Living with Chronic Illness and Pain

Arthritis and rheumatism

Acknowledgment: Source Victorian Arthritis Foundation. The role of the arthritis foundation is to provide information and assistance for people with arthritis and related musculoskeletal conditions.

What is arthritis?

Definition: The word arthritis comes from Greek: arth- = joint and -itis = inflammation. So, arthritis really means inflammation of the joint.

However, arthritis is not a single condition. There are well over 150 kinds of arthritis, all of which affect one or more joints in the body, and some of these forms of arthritis don't involve any inflammation.

Perhaps it is more useful to think of arthritis meaning problems with the joint!

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The anatomy of a joint

A joint is a meeting of two bones so that movement can occur.

Parts of a typical joint:

Cartilage

This is a strong, smooth material which forms a cushion at the end of each bone in a joint. It absorbs shock and prevents bone from rubbing against bone. If the cartilage is damaged or degenerates, osteoarthritis can occur.

Synovial membrane

This membrane encloses the synovial sack, filled with a lubricating fluid, which protects and lubricates the joint. Synovitis occurs when this membrane becomes inflamed, and is typical of rheumatoid arthritis. An infection can also cause inflammation in the synovial fluid. The deposit of crystals in the synovial fluid is a characteristic of gout.

Bursa

This is a small lubricating sac which is not actually part of the joint but which lubricates the movement of muscle over muscle and of muscle over bone. The bursa can become inflamed bursitis.

Muscle

The muscles move bones by contracting and expanding. In conditions such as polymyalgia rheumatica, the muscles become inflamed.

Tendon

The tendon is a fibrous cord that attaches muscle to bone. Tendinitis is inflammation of the tendon.

Ligament

The ligaments are short fibrous cords that attach bone-to-bone, making up the joint capsule. A problem called enthesopathy occurs when ligaments become inflamed, as in ankylosing spondylitis.

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What can go wrong in a joint?

The various forms of arthritis are part of a group of diseases called musculoskeletal disorders. These conditions affect bones, muscles and joints, for example:

• Disorders of bone: eg. osteoporosis
• Disorders of muscle: eg. polmyosotis, polumyalgia rheumatica
• Disorders of joints.

What can go wrong in joints?

• The cartilage can degenerate
• Osteoarthritis
• The joint lining can become inflamed
• Rheumatoid arthritis
• The joint fluid can become inflamed
• Gout
• Infection.

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Forms of arthritis

Dr James Fries has developed eight categories of arthritis that help people understand how arthritis affects different structures of the body.

His book Arthritis, A Take Care of Yourself Health Guide is highly recommended and is available through Arthritis Victoria. He is also the co-author, with Dr Kate Lorig, of the Arthritis Helpbook which is the basis of the Arthritis Self Management Course offered in community settings throughout Victoria.

The eight categories

Categories	What's happening?	Who is affected?	Most typical conditions	Typical places affected
Inflammatory	Inflamed membrane of the joint	Any age, mostly women	Rheumatoid arthritis	Fingers, wrists, knees
Attachment arthritis: enthesopathyhy	Inflamed ligament or tendon attachment to bone	Mostly men, onset age 15-40	Ankylosing spondylitis	Lower back, heels
Crystal arthritis	Chemical crystals in the joint	Mostly men, onset age 35-90	Gout	Knee, ankle, big toe
Joint infection	Bacteria in the joint	Any age, either sex	Staphylococcus Gonococcus	Knee, hip, shoulder
Cartilage degeneration	Breakdown of joint cartilage	Either sex, age 45-90	Osteoarthritis	End finger joints, hips, knees, neck, lower back
Muscle inflammation	Inflamed muscle tissues	Either sex, any age	Polymyalgia rheumatica Polymyositis	Muscles, not joints
Local conditions	Local injury	Either sex, any age	Bursitis (housemaid's knee) Tendinitis (tennis elbow) Low back strain Frozen shoulder	Elbow, shoulder, lower back
General conditions	Poorly defined	Either sex, any age	Fibromyalgia	All over

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What can be done?

Pain, stiffness and inflammation are hallmarks of arthritis, which is not a single disease but a range of 150 or more separate conditions. Two common forms are osteoarthritis (OA) and rheumatoid arthritis (RA).

Osteoarthritis: is essentially a degenerative process with symptoms including pain, stiffness, muscle weakness and cramps or muscle spasm around the affected joint.

Rheumatoid arthritis: a complex, frequently progressive disease that is characterised by inflammation and joint deterioration.

Some patients with osteoarthritis or rheumatoid arthritis find exercise, physiotherapy, occupational therapy and rest can help, but medication may often be required under a doctor's supervision.

The types of medication used to treat arthritis range from analgesics such as paracetamol and aspirin (also an anti-inflammatory) to prescription medications such as the non-steroidal anti-inflammatory drugs (NSAIDs).

Although cures are possible in some forms of arthritis, the basis of much therapy recommended by doctors is to control the disease and therefore the symptoms.

Exercise is an important management strategy.

There are many other strategies to choose from in living with arthritis and other musculoskeletal conditions.

Other helpful health treatments can include:

Physiotherapy

In spite of limited scientific evidence of effectiveness or precise mode of action, a broad range of treatments are successfully used by the physiotherapist to treat pain, stiffness, increase muscle strength and maintain joint mobility.

