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Understanding arthritis


It’s a disease that will eventually affect half of us. Nadia Badarudin gets some answers from the president of Arthritis Foundation Malaysia

DANIEL Johns, guitarist and vocalist of Australia’s rock band Silverchair was diagnosed with arthritis when he was working on the band’s fourth album, Diorama, in late 2001.

Johns developed pain in his knees that soon spread to his shoulders, back, feet, wrists and pelvis. He claimed that the pain was so excruciating that nobody could join him when he sat on the sofa as the movements on the cushions would make the pain worse.

For Johns and individuals with arthritis, doing simple tasks such as walking, buttoning up a shirt or holding a pen are impossible without effort.

Arthritis Foundation Malaysia president Dr Amir Azlan Zain says arthritis is part of a complex family of musculoskeletal conditions in which an inflammatory process destroys joint tissues. “Arthritis in general will affect half of us at some in point our lives. It’s part and parcel of the ageing process. The joints age and that’s when the problem starts to occur.

“It will particularly affect people who don’t practise an active lifestyle,” adds Dr Amir, who is also a consultant physician and rheumatologist.

Arthritis is now the main cause of disability among people over 55 years in industrialised countries. The debilitating effect of arthritis not only affects the physical ability of a person but also his quality of life, leading to a vicious cycle of mental and emotional disturbances.

Left untreated and inadequately managed, arthritis can evolve into a social and economic burden. There is no cure for arthritis but there are a number of treatments that can help slow down the condition’s progress.

Dr Amir answers more questions below.

What are the common types of arthritis among Malaysians?
Osteoarthritis. A progressive degenerative joint disease characterised by the breakdown of joint cartilage associated with risk factors such as overweight/obesity, history of joint injury and age.

Rheumatoid Arthritis. A systemic disease characterised by the inflammation of the membranes lining the joint which causes pain, stiffness, warmth, swelling and sometimes severe joint damage.

Juvenile Idiopathic Arthritis.

An umbrella term used to describe the many autoimmune and inflammatory conditions that can develop in children of 16 years and younger. Children with this condition present in a number of ways, from generalised systemic symptoms involving weight loss, fevers and joint pains to just one joint being affected by pain, swelling and subsequent damage.

Which groups are prone to arthritis?
Family history. Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. Your genes can make you more susceptible to environmental factors that may trigger arthritis.

Age. The risk of many types of arthritis increases with age.

Sex. Women are more likely than men to develop rheumatoid arthritis, while men are likely to have gout.

Previous joint injuries. People who have injured a joint perhaps while playing a sport, are more likely to eventually develop arthritis in that joint.

Obesity. Being overweight is a significant risk factor in the development of arthritis. Obesity puts additional strain on the weight-bearing joints and can lead to arthritic problems at an early age.


What are the causes of arthritis?
What goes wrong depends on what type of arthritis you have. It could be that the cartilage is wearing out, a lack of fluid, autoimmunity (your body attacking itself), infection or a combination of factors.

Generally, arthritis occurs due to the degeneration of joint cartilage, a portion of the joints, which functions as a cushion between bones to prevent them from rubbing against each other. The cartilage, which acts as a shock absorber, will gradually wear out in some areas due to constant friction. As the cartilage becomes damaged, and tendons and ligaments become stretched, every rub then triggers inflammation that eventually leads to severe pain and joint stiffness.

How is the illness diagnosed?
The doctor will ask questions about your symptoms and how they have developed. Some of the questions are as follows:

•     The site of your pain and the joints involved.
•     Restricted movement.
•     Any swelling in or around your joints, which could signal inflammatory arthritis.
•     Other aspects of your health as arthritis can affect other organs in your body.
•     Possibly, physical tests will be performed to clarify things and the physical exam may show:
•     Fluid around a joint.
•     Warm, red, tender joints.
•    Difficulty in moving a joint.
•     Blood tests and joint X-rays are often done to check for infection and other causes of arthritis.

What will happen if the illness is not treated?
On a mild level, arthritis sufferers will find good and bad days. Most patients with arthritis will suffer from discomfort, pain, stiffness and/or fatigue.

