What is arthritis and why does it need support?
Arthritis has been reported to be one of the most prevalent health conditions across the US and Europe, leading to multiple joint disabilities. Arthritis is a condition which is associated with pain and inflammation of the joints. The condition affects the whole joint including the surfaces of the bones in those joints and the surrounding connective tissues.
Arthritis is now the biggest contributor to physical disability across the world, with an estimate of nine million people being affect with a form of arthritis here in the UK and over 60 million in the US. 1 in 5 people will be affected in their lifetime and 1 in 3 people are now not physically active because of it. The condition is invisible and as such, people suffering with it don’t get the help or support needed despite 33% of sufferers reporting severe joint pain.
It is usually the elderly that are the most thought of when it comes to arthritis, however, roughly 30,000 people under the age of 25 in the UK suffer from arthritis, of which half of these are children. When linked with the fact that our expected living age is on the rise, people will be expected to live with the condition for much longer. Currently arthritic wear has no direct cure and experts predict numbers will increase by a further 49% by 2040.
With this, charities and organisations are trying to further the public’s awareness of arthritis and educate people about its general presentation and its more specific types. Twice a year as monthly awareness campaigns, the condition is supported and discussed globally. Here in the UK and Europe, arthritis awareness is usually supported through the month of October, however, this month we still support the US campaign, with events and support being shown throughout the UK too.
The focus of such awareness months is to educate and inform people about arthritis, how it presents through difference forms, how it affects people’s lives from how it limits mobility, to how it affects mental health and help build support networks across multiple platforms.
Some facts and related statistics about arthritis.
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The most common forms of arthritis are osteoarthritis (OA), followed by rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and gout.
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Osteoarthritis is the most common worldwide presentation affecting 10% of all men and 18% of all women.
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Rheumatoid arthritis is an inflammatory arthritis disease which is less common and affects roughly 1% of the UK population .
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18% of all arthritic joint symptoms arise from the knee, followed by 8% in the hip, and 6% in the hand and wrist.
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Arthritis is the most frequent cause of chronic physical disability.
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1 in 2 of us will have some form of arthritis by the time we are 70 years old.
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It costs the NHS more than £3 billion annually, and when included with other healthcare providers and services costs in excess of £10 billion.
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There are strong associated links to increased rates in mental health cases and depression when arthritic conditions present with chronic pain.
Osteoarthritis (OA)
OA is generally stigmatised as ‘Old Age’ arthritis and is where the joint and associated tissues breakdown due to prolonged wear and tear, or onsets early due to trauma or surgery. It affects the cartilage and smooth linings of the joint which makes movement more difficult causing stiffness and pain. Osteoarthritis can also occur secondary to other prolonged joint related arthritis’s such as rheumatoid and gout. Once the lining and cartilages thin out, the bones which come together within the joint start to make contact and rub together. Sometimes bony spurs (osteophytes) can be formed within the joint causing further disruption and pain. Over time the bony ends start to miss shape and deform, and the cartilage and joint space is reduced.
Wear and tear arthritis has no direct cure, and the parts cannot be easily repaired or restored, ultimately leading to sufferers to self-manage with pain management (pain killers, anti-inflammatory drugs, and joint related supplements), physical therapy, exercise and bracing. When self-management cannot control the symptoms any longer, surgery and joint replacements maybe offered.
Rheumatoid arthritis (RA)
RA is an autoimmune disease and breaks down the joint and associated tissues when the body’s natural immune system is defective. The way that RA damages the joint is different to OA and rather than the boney ends and cartilage wearing away from continual use or trauma, the immune system falsely attacks the cells that line the joint capsule (synovium) by mistake. The diseases cannot differentiate between its own healthy tissue and foreign infections, viruses, or bacteria. The result being that the joint fills with unwanted fluid, swells and destroys the linings by means of corrosion. These changes cause the joint to then misshape and then can cause unwanted mechanical wear which leads to further OA onset.
Since RA is a disease, this is something which is usually always treated by a consultant called a rheumatologist and will need to be diagnosed by means of radiography and blood tests. Once diagnosed your consultant will usually prescribe immunosuppressant drugs / disease modifying drugs (DMARDS) which help to maintain a healthier / normalised immune system, lowering the risk of joint destruction. These can be used alongside specific pain killers and either steroidal or non-steroidal anti-inflammatory medicines (NSAIDS) to keep swelling to a minimum.
Psoriatic arthritis (PsA)
PsA is another autoimmune arthritis. This type generally affects people that suffer with psoriasis, however, skin psoriasis is not always present and it can manifest with no physical skin related symptoms. PsA is a less common type of arthritis but can be severe. The condition will always most likely progress and worsen with time, and joint damage and deformation can cause permanent damage just as OA and RA can. Similar to other autoimmune diseases, if the right diagnosis occurs early then medicines and consultant care can limit the effect of the disease and lessen the risk of life changing irreversible damage.