These commonly include heat, cold, ultrasound and electrical treatments such as TENS and interferential. The treatments are often used in combination with an individual exercise programme, massage, joint mobilisation and postural assessment.

Education about management of the disease is also a very important aspect of physiotherapy in rheumatic conditions.

Chiropractic

Good results can be achieved in some patients by well-trained, experienced chiropractors. Manipulation is a commonly used technique for the treatment of mechanical and degenerative spinal disorders.

Acupuncture

Properly applied acupuncture has a role in the relief of pain, but it has not been established to be more effective than physiotherapy or anti-inflammatories.

Osteopathy

This treatment consists of a wide range of soft tissue stretching, massaging and relaxation techniques, as well as manipulative therapy for specific spinal joints and soft tissues. Its effectiveness has neither been proven nor disproven.

'Unproven' remedies

Many patients are keen to try 'new' treatments that may be recommended by relatives and friends or have been featured in the media. When taking unproven remedies or other treatments purchased without a prescription, this should be discussed with your doctor. A great deal of money may be spent on some unproven remedies that may be of no benefit.

Copper

The use of copper has little scientific support. Copper bracelets are a popular alternative treatment for arthritis, but there have been no proper trials of copper bracelets in rheumatoid arthritis.

Evening primrose oil

Evening primrose oil supplements have been shown to decrease inflammation, but the benefits are still not confirmed. The safety of long term use has not been determined.

Fish oil

There have been a number of studies examining the relationship between treatment with fish oil and rheumatoid arthritis, which found a modest improvement in morning stiffness, number of tender joints and onset of fatigue. There is research under way investigating the possibility of using fish oil in combination with anti-inflammatories. It may be beneficial to include several fish meals in the diet each week.

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Supplements

Vitamin and mineral supplements, herbal and homeopathic remedies have been advocated for arthritis. The claims for these therapies are largely unproven and they may have adverse effects. In addition these supplements may be highly priced and they should not be a substitute for treatments that have been proven to be effective.

Zinc has not been proven to have a significant anti-rheumatic effect and prolonged use may be harmful.

Selenium supplements require further study to determine their role, if any, in the treatment of rheumatoid arthritis.

Vitamins

Although vitamin C levels may be reduced in rheumatoid arthritis patients, large doses have not been found to be effective. Serious toxic effects have been reported in patients taking large doses of water soluble vitamins such as vitamins B3, B6 and C and fat soluble vitamins (A, D, E, K).

Herbal medicine

A large number of herbs have been advocated for use in arthritis, including celery, devil's claw, willow bark and yucca. There is little information regarding their safety and some may have long term adverse effects. Some herbs such as devil's claw and celery should be avoided in pregnancy. Large quantities of any one product taken over a long period of time may be dangerous. Scientific studies on the efficacy of herbal remedies are generally lacking. Patients should tell their doctor if they are taking herbal remedies.

New Zealand green-lip mussel

Green-lipped mussel extract has not been proven to be beneficial in reducing inflammation in arthritic patients.

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Where can I go for help?

• Your doctor
• The Arthritis Australia website
• The Arthritis Foundation office in your state

On the web

• Arthritis Australia website:
  http://www.arthritisfoundation.com.au

Arthritis Foundation in your state or territory

Arthritis Foundation of NSW
13 Harold Street,
North Parramatta NSW 2151
Locked Bag 16
North Parramatta NSW 2151
Phone: (02) 9683 1622
Fax: (02) 9683 1633
Website: www.arthritisnsw.org.au

Arthritis Foundation of VIC
263-265 Kooyong Road
Elsternwick VIC 3185
PO Box 130
South Caulfield VIC 3162
Phone: (03) 9530 0255
Fax: (03) 9530 0228
Website: www.arthritisvic.org.au/

Arthritis Foundation of QLD
Cnr Cartwright ST & Lutwyche Road
Windsor QLD 4030
PO Box 2121
Windsor QLD 4030
Phone: (07) 3857 4200
Fax: (07) 3857 4099
Website: www.arthritis.org.au

Arthritis Foundation of SA
Unit 1, 202-208 Glen Osmond Road
Fullerton SA 5063
Phone: (08) 8379 5711
Fax: (08) 8379 5707
Website: www.arthrissa.org.au

Arthritis Foundation of WA
17 Lemnos Street
Shenton Park WA 6008
PO Box 34
Wembley WA 6014
Phone: (08) 9388 2199
Fax: (08) 9388 4488
Website: www.arthritiswa.org.au/

Arthritis Foundation of TAS
Box 30, McDougall Building Ellerslie Road
Battery Point TAS 7004
Phone: (03) 6224 4755
Fax: (03) 6223 7318
Website: www.arthritistasmania.com.au

Arthritis Foundation of ACT
27 Mulley Street
Holder ACT 2611
GPO Box 1642
Canberra ACT 2601
Phone: (02) 6288 4244
Fax: (02) 6288 4277
Website: www.arthritisact.com.au

Arthritis Foundation of NT
6 Caryota Street
Coconut Grove NT 0810
Phone: (08) 8948 5232
Fax: (08) 8948 5234
Website: http://www.aont.org.au/

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