Arthritis: Symptoms & Treatment

Arthritis literally means joint inflammation (arthro- means joint, -itis means inflammation).

It’s a condition that affects many people, young and old, to varying degrees: from the odd twinge to disabling chronic problems. So what can be done? The answer is, it depends, but in many cases there much scope for help and improvement.

There are over 100 different kinds of arthritis and it’s helpful to think of them in 2 groups based on cause and implications for treatment:

Osteoarthritis

• Natural process of degeneration resulting in the wearing of joint cartilage
• Often affects larger weight bearing joints (knees, hips, spine), or small joints in the fingers
• Associated problems, such as pain and restriction, are more common with old age – but not inevitable!
• Not associated with any other disease, but can be impacted by co-morbidities (the presence of other diseases)
• Some people may be predisposed due to genetics, prior injury or mechanical compromise (how your body moves or doesn’t move)
• The goal of treatment is to prevent the degeneration from progressing and causing extreme joint damage and disability
• Conservative (non-surgical) treatment includes hands-on approaches and addressing pre-disposing/maintaining factors such as strength and mobility, with an osteopath or physiotherapist

Inflammatory Arthritis

• Collective term for numerous conditions
• Joint inflammation related to an auto-immune disease process (when the body’s immune system targets it’s own tissue instead of foreign substances like bacteria and viruses)
• Often accompanied by systemic issues which can affect the skin or organs, and may cause fatigue or flu-like symptoms
• Most autoimmune diseases can start at any age
• It is important to consult with a Rheumatologist for appropriate tests and diagnosis, and to establish the best possible treatment.
• The goal of treatment is to prevent long term joint and organ damage
• Treatment involves tools and medications that can control symptoms and help to achieve remission (when symptoms are nearly gone and joints are not longer inflamed)

What is Osteoarthritis (OA)

This describes the natural degeneration process in joints and happens to us all to some degree as we age: anyone x-rayed in their twenties or older will probably show some degree of natural ‘wearing’ of the joints, somewhere in the body. Osteoarthritis often affects weight bearing joints (knees, hips, spine), or the small joints in the hands or feet.

If osteoarthritis progresses, the joint cartilage can wear away to expose the underlying bone. The soft connecting tissues in the joint can become thickened as the joint tries to stabilise itself and swelling is common. The joint may also become somewhat deformed due to osteophytes (additional bone growth resulting from the body’s attempts to heal the damage).

Genetics, prior injury and mechanical compromise may mean someone is predisposed to osteoarthritis. Severe osteoarthritis is more likely with older age, but it is not an inevitable part of ageing. If you have osteoarthritis it doesn’t always mean you will develop symptoms or that it will progress and become severe. One person’s experience can be very different to the next and pain is not always reflective of the level of degeneration.

What can be done about Osteoarthritis?

Joints like movement. It is the most powerful thing in keeping the musculo-skeletal system healthy and addressing existing problems. There is no substitute. If there’s one thing you can do that your body will continue to thank you for now and in the future, it is to move regularly.

If movement is problematic for you, seek help and read my tips: often there is a lot of scope for improvement even after injury or a long history of problems in a specific joint or area such as the back, before resorting to surgery. Specific targeted movement therapy with hands on treatment can be key in enabling or regaining good confident movement for the whole body.

Learn more about how I can help, or continue reading.

Surgery

There are numerous options that can help with degeneration of cartilage in knees and hips. Ranging from steroid injections, to key-hole surgery (arthroscopy to ‘clean’ the joint called lavage and debridement), and other less common approaches, such as Autologous chondrocyte implantation (ACI), which are not widely available on the NHS due to a lack of outcome certainty.

In severe cases joint replacement surgery might be appropriate, most commonly of the hip or knee, I’ve treated many patients who have enjoyed good outcomes following joint replacement surgery but surgery always carries risks and really is a last resort, it’s important to avoid going down the surgical route prematurely.

Click HERE for NHS information on surgical options for knees, or HERE for information on hip surgery.

Degeneration in the spine involves the wearing of cartilage and-or discs joining the vertebral bones, and can result in nerve compression and surrounding soft tissues symptoms. A conservative approach is always key in addressing movement patterns and compensations that may have caused spinal issues. Steroid injections can also help but, like surgery, this doesn’t address the cause and may only provide temporary relief.

In this article Spinal Surgeon Mr Damien Fahy talks about the importance of movement in addressing back issues. He also discusses the potential merits and disadvantages of spinal procedures. For example, a laminectomy (surgery to decompress nerves in the low back) is effective for taking pressure off nerves, but is not effective for treating back pain and may actually make it worse.

It’s important to be well informed about the goals of ANY treatment or procedures you are advised to have (whether conservative or surgical). A second opinion is often really helpful and it’s important to commit to a comprehensive conservative approach with hands on and movement therapy (with an osteopath or physiotherapist) before considering spinal surgery.

