you have no other options. This can sometimes be stressful and may result in feelings of resentment towards the person you're caring for, which can leave you feeling guilty. You may have been forced to leave your job, give up hobbies and stop socialising, which can be very isolating.
It's important to remember that you're not alone and that there is support available. By law you're entitled to a free health and social care assessment, which you can access through your local council. The assessment will look at the possibility of you getting practical and financial help.
People respond differently to treatments, but some people find that complementary therapies can ease the discomfort and pain caused by arthritis. There are also complementary therapies that reportedly improve flexibility and mobility.
Most of the evidence regarding the beneficial effects of complementary therapies for treating the symptoms of arthritis is anecdotal and hasn't been clinically proven to be effective. However, if you're suffering pain, and arthritis is having a detrimental effect on your life, then trying out complementary therapies is a positive way of taking control of your symptoms and may help you manage your pain.
Your GP or consultant should be able to advise you about your different treatment options, including some complementary therapies. Arthritis Care can also provide you with further information.
How do I know which complementary therapy is safe?
The following checklist will help you ensure your treatment is safe and reliable.
- Ask how long the treatment is likely to last and how much it will cost.
- Find out if there is a governing body and if your chosen therapist is a member.
- Make sure they have insurance cover.
- Ask about their training, how long they have practised and if they have any particular areas of expertise.
- Tell them about any medication you're taking.
- Don't stop taking any medication until you have discussed it with your GP or consultant.
- If you don’t trust a therapist, don’t use them.
I have heard that acupuncture may help treat the symptoms of arthritis and prevent further deterioration, is this true?
There's no clinical proof of this, or that acupuncture will prevent the progression of the disease. Some people report that acupuncture has helped them to manage the pain that's associated with arthritis. If you're interested in trying acupuncture, talk to your doctor.
'Dancing got me through the roughest times'
Paul Casimir has been living with arthritis for half his life, but doesn’t let it stop him from doing the things he enjoys. He tells his story
Paul Casimir was diagnosed with rheumatoid arthritis at 20. He was a fast runner throughout his teens, but at 19, his body started to stiffen up.
“I had been feeling a little bit strange for about a year before I was diagnosed with arthritis,” says Paul. “I just seemed to move at the pace of a distracted goat. I didn’t really know what was going on. I was at drama school at the time and I kept getting cast as octogenarians.”
One day, after finishing a play, he collapsed into bed completely exhausted. When he woke up, his knees had swollen to the size of dumplings, and he was in bed for four days. His doctor was puzzled.
“It then went away for a while but returned with a vengeance a couple of months later,” says Paul. "I was referred to a rheumatologist, who diagnosed rheumatoid arthritis. It was something I’d never heard of and I didn’t know why it was happening to me. I felt tears in my eyes when she told me.“
Paul managed his condition with painkillers and anti-inflammatory medication for the next few years. It was difficult for him to move properly. "Dancing was what got me through the roughest times," he says."Even when I could barely move, I could still dance. Standing still was excruciating, but transferring my weight from one leg to the other was bearable."
One day, he decided to see how he would get on without medication. He has never looked back.
“I didn’t really notice much of a difference with the medication,” he said. “People diagnosed now would be offered different kinds of medication, such as disease modifying medication, but I guess that wasn’t around when I was diagnosed.
“After a while it became really important to me to start challenging the condition, to take back control of my life.”
He started swimming and going out dancing, and stopped worrying about what other people thought. It's been five years since the last big flare-up.
“I just learnt to get on with life," he says."It’s easy to dwell on the pain and misfortune and ‘why me’. But, in the end, that's really quite futile. What’s important is to focus on all the things you enjoy. I swim regularly and enjoy a ramble in the woods, whereas 20 years ago I'd have thought 'Let's go for a walk' was the most ridiculous suggestion someone could make! The richer your experiences are in life, the more you're distracted from the pain.
"And I still look good on the dancefloor, dancing like a robot from 1984!”
'Osteoarthritis affects almost every part of my life'
Jo has been living with osteoarthritis for 15 years. When she felt her independence slipping away, she knew she had to take stock of her life
“I broke my ankle in 1990 and was warned by an orthopedic surgeon to expect the onset of osteoarthritis. What I didn’t anticipate was that within five years, not only both my ankle joints, but also my knees and hips would be affected. I currently live with a dull constant pain, which will continue for the rest of my life.
