Arthritis

Arthritis is common, can affect people of all ages, and causes pain and inflammation in a joint. It is a term used for over 140 conditions (Arthritis New Zealand, 2019). It has no cure but symptoms can be managed.

Osteoarthritis and Rheumatoid Arthritis are the two most common types (NHS, 2018).

Osteoarthritis:

This usually develops in adults over the age of 40, more so in women and those who have a family history of osteoarthritis (OA) (NHS, 2018). Most commonly, the hands, spine, knees and hips are affected (NHS, 2018).

Cartilage is found at the end of each bone, and provides a smooth surface for movement. OA occurs when the cartilage wears away over time (Health Navigator, 2019). OA can occur due to normal age related changes in the joint, but can also be caused by various other problems such as obesity, joint injury, gout, infection and congenital abnormalities (Southern Cross, 2017).

A doctor could do an assessment of your symptoms. X-rays and MRI scans can be used to confirm OA, but what shows on a scan may not be similar to the level of pain or disability you have (Arthritis New Zealand, 2019).

SYMPTOMS (from Physiopedia, 2019):

• Pain – mechanical pain usually related with activity. Can increase with fatigue and reduce with rest
• Pain in the morning for 10-15 minutes or after a time of being inactive
• Reduced range of movement, usually progressive
• Crepitis – this is the sound from the joint, usually from irregularities in the articulating joint surfaces (you can get clicking from your joints normally, and this isn’t a sign of arthritis)
• Mild swelling
• Muscle weakness

TREATMENT

Health Professionals, such as Doctors and Physiotherapists, recognise the impact OA can have on your daily function, leisure activities, occupation and mood and have tools to help you.

• Physiotherapy treatment can include education, self-management advice for flare ups, exercise and manual therapy (NICE, 2014).
• Behavioural changes can also have a positive impact on your pain such as exercise, weight loss, pacing, wearing appropriate footwear. A Physiotherapist can give you advice regarding these.
• Using a TENS machine can be beneficial for pain relief. If you are struggling with the pain severity, speak to a pharmacist or GP about pain relief.
• Wrapping heat or ice in a layer and applying to the joint (as long as there is no sensation loss) can be helpful for a short time (NICE, 2014).
• Pacing – little and often can allow you to achieve more than too much at once.
• Health Professionals will include you in your goal setting and plans/expectations for managing OA.
• Severe OA can be treated with a joint replacement (depending on severity or pain, disability and the individual person). However, 20% of patients have reported dissatisfaction with the result. Evidence has suggested better pre surgery health is a good indicator of a good post-operative outcome (Young, 2019).
• Young (2019) suggested a 6 to 8 week programme, exercising 3 to 5 days a week prior to surgery.

WHEN WOULD I BE REFERRED FOR FURTHER MANAGEMENT OR SURGERY?

Sometimes, your affected joint(s), such as your knee can ‘lock’. When this occurs, you cannot move the joint. This would require urgent medical attention.

Steroid injections can be used for pain relief if indicated, depending on the severity of symptoms and how advanced the OA has become.

Surgery would only be considered for those who have addressed all self-management strategies such as strengthening, weight loss and physiotherapy. It also depends on the health of the individual and the severity of the arthritis.

You would only be referred for surgery if you have had prolonged pain and functional limitation which has caused significant limitations on your daily life (NICE, 2014).

WHAT EXERCISE?

Exercise should include cardiovascular and localised strengthening exercise (NICE, 2014).

Cycling, walking, rowing, using the cross trainer are good forms of cardiovascular exercise. If you have symptomatic OA in your lower limb joints, high impact exercise can be painful at times.

A Physiotherapist can provide you with many exercises and advice for pacing. They would consider what you enjoy, what may flare you up, and make a plan based on the individual.

Rheumatoid Arthritis:

This is less common. It usually occurs between ages 40 and 50, and women are 3 times more likely to be affected than men (NHS, 2018).

Rheumatoid Arthritis (RA) is an autoimmune disease. An autoimmune condition is where your immune system attacks healthy tissue, not just infections. This creates inflammation (Arthritis New Zealand, 2019). In RA, the immune system attacks the synovium, which is a thin membrane lining the joints and makes a fluid to help the joints move freely. The inflammation thickens the synovium, which results in swelling and pain in the joints. It usually starts in the hands and feet. Over time, the inflammation can cause damage to the bone and damage if not treated effectively initially (Arthritis New Zealand, 2019).

SHOULD I GET THIS INVESTIGATED?

Doctors and Health Professionals such as Physiotherapists would ask you certain questions regarding your symptoms to rule out an inflammatory arthritis. These include the following (from Arthritis New Zealand, 2019):

• Morning stiffness lasting over 30 minutes
• Pain and stiffness that improves with movement but worsens with rest
• Pain and stiffness during the second half of the night
• Blood tests to check inflammatory markers
• A review with a Rheumatologist
• Other inflammatory problems which include inflammatory bowel disease (Crohns or Colitis), Enthesitis (inflammation of the area where tendon or ligament inserts on to the bone), Psoriasis, Uveitis (eye inflammation)
• Peripheral joint involvement (further away from the trunk such as hands, feet)

Other types:

• Ankylosing spondylitis
• Gout
• Psoriatic Arthritis
• Enteropathic Arthritis
• Reactive Arthritis
• Polymyalgia Rheumatica

RA is usually managed by a Rheumatologist. Rheumatology trained Physiotherapists can also provide great advice and rehabilitation for management of your symptoms.

Summary

Physiotherapists can help you manage your Arthritis symptoms with pacing, exercise and education. There is evidence to support this in the long term management of your symptoms.

References:

Arthritis New Zealand. 2019. Rheumatoid Arthritis. [online]. Accessed 30^th July 2019]. Available from: http://www.arthritis.org.nz

Arthritis New Zealand. 2019. What Is Arthritis? [online]. [Accessed 23^rd July 2019]. Available from: http://www.arthritis.org.nz

Arthritis New Zealand. 2019. Osteoarthritis. [online]. [Accessed 29^th July 2019].

Health Navigator. 2019. Osteoarthritis. [online]. [Accessed 29^th July 2019]. Available from: http://www.healthnavigator.org.nz

National Health Service. 2018. Arthritis. [online]. [Accessed 23^rd July 2019]. Available from: http://www.nhs.uk

Southern Cross. 2017. Osteoarthritis. [online]. [Accessed 29^th July 2019]. Available from: http://www.southerncross.co.nz

Young, S. 2019. Why Exercise before a Knee Replacement leads to a Better Outcome [online]. [Accessed 29^th July 2019]. Available from: http://www.axissportsmedicine.co.nz