Gout
Gout is an acute reactive arthritis which comes with sudden onset and causes severe joint pain and stiffness. Many people are unaware that gout is a type of inflammatory arthritis and there is common misbelief that it is caused by a ‘rich lifestyle’. This lifestyle usually involves the intake of high calorific fatty foods and drink (such as alcohol) which are rich in a substance called purines. These purines are broken down by our body’s and leaves a byproduct called urate which our body’s cannot then remove efficiently, which causes gout.
The bodies inability to break down urate occurs in the kidney and is known as hyperuricemia. Gouty arthritis is caused by the increased uric acid levels in the blood and when left in the blood in excessive levels forms crystals which settle in the joint’s soft tissues and synovium. These crystals cause joint stiffness, swelling, and damage to the boney surfaces in the joint. Management for gout includes getting diagnosis via blood tests and it is advised to increase water intake, make dietary changes to cut down foods and drink which are high in purines, and a Dr can prescribe medicines to help the bodies ability to break down the uric acid in the body.
Ways to self-manage arthritis.
The key point (Lose weight and keep fit)
Increased body weight and load cause great strain on our joints. Exercise improves the joints integrity and helps to reduce body weight. The key is to lose weight via life-style changes and choosing exercise which is less impact heavy, so the weight loss is healthy, sustainable and doesn’t initially upset the joint.
Our weight has a huge effect on loads going through weight bearing joints. Roughly for each KG of body weight, the weight bearing joint will experience 3 times the force. For example, a 100kg man will experience 300kg of force through their knees. This can be almost doubled through impact and exercise, therefore, it is important to progressively reduce weight in a safe manner before including high impact exercise such a running or jumping.
A simple way for an average person suffering with arthritic pain to lose weight healthily is via a calorie deficit. To do this, find out your BMR (the number of calories needed to keep your body functioning at rest) and aim to maintain this as your daily intake. This essentially will put you into a calorie deficit once we factor in our general daily living tasks, and will result in steady maintainable weight loss. There are calculators online which can assist you to find out your BMR fairly easily.
Once body weight is reduced, and we have slowly introduced exercise in a non-impact heavy way, a slow introduction of more impact type exercises can commence. Research has recently shown that once your body weight and BMI becomes normalised, that exercise such as running and weight training can be beneficial to our joints. Cartilage adapts to repeated exposure to weight load and force and regular exercise and resistance training has shown in multiple systematic reviews and meta-analysis’s to improve symptoms of arthritis.
Studies which have taken place over periods of 10 years have looked at knee wear and prevalence of arthritis. They have shown that there is no increase in the occurrence of arthritis in the knee when comparing runners and non-runners, and that there is no association with accelerated onset in runners compared to non-runners. In fact, one study showed that over a 18 year period, that the prevalence of arthritis in runners was 20% compared to that of 32% in non-runners, and both showed less joint deterioration when compared to the non-active control group.
Research and reviews on weight training have showed similar. They explain that quality of life, pain, function and BMI were all improved in arthritic groups, with no increase or acceleration in the wear and tear of the joint when compared to non-weight training control groups. Systematic reviews indicated that low intensity and high-intensity strength training actually improved muscle function, joint stability and reduced pain. Both did not exacerbate the disease progression or inflammation relative to / compared to control groups.
Combining steady dietary weight loss via calorie-controlled diet and resistance exercise can boost overall weight loss, and will then lessen loads through the joints and will help improve not only your mobility and pain levels, but will create stronger bone density, stronger muscles, and will also trigger the feel good hormones (dopamine and serotonin) into your body. These will help with lowering stress levels, improve sleep patterns, and ultimately improve your general wellbeing and mental health.
Talk to a professional.
If self-management via weight loss, exercise and inclusion of assistive devices and supplementation have not helped, it’s advisable to then approach your health care professionals. Lots of people negate talking to their healthcare professionals or doctors and choose to live with the pains and discomforts, waiting for them to disappear. This can be the right thing to do in some cases and is likely the correct approach after a light sprain or strain, however, if your pains and discomforts are chronic and are ongoing, then highlighting this to your GP or Doctor is advisable.
Sudden injury and acute pain which includes bruising and swelling still needs attention regardless. However, if ongoing joint pains persist without incident, it is important to get this investigated and get an accurate diagnosis so that conditions such as autoimmunity or rheumatic diseases can be ruled out. By doing this treatments can start early, meaning symptoms are reduced and the risk of any long-term damage can be minimised.
Protect the joint
Protecting the joint with assistive devices such as orthotics and supplements are now well documented as an efficient way to helping with arthritis management.