"I was lucky to be diagnosed by my GP on the second visit. My doctor was very thorough and sent me to a rheumatology clinic for tests to make absolutely certain that the condition I had was osteoarthritis.
“Osteoarthritis affects almost every part of my life. My favourite pastime is making wooden toys. Unfortunately, I now also experience pain in my finger joints. My aim now is to keep my hands moving and try to lessen the damage so I can continue to enjoy my hobbies as long as possible.
“I have now been living, struggling and sometimes laughing with and at osteoarthritis for the last 15 years. In the last two years, my osteoarthritis has worsened significantly. My knees are beginning to give way, my left calf muscle has become wasted and my feet are ‘turning over’. I enjoy walking, as I'm a country girl at heart, but it's increasingly becoming agony even to pop along to the supermarket in the next street.
“In the past, my ‘disability’ went seemingly unnoticed by others. I was pushed out of the way and ranted at on buses for asking for a seat. I began to fear that I was losing control of my independence. I had to take stock of my life and my future.
"At this time, a good friend gave me a walking stick. It stayed consigned to the corner for several months because I wasn't prepared to carry a symbol of my increasing disability. One day I was unable to stand up and needed friends to help me to my feet. The shock and the embarrassment were what I needed to shake me out of my pride and into the stark reality of my situation.
"I started to use the stick to come in to work. I immediately noticed that with a visible sign of my problems, people were more patient, the pushing stopped and I got offered a seat on the bus. The stick has given me back my confidence for walking. Although other people notice it, I'm gradually becoming less aware of my constant companion and friend. Everyone needs a friend they can lean on!
“I feel passionately about the need for good quality care for patients with osteoarthritis across the country. It's important to me that everyone gets the same sort of attention and treatment from the NHS that I have had. Early diagnosis is crucial, but so is swift access to the right treatment, information and programmes.”
'It was difficult as I felt quite isolated'
When we think of arthritis, we normally think of old age. But the disease can strike young people too. Kate Llewelyn, 34, first noticed her symptoms when she was just 13
“The soles of my feet became very painful,” she recalls. “I went to the doctor. He wasn’t my usual GP and he just told me to buy new shoes! I did, but they didn’t help. A month later two of my fingers swelled up and became very painful. I went back and saw my regular doctor, who diagnosed rheumatoid arthritis.”
Kate was put on to anti-inflammatory drugs and also had to take 12 soluble aspirins a day. “I still hate the taste!” she says. She had hydrotherapy sessions three times a week, which helped her pain. However, at 14, she had to take a year off school as her pain got worse.
“Every joint in my body would ache, apart from my hips, which luckily have never been affected,” she says. “It was difficult as I felt quite isolated. I had home tuition, but I lost contact with lots of friends.”
However, Kate refused to let the disease beat her. She gained good GCSEs and A-levels, then went to university. “All my tutors were very supportive,” she says. “Of course, the arthritis did affect my social life. I couldn’t be spontaneous as I always had to plan how I’d get home from somewhere, as I couldn’t walk very far.” Following university, she got a job with Arthritis Care and now edits the charity’s magazine.
Kate has a very aggressive form of rheumatoid arthritis and so far has had an elbow and a knee replacement. In the past, she’s tried several drugs, including methotrexate and gold injections. She's currently on anti-TNF, a new arthritis drug designed to stop the disease progressing, which she says is working well.
She’s under no illusions about the severity of her illness. “Sometimes, when the pain is bad, I think: is this the next stage? I know that I’ll need more operations in the future but I try to stay positive. It can be hard. It’s not obvious that I’ve got arthritis and I’ve been shouted at for parking in disabled spaces! But I try not to get angry because I know people are just ignorant."
Kate has learned to live with the disease. “I have to watch my energy levels. If I know that, for example, I’m going to a wedding, I’ll do absolutely nothing the day before because I know it will wipe me out and I’ll be fit for nothing the day after. I also have to be ruthlessly practical in every aspect of my life, for example, if I have a work meeting I always try and get people to come to me.”
She urges anyone with arthritis to learn about their condition. “Get in touch with Arthritis Care and you’ll get all the information you need,” she says. “You’ll also find support and help with what can be a very isolating condition.”
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NHS Choices links
- News: protein
- News: knee surgery
- News: arthritis gene
- Carers Direct
- Carers: practical support
- Choices' arthritis blog
- Health A-Z: rheumatoid arth.
- Health A-Z: osteoarthritis
- Video: over-60s treatment