Wear and tear arthritis, medically known as osteoarthritis is not life-threatening, but can be extremely painful and uncomfortable and sadly there is still no real cure on the horizon to ease the burden of this type of arthritis.
However, there are ways to help cope with the condition, whichever form it comes in – either osteoarthritis or rheumatoid arthritis. I went along to St Mary’s Hospital to speak to Dr Mark Pugh (left), consultant rheumatologist who has been working on the Island since January 2003, and prior to that was a consultant in Solihull, West Midlands.
Mark explained: “With osteoarthritis you get failure of the cartilage in the joints, where as rheumatoid arthritis starts to attack the lining of joints which then damages the cartilage and bone. Typically rheumatoid arthritis is regarded as a more severe form of arthritis although you can have mild rheumatoid arthritis, and in that case severe osteoarthritis is much worse.
“The classical symptoms of arthritis are pain, stiffness and swelling. Some of the drugs we use to treat rheumatoid arthritis can help the symptoms of osteoarthritis, especially in the early phases of the condition, although it doesn’t improve the long-term outcome.
“There are several causes of osteoarthritis, but it is the most strongly inherited of all common types of arthritis, so if your mother and father had dodgy knees or back, there is every likelihood you will go the same way. Symptoms can come on quite suddenly and in lots of places. It can be in one joint or in many joints, and in small or big joints.” So if you suffer from osteoarthritis, the question is what next?
Mark said: “It is important to stay mobile, and generally not rest the joint. Even if using it causes discomfort, it keeps the muscles strong, which in turn helps the joint. With strong muscles you normally get less pain. If you are carrying extra weight, then reducing that also helps and slows down the rate that your hip, knee or back will wear out.
“If you wear padded footwear, like trainers, that reduces the symptoms, particularly in the knee and to a lesser extent the hip. My advice is if you do something today; are aching stiff tomorrow but by the day after you feel ok, that’s all right. But if you do something and wipe yourself out for three or four days, you have obviously overdone it , but you have exercised the right bit, because it has complained. So you need to find your baseline, and over three months of more exercise you should get less pain.”
Mark has no evidence that cutting down on drinking or smoking helps, although drinking sometimes makes you put on weight. There is also no evidence that cutting out red meats, tomatoes, and acid foods makes a difference.
He continued: “There are lots of different types of pain relief medication and injections which can ease symptoms and allow people to live with their symptoms, without needing to progress to surgery. In fact most people who get osteoarthritis don’t need a joint replacement – it is not inevitable. But if you need hip or knee surgery, then they are about the most successful operations medicine has to offer, and results are normally very good.
“Cod liver oil contains something similar to aspirin so if you take it you get a pain-relieving effect with it, and I have no problem with that although taking one cod liver oil tablet a day probably doesn’t make much difference. You normally have to take it under prescription several times per day to have any real effect. However, if you feel something works, then take it, but everyone needs to work out what tablets work best for them.
“If you are taking an anti-inflammatory tablet, then there is no point in using a gel as well. Gels are probably not as effective as tablets, but they do work, are safer to use, and you can get some benefits.
“Most muscle and joint pains are worse in cold weather, and people will tell you if they go away for a sunny holiday it helps. There are lots of good reasons why that should be the case, because warmth improves blood flow, and when you are cold muscles shrink a bit, and that pulls on your painful joints and tendons.”
In terms of the future for rheumatologists, osteoarthritis is the holy grail of research at the moment. A lot of money and effort is being spent to try to discover treatments that will improve symptoms, and control and try to prevent damage progressing once it occurs.
Mark added: “There are various tablet and injection based treatments being used to try to alter the chemical structure of cartilage and try to toughen it up and make it less likely to wear away. There is a lot of research, but there is nothing dramatic that will be available shortly. I believe it is still more like five to 10 years away. At present it is almost inevitable that if you live long enough you will suffer symptoms of osteoarthritis, as we are living longer and longer this is likely to become a bigger problem for society and that is why on-going research in this area is so important.”