Arthritis

Introduction
Arthritis is a common condition that causes pain and inflammation in ajoint.
In the UK, around 10 million people have arthritis. It affects peopleof all ages, including children (see below).
Types of arthritis
The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.
Osteoarthritis
Osteoarthritis is the most common type of arthritis in the UK, affecting around 8 million people.
It often develops in people who are over 50 years of age. However, it can occur at any age as a result of an injury
or another joint-related condition.
Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes movement more difficult than
usual, leading to pain and stiffness.
The cartilage lining of the joint can then thin and tissues within the joint can become more active. This can then
lead to swelling and the formation of bony spurs, called osteophytes.
In osteoarthritis, the cartilage (connective tissue) between the bones gradually erodes, causing bone in the joints
to rub together. The joints that are most commonly affected are those in the hands, spine, knees and hips.
Read more aboutosteoarthritis.
Rheumatoid arthritis
In the UK, rheumatoid arthritis affects more than 400,000 people. It often starts when a person is between 40 and
50 years old. Women are three times more likely to be affected than men.


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Rheumatoid and osteoarthritis are two different conditions. Rheumatoidosteoarthritis occurs when the body's
immune system targets affected joints, which leads to pain and swelling.
The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading
to further swelling and a change in the joint's shape. This can cause thebone and cartilage to break down.
People with rheumatoid arthritis can also develop problems with other tissues and organs in their body.
Read more about rheumatoid arthritis.
Other types of arthritis and related conditions
G Ankylosing spondylitisa long-term inflammatorycondition that mainly affects the bones, muscles and
ligaments of the spine, leading to stiffness. Other problems can include the swelling of tendons, eyes and
large joints.
G Cervicalspondylosisalso known as degenerative osteoarthritis, cervical spondylitis affects the joints
and bones in the neck, which can lead to pain and stiffness.
G Fibromyalgiacauses pain in the body's muscles, ligaments and tendons.
G Lupusan autoimmune condition that can affect many different organs and the body's tissues.
G Gouta type of arthritis caused by too much uric acid in the body. This can be left in joints (usually affecting
the big toe) but can develop in any joint. It causes intense pain and swelling.
G Psoriatic arthritisan inflammatory joint condition that can affect people withpsoriasis.
G Enteropathic arthritisa form of chronic, inflammatory arthritis associated with inflammatory bowel
disease (IBD), the two best-known types being ulcerative colitis and Crohn's disease. About 1 in 5 people
with Crohn's or ulcerative colitis will develop enteropathic arthritis. The most common areas affected by
inflammation arethe peripheral (limb) joints and the spine.
G Reactive arthritisthis can cause inflammation of the joints, eyes and urethra (the tube that urine passes
through).It develops shortly after an infection of the bowel, genital tract or, less frequently, after a throat
infection.
G Secondary arthritisa type of arthritis that can develop after a joint injury and sometimes occurs many
years afterwards.
G Polymyalgia rheumaticaa condition that affects people over 50 years of age, where the immune system
causes muscle pain, stiffness and joint inflammation.
Symptoms of arthritis
Thesymptoms of arthritis you experience will vary depending on the type you have.


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This is why it's important to have an accurate diagnosis if you have:
G joint pain, tenderness and stiffness
G inflammation in and around the joints
G restricted movement of thejoints
G warm, red skin over the affected joint
G weakness andmuscle wasting
Arthritis and children
Arthritis is often associated with older people, butit can alsoaffect children. In the UK, about 15,000 children and
young people are affected by arthritis.
Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA). JIA causes pain andinflammation
in one or more joints for at least six weeks.
Although the exact cause of JIA isunknown, the symptoms often improve as a child gets older, meaning they can
lead a normal life.
The main types of JIA are discussed below. You can also readmore about the different types of juvenile idiopathic
arthritis on the Arthritis Research UK website.
Oligo-articular JIA
Oligo-articular JIA is the most common type of JIA. It affects fewer than five joints in the bodymost commonly in
the knees, ankles and wrists.
Oligo-articular JIA has good recovery rates and long-term effects are rare. However, there's a risk that
childrenwith the condition may develop eye problems, so regulareyetests with an ophthalmologist (eye care
specialist) are recommended.
Polyarticular JIA (polyarthritis)
Polyarticular JIA, or polyarthritis, affects five or more joints. It can develop at any age during childhood.
The symptoms of polyarticular JIA are similar to the symptoms of adult rheumatoid arthritis. The condition is often
accompanied by a rash and a high temperature of 38C (100.4F) or above.