If left untreated, arthritis can cause joint destruction. Arthritis attacks bone, cartilage and soft tissue causing joints to weaken, and deform to varying degrees.

However, the illness can lead to disability and permanent damage to vital organs. People who have rheumatoid arthritis, for instance, have an increased risk of coronary artery disease (hardening of the arteries to the heart) compared with those who don’t have rheumatoid arthritis.

What are the treatments available?
Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint swelling. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength.

Medication can help relieve the symptoms of arthritis. The goal of treatment is to reduce pain, improve function and prevent further joint damage. The underlying cause often cannot be cured.

Other things you can do include:

•     Get enough sleep. Sleeping eight to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent flare ups.
•     Avoid staying in one position for too long.
•     Avoid positions or movements that place extra stress on your sore joints.
•     Try stress-reducing activities such as meditation, yoga, or tai chi.
•     Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E.
•     Eat foods rich in omega-3 fatty acids such as cold water fish (salmon, mackerel and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
•     Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.
•     In severe cases, surgery may be done if other treatments have not worked. This may include arthroplasty to rebuild the joint and joint replacement such as a total knee joint replacement.

What are the common myths linked to arthritis?
Myth 1: Arthritis is just minor aches and pains associated with getting older.

Fact: Arthritis is actually a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that can affect people of all ages, races and genders.

Myth 2: Arthritis is not a serious health problem.

Fact: Arthritis places a growing burden on the health care and economic systems in this country. It is actually a more frequent cause of activity limitations than heart disease, cancer or diabetes.

Myth 3: People with arthritis should avoid exercising.

Fact: Exercise is an important tool in the fight against arthritis.

Myth 4: Not much can be done for arthritis.

Fact: Relief is available and new treatments are in the pipeline. The Arthritis Foundation Malaysia helps people who already have arthritis to live better with the illness.

Myth 5: Taking supplements such as glucosamine alone can cure arthritis.

Fact: Maintaining an active and healthy lifestyle, and taking supplements can help to slow down the progress of the illness.

What can a patient do to alleviate pain?
Arthritis takes a very long time to manifest with painful symptoms. The rebuilding of cartilage also takes time. However, by rebuilding and restoring general health, arthritis can be conquered. With a healthy diet filled with wholesome food and natural supplements, and a positive attitude, you will discover that the natural answer to a pain-free lifestyle must be nurtured from within.

Pain can also be relieved with ice packs or heating pads. Ultrasound and hot packs provide deep heat, which relieves localised pain and relaxes muscle spasm around the affected joint. You may find that a warm bath/shower makes it easier for you to exercise afterwards.

Patients who are physically active generally enjoy better health, are happier, live longer, experience improvements in pain, sleep, day-to-day functioning and general energy levels.

Read more: Understanding arthritis – Health – New Straits Times

via Understanding arthritis – Health – New Straits Times.


Arthritis can affect toddlers too, says mother of two-year-old Blaze

Blaze O'Sullivan

Blaze need daily medication
By Caroline Parkinson Health editor, BBC News website


“Arthritis isn’t something you think a two-year-old could have.”

But that was the explanation Kelly O’Sullivan was eventually given for her two-year-old daughter Blaze’s unusual symptoms – a rash that covered her body and swollen joints which stopped her wanting to walk.

Kelly, from Bolton, says Blaze had a normal birth and developed normally, walking when she was a year old.

But Blaze became ill in January this year when she was 18 months old.

Kelly says: “At first she got a rash all over her and a high temperature and she didn’t want to walk.

“I took her to the doctor and she was given lots of different medicines, antibiotics.

“Then she started walking with a limp, and it got progressively worse and her knee swelled up to the size of a tennis ball.”

Doctors thought Blaze’s symptoms were caused by a viral infection, but then she began to experience stiffness in her neck and this time was referred to her local hospital.

Kelly said: “They still thought it was a viral infection. She was in there for about four weeks, and given intravenous antibiotics. Lots of doctors from different specialties saw her.”