Tips:

1. Don’t assume that joint pain is actual joint damage. There are lots of soft tissues intricately involved in joint function which can become injured, cause pain or other problems, and respond well to conservative treatment. Problems due to actual damage are also often treatable so seek advice if you are concerned about joint related symptoms that are persistent or progressing over a number of weeks, months or years.
2. If you have been recommended surgery, or someone has suggested it will be inevitable in a few years, do get a second opinion and do your own research so that you are well informed. Keep your body in the best condition possible in terms of weight, nutrition and exercise. This will likely have a beneficial impact on current symptoms and you will recover better if, in the end, you do need surgery.
3. If movement, walking or exercise is problematic and you want to up your activity levels, seek advice and support. You might be surprised by the difference that can be made with the right help. Look for alternative types of activity/exercise to keep you active, such as swimming or pilates, which are low impact and more manageable while you address any issues. It’s a HUGE bonus to find something you enjoy so be creative.
4. Find a recommended practitioner who can provide hands on treatment, address movement patterns, and help you with exercise strategies that improve your symptoms through strength and mobility. Treatment in the form of manual therapy with exercise such as osteopathy or physiotherapy can be very effective.
5. Ensure that your treatment:
• Addresses movement patterns
• Provides hands on treatment (soft tissue or joint mobilising techniques)
• Is a body-wide approach rather than only focussing on one problematic joint/area

How I Can Help With Osteoarthritis

Think of me as a mechanic for the human body. Helping to restore good confident movement for strength and agility in all we do at any age: sitting, walking, running, and everything in between.

Addressing and reconditioning what are often relatively simple, whole-body functions can make a huge difference to pain and ability. Even if symptoms are years old or post surgery.

No part works in isolation; for example, the state and function of knees and hips are intimately connected to that of the foot-ankle and the spine. The system works as a unit, it’s all part of the same team effort that responds to your brain saying “move”.

Sometimes changes to how this body-unit works are due to obvious prior or recent injury. But dysfunction can be much more subtle over time, undetectable until you get symptoms from something like cartilage degeneration (osteoarthritis) seemingly ‘for no reason’ – which is why you’d be forgiven for thinking osteoarthritis is an inevitably painful part of ageing.

All parts of the body enjoy the benefits of the team effort of movement, and any part can be affected when the ‘team’ is prevented from working together for whatever reason – each part has a job to do to help the whole.

Working with me involves collaboratively looking at and working on your body’s big picture. To help the body deal with issues associated with degeneration we can address how the whole is working to take pressure off the areas experiencing problems. By reconditioning the body’s ability to move with a combination of hands on treatment and active movement strategies, it’s possible to regain strength and agility for confident motion.

It’s impossible to ‘heal’ osteoarthritis but we can alter how the body’s mechanics responds to it and have the potential to have a real impact on symptoms.

The good news is, in many cases, with help you can regain this scope of movement and make a real difference to how your body works, with knock on benefits to pain levels and general ability now and as you age.

What Is Inflammatory Arthritis?

This describes a group of autoimmune conditions, which can cause episodic painful swollen joints and resulting joint damage with repeated flare-ups. These conditions are different to osteoarthritis because the immune system in involved. It becomes hyperactive and targets the body’s own tissues (such as synovial membranes in joints), as well as its usual targets (germs, viruses and foreign substances).

Depending on which kind of inflammatory arthritis, it may be accompanied by system-wide symptoms such as fatigue, fever or flu like symptoms, skin problems, or inflammation elsewhere in the body such as in organs.

It’s important to see a Rheumatologist for specialist tests, treatment and management: the goal of the treatment is to lower the disease activity and early intervention results in less joint or organ damage and earlier remission.

The cause of auto-immune conditions is not well understood but it is thought to be genetic, hormonal and/or environmental factors.

There are also other types of inflammatory arthritis that are not due to autoimmune diseases:

Reactive Arthritis is a response to infection and generally clears up within a few months without long term problems.

Gout is common condition causing localised inflammation of a joint (often in the big toe) due to the build up of urate in the blood, which causes crystals to form in joint cartilage. When these shed into the joint cavity it produces an acute inflammatory response, which is very painful but easily treated with medication. It’s important to control this so that the joint doesn’t become damaged.

The tests performed by a Rheumatologist to rule out or diagnose an auto-immune disease are:

• Autoantibody tests (for antibodies that are specific to your own tissues)
• Antinuclear antibody tests (for antibodies that attack the nuclei of cells)
• Complete blood count (measures the amount of red and white blood cells present, if the body is fighting something, these amounts will be different to the norm)
• Inflammatory marker tests (if inflammation is raised CRP/C-reactive protein levels will be higher, ESR tests measure how much inflammation is in the body)
• Tests for specific blood markers which are present in specific conditions (most people with Rheumatoid Arthritis have an antibody called rheumatoid factor present. Most people with Ankylosing Spondylitis test positive for the HLA-B27 gene, but some people with this gene don’t have it so it can indicate AS but won’t confirm the diagnosis)

As with any condition, lifestyle factors are important to consider – there are always things you can do to help yourself, which may be general or specific to you:

• Medications work better if you are in good health in terms of weight and nutrition (balanced diet), blood pressure (cardiovascular system) and respiratory system, so exercise and not smoking are important.
• Some people find that anti-inflammatory diets help to reduce symptoms by avoiding foods that are considered pro-inflammatory.