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Systemic onset JIA
Systemic onset JIA begins with symptoms such as a fever, rash, lethargy (a lack of energy) and enlarged glands.
Later on, joints canbecome swollen and inflamed.
Like polyarticular JIA, systemic onset JIA can affect children of any age.
Enthesitis-related arthritis
Enthesitis-related arthritis is a type of juvenile arthritis that affects older boys or teenagers. It can cause pain in the
soles of the feet and around the knee and hip joints, where the ligaments attach to the bone.
Treating arthritis
There's no cure for arthritis, but there are many treatments that can help slow down the condition.
For osteoarthritis, painkillers,non-steroidal anti-inflammatory drugs (NSAIDs) andcorticosteroids are often
prescribed.
In severe cases, the following surgical procedures may be recommended:
G arthroplasty (joint replacement)
G arthodesis (joint fusion)
G osteotomy (where abone is cut and re-aligned)
Read moreabouthow osteoarthritis is treated.
In treating rheumatoid arthritis, the aimis to slow down the condition's progress and minimise damage to the
joints. Recommended treatments include:
G analgesics (painkillers)
G disease modifying anti-rheumatic drugs (DMARDs)
G physiotherapy
G regular exercise
Read moreabouthow rheumatoid arthritisis treated.
Further information and support


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Arthritis Research UK and Arthritis Careprovide moreinformation about arthritis, as well as advice and support
for people living witharthritis.
You can also use the NHS post code search tofind arthritis services in your area.




Living with arthritis
Living with arthritis isn't easy and carrying out simple, everydaytasks can often be painful and difficult.
However, there are many things you can do to make sure you live a healthy lifestyle.A range of services and
benefits are also available.
Work
Many people with arthritis want to continue working for many reasons, including betterfinancial security and higher
self-esteem.
Improved treatment approaches have helped ensure that many peoplewho are diagnosed with arthritis can return
to work.This is particularly the case if arthritis is diagnosed and treated at an early stage.
You may find work challenging, but your employer should help you with the training and support you need.
Help is also available if your arthritis is so severe that you're unable to work. Find out more about the Personal
Independence Payment (formerly known as the Disability Living Allowance).
TheArthritis Care website also hasmore useful information about working with arthritis.
Healthy eating
It's very important to eat ahealthy, balanceddiet if you have arthritis. Eating healthily will give you all the nutrients
you need and help you maintain a healthy weight.


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Your diet should consist of a variety of foods from all five foodgroups. These are:
G fruit and vegetables
G starchy foodssuch as bread, rice, potatoes and pasta
G meat, fish,eggs and beans
G milk and dairy foods
G foods containingfat and sugar
Read more about how to have a healthy, balanced diet.
If you're overweight, losing weight can help considerably.Too much weight places excess pressure on the joints in
your hips, knees, ankles and feet, leading to increased pain and mobility problems.
Read more abouthow you can lose weightusing the weight loss guide.
Exercise
If your arthritis is painful, you may not feel like exercising. However, being active can help reduce and prevent pain.
Regular exercisecan also:
G improve your range of movement and joint mobility
G increase muscle strength
G reduce stiffness
G boost your energy
As long as you do the right type and level of exercise for your condition, your arthritis won't get any worse.
Combined with a healthy, balanced diet (see above), regular exercise willhelp you lose weight and place less
strain on your joints.
Your GP can advise about the type and level of exercise that's right for you. Arthritis Care also produce a number
ofuseful booklets, includingExercise and arthritis (PDF, 5Mb) andPain and arthritis (PDF, 1.7Mb).
Joint care
If you have arthritis, it's important to look after your joints so that there is no further damage. For example, try to
reduce the stress on your joints while carrying out everyday tasks like moving and lifting.
Sometips for protecting your joints,particularly if you have arthritis, include:


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G use larger, stronger joints as leversfor example,take the pressure of opening a heavy door on your
shoulder rather than on your hand
G use several joints to spread the weight of an objectfor example, use both hands to carry your
shopping or distribute the weight evenly in a shoulder bag or rucksack
G don't grip too tightlygrip as looselyas possible or use a padded handleto widen your grip
TheArthritis Care website has more information and advice about taking care of your joints.
It's also important toavoid sitting in the same position for long periods of time and to take regular breaks so you
can move around.
Read more about good posture and how to sit correctly.
At home
If you have arthritis, carrying out tasks around the home can be a challenge. However, making some practical
changes to your home and changing the way you work should make things easier.
Practical tips that could help include:
G keeping things in easyreach
G using a hand rail to help you get up and down the stairs
G using long-handled tools to pick things up or to clean
G fitting levers totaps to make them easier to turn
G using electric kitchen equipment, such as tin openers, when preparing food
You can find more useful information and advice about living independently at homeon the Arthritis Care website.
Occupational therapy
An occupational therapist can help if you have severearthritis that's affecting your ability to move around your
home and carry out everyday tasks, such as cooking and cleaning.
They can advise about equipment you may need to help you live independently.
Depending on the exact nature of your condition, your GP may be able to refer you to an NHS occupational
therapist. However, you may need to access this type of therapy through your local council (external website).


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Read more about occupational therapy.
Does acupuncture help?
Some people with osteoarthritis say that acupuncture has helped relievetheir symptoms.
However,if you wish to try it, bear in mindthat any benefitsof acupuncture are likely to be the result of expectation
or placebo effect (external link).
Read moreabout the placebo effect.
The lack of evidence for the effectiveness of acupunctureis why health watchdog NICE doesn't recommend it for
treating osteoarthritis.
Arthritis and driving
You only need to inform the DVLA if you have arthritis and use special controls for driving.
TheGOV.UK website has more information and advice about telling the DVLA about a medical condition or
disability.
"Dancing got me through the roughest times"
Paul Casimir has been living with arthritis for half his life, but doesnt let it stop him 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 didnt 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 bedfor 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


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to a rheumatologist, who diagnosed rheumatoid arthritis. It was something Id never heard of and I didnt know why
it was happening to me. I had tears in my eyes when she told me.
Paul managed his condition with painkillers and anti-inflammatory medication forthe nextfew 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 didnt really notice much of a difference with the medication, he says. People diagnosed now would be offered
different kinds of medication, such as disease-modifying medication, but I guess that wasnt 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.
Hestarted 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.Its easy to dwell on the pain and misfortune and to think why me. But in
the end, that's really quite futile. Whats 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 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
didnt 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 be certain that the condition I had was osteoarthritis."


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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 for 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 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 wasnt my usual GP, and he just
told me to buy new shoes! I did, but they didnt 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 the pain. However, at 14, she had to


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take a year off school as the pain got worse.
Every joint in my body would ache, apart from my hips, which luckily have never beenaffected, 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 couldnt be
spontaneous as I always had to plan how Id get home from somewhere and I couldnt walk very far. Following
university, she got a job withArthritis Care and now edits the charitys magazine.
Kate has a very aggressive form of rheumatoid arthritis, and so far has had an elbow and a knee replacement. In
the past, shes 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.
Shes under no illusions about the severity of her illness. Sometimes, when the pain is bad, I think: 'is this the next
stage?' I know Ill need more operations in the future, but I try to stay positive. It can be hard. Its not obvious that
Ive got arthritis and Ive 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 illness. I have to watch my energy levels. If I know that, for example, Im going to a
wedding, Ill do absolutely nothing the day before because I know it will wipe me out and Ill 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 youll get all the
information you need, she says. Youll also find support and help with what can be a very isolating condition.


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