However there was still no diagnosis – and Blaze was moved to Manchester Children’s Hospital where another raft of tests, including a lymph node biopsy and a bone marrow test, were carried out.

Finally – in March – she was diagnosed with systemic juvenile idiopathic arthritis (JIA).

‘She shouldn’t miss out’

JIA refers to a group of arthritic conditions which affect children. All cause inflammation, but relatively little is known about them and how they will progress.

Any problem usually starts before a child is five, and affects more girls than boys. An estimated 12,000 children in the UK have a form of arthritis.

Some only have a short-term illness, while around a third continue to have symptoms into adulthood – but it is hard to predict how an individual’s illness will progress.


There is so little known”

Prof Wendy Thomson, CAPS study

Kelly said she was pleased that Blaze had a diagnosis at last – but surprised.

“I didn’t know a two-year-old could get arthritis. It’s not something you think they can have.”

Blaze now has to have daily and weekly injections and takes steroids to control her symptoms.

Kelly, who also has a two-week-old baby, says the medication is helping but Blaze cannot lead a normal toddler’s life.

“She should be able to run around like any normal toddler. And I can’t get her into a nursery because one of the drugs she takes, methotrexate, affects the immune system and they won’t take her.

“I’m trying to get her a place though, because she shouldn’t have to miss out.”

‘Worth it’

Blaze is one of over 1,300 children taking part in a study overseen by the University of Manchester, and backed by the charity Arthritis Research UK, which aims to find out more about JIA.

Geneticist Prof Wendy Thomson, who is one of the researchers working on the study, said: “There is so little known. Parents often say there’s a lack of information about what might happen to their child.”

Children in the study, which began in 2001, are followed up annually to the age of 16, with subsequent checks at the age of 18 and 21.

Kelly said: “When it was explained they they didn’t know much about the illness and wanted to find out more, I decided to get involved.

“If that helps another family in the future, rather than them having to go through months waiting to find out what it is, it’s worth it.”


Arthritis: How sports stars can learn to reduce risk

Ciaran Burns
Ciaran Burns played basketball at a high level

Sports-mad Ciaran Burns was 22 years old when he was diagnosed with degenerative arthritis in his right knee.

For a semi-professional basketball player who had represented the Republic of Ireland at junior level, the news was devastating.

“At my age I didn’t think anything like that was going to bother me.

“I’d been playing sport competitively since I was 10 years old. It was very hard to give up.”

Ciaran joins a long list of sportsmen and women whose careers have been curtailed or ended by this kind of injury.

England cricketer Andrew Flintoff and Spurs defender Ledley King’s chronic knee problems are probably the best-known examples.

Professional sports people get early arthritis because of the frequent trauma to their joints”

Dr Tom Saw

It’s not surprising that athletes place great physical pressure on their bodies, but scientists now want to find out how far they can go before risking long-term injury.

A new national research centre, funded by £3m ($4.7m) from Arthritis Research UK, may provide the answer.

Prof Alan Silman, medical director of the charity, say there are lots of unknowns in this area.

“We need to know how to achieve a balance between exercise that is good and exercise that is harmful.

“In general, using your joints is good because cartilage and bone need the stimulus of exercise.

“Even a little bit of damage is okay because it will repair, but when damage is outweighing the repair mechanism, then it becomes something else.”

What it tends to become is osteoarthritis.

Osteoarthritis affects the joints, causing pain, stiffness and reduced mobility – and it affects the lives of around nine million people in the UK.

Although it occurs more frequently in older people, young people and children can still be affected.

Ciaran knew that the wear and tear on his joints from playing basketball and a bad cruciate ligament injury at 19 had contributed to serious problems in his knee.

His injury is also typical of footballers, and his arthritis diagnosis shows what can happen when a joint is left permanently damaged and changes occur in how the joint works.
Ciaran Burns
Ciaran was told he might need a knee replacement

Tom Saw, a GP in Milton Keynes with a specialism in sports and exercise medicine, says he sees people of all ages with joint pain.

But the older we get, the less hope we have of avoiding it.

“One hundred per cent of 60 year olds have arthritis in their lumbar spine,” he says.

“People who are obese are more likely to have joint pain, and professional sports people get early arthritis because of the frequent trauma to their joints.”

Dr Saw’s advice is to keep the weight down and exercise regularly – and sensibly.

There are certain forms of exercise, he says, which are better than others.

“Swimming, cycling and walking is a good combination.”

This is because they combine joint-friendly cardiovascular exercise and the use of big muscles in cycling which can result in weight loss.

‘Carry less weight’

Learning how to jump and turn and land is vital”

Prof Alan Silman

Dr Simon Till, consultant in sport and exercise medicine at the Royal Hallamshire Hospital in Sheffield, says the message on how to keep your joints healthy is to keep active.

“It doesn’t have to be going to the gym. Being active throughout the day is better.

“For example, walking rather than using the car, getting off the bus a stop early and doing the gardening regularly.”

Even for someone with osteoarthritis, the advice is still to carry less weight and build up cardiovascular fitness, Dr Till says.

Ciaran, who is now 29, was told that he would need a knee replacement at 35 if he kept punishing his joint.

“My daughter was six months old at the time and it was very difficult to kneel over a bath. My knees would be clicking away going up and down stairs, and swelling up.”

He found that physiotherapy and taking an alternative rosehip therapy helped him.

Dr Saw acknowledges that some natural remedies, as well as aspirin and anti-inflammatories, can have a positive effect on joint pain.

But the most important remedy and means of prevention – for professionals and amateur athletes – is to engage in sporting activities without overloading the joints, Prof Silman says.

“Warming up and training exercises are key. Learning how to jump and turn and land is vital.

“Research shows that the way you train can have a big impact on your body.”


Arthritis sufferers ’40 per cent more likely to develop fatal heart problems’

A survey found that arthritis sufferers have a 40 per cent higher risk of suffering from an irregular heartbeat

Arthritis sufferers are far more likely to develop fatal heart problems and strokes, a major study reveals today.

It shows that patients with rheumatoid arthritis have a 40 per cent higher risk of suffering from an irregular heartbeat which can lead to heart attacks and death.

They have also been found to be at 30 per cent greater risk from suffering strokes.

Danish researchers believe the inflammation of joints that occurs in arthritis may cause the heart to beat irregularly – a condition known as atrial fibrillation.This can lead to the formation of blood clots which in turn can trigger a stroke.

Around 400,000 people in England and Wales suffer from rheumatoid arthritis which causes debilitating pain and swelling in the joints.

Scientists from Copenhagen University studied more than 4 million people of whom 18,250 had rheumatoid arthritis over a period of five years.

Those with rheumatoid arthritis were 40 per cent at higher risk of atrial fibrillation and 30 per cent higher risk of strokes than the general public.

Although this seems like a big increase, the overall risk still of having heart problems or strokes still remains low.

In a group of 1,000 normal patients, six would likely suffer from atrial fibrillation in any given year while 5.7 would be likely to have a stroke.

But amongst a group of 1,000 rheumatoid arthritis sufferers, 8 would be expected to have atrial fibrillation while 7.6 would be likely to have a stroke.

However the researchers – whose findings are published on the website – point out that doctors need to be aware of these heightened risks amongst their patients.

Professor Michael Ehrenstein, of Arthritis Research UK said: ‘Inflammation plays a central role in rheumatoid arthritis and in the disease process of many other related conditions, so it’s not surprising that it may also play a role in the development of atrial fibrillation.’

Rheumatoid arthritis tends to strike between the ages of 40 and 70 and is more common amongst women than men.

It happens when the body’s immune system attacks the cells lining the joints making them swollen, stiff and very painful.

Experts believe that it may trigger inflammation of the blood vessels which in turn triggers heart problems.

In 2010 Swedish researchers who had looked at 400,000 people found the condition was also linked to heart attacks.

They were found to be 60 per cent more at risk compared to other patients.

Read More: DailyMail

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