To assist in increasing your physical activity levels, and to help to give extra support to the joints for mechanical purposes orthosis can be purchased or prescribed to help. These can offer cognitive and mechanical reassurance and provide piece of mind.
Orthosis can come in wide array of designs, offering multiple different functions to the user. Choices can be vast and confusing but when selected appropriately can have a great impact on users’ ability to mobilise better, without pain or restriction. Further down in this blog I have briefly gone into a little more detail regarding bracing and what they can offer.
Supplements can be included into your diet to help preserve the joints and give extra nutrients to the area to lessen the risks of further deterioration. Dietary supplementations with products such as Glucosamine, Turmeric, Chondrotin, and Omega oils have all been well reported in assisting with arthritis care. The reports have mixed results from research papers but have shown many consumers finding great anecdotal results from them.
Learn and educate.
The NHS and Charitable organisations such as arthritis action, National RA Society, and Versus Arthritis all offer a depth of knowledge and contents to help and assist suffers of arthritis. They offer support, advice, and workshops to help you learn about the conditions and how to best make decisions about your treatments. By self-educating you can better formulate management skills to further your health and help you live more active lifestyles without disability. Educating and learning about the condition can help improve mobilisation, pain management, lower stress levels and limit the risks of associated mental health concerns. These groups also offer a great way to communicate with other sufferers and help build networks for better wellbeing and care.
Bracing structure and design
Design and function affects how an orthosis helps with arthritic changes and pains. Some braces have specific offloading ability to help to mechanical change the limb alignment and offer direct relief to the arthritic joint. This occurs mainly through weight bearing joints such as the knee and the hip and the device will generally either be a hard-shell orthosis made from plastics or alloys, softer textile devices with rigid straps or via a combination of both.
Hard shell devices offer a more rigid support and will encumber the limb with usually an aluminium alloy frame, and can sometimes offer an adjustable aspect which will offer direct pressure relief to a specific area of the joint. These braces tend to be heavier and bulkier in their nature but offer the best levels of support as one would expect from a more rigid device.
Soft shell or textile devices are generally a much easier option to live with on a day-to-day basis. These offer a more comfortable fit and a much lower profile, but don’t often offer the same amounts of support. They can come with rigid fabric straps and stays to either offer a more specific offload or to wrap the joint securely to isolate and limit unwanted movement.
Combination bracing offer the best compromise for support and comfort by using hard-shell plastics, aluminium framework, soft textiles, and rigid strapping. These utilise the harder shell as an anchoring point against the limb and allows any strapping to work effectively offload the joint. These types of braces work by means of a 3 points of pressure system.
The hard shell applies a force to the limb at both the top and bottom of the brace whilst a counter force applies a third opposing force. This third force acts as a leverage point, and creates a turning moment on both the bones which form the joint. This works by then shifting the joint away from the area which is damaged and mechanically offloads the arthritic area.
Unloading type orthosis have shown to significantly improve patients quality of life and have shown to delay the need for surgical intervention. As a cost effective non-invasive option, surgeons are much more keen to prescribe such devices inline with a multi-disciplinary approach including rehab and exercise and is now classed as one of the best conservative managements for arthritis.
Materials
Neoprene is a thermo-therapeutic material which is not only breathable which helps to give mild compression, but also provides and maintains warmth to the area.
Heat therapy is a very easy way to help ease arthritic pains and is also a cost-effective management. Heat helps in a multitude of ways. It can help to aid healing via improving circulation to the tissues which increases essential nutrients and oxygen to the muscles and soft tissues, and they decrease joint stiffness as warm muscles and soft tissues are generally more flexible ones. Therefore, the connective tissues when warm can move more freely as the liquid within the joint becomes more viscous. Warmth also has an effect on settling sensory stimuli as receptors in the skin decrease transition of pain signals back to the brain when they are warmer.
Elastic offers similar results but achieves these from a different method. They don’t carry the same thermo properties as neoprene but rely more on adding compression to the joint by adding mild mechanical assistance and proprioception. Like neoprene, compression garments lessen pain by improving sensory stimulus and circulation, and do this primarily by reducing swelling.
When considering an inflammatory process, the compression that elastic devices offer, helps restrict unwanted fluid in the joint and its soft tissues. This swelling (effusion) has a negative effect on the joint as it creates stiffness which causes muscle pains, lessens venous return, and subsequently reduces circulation. The elastic helps to reduce this swelling by means of compression which allows the joint to move through greater ranges of movement. This subsequently improves coordination and control of the joint. As the movement improves, the swelling is further reduced and this increases bloodflow back into the joint.
Elastic also provides compression over the dermal layers of the skin which activates the sensory receptors in the dermis to feedback more freely to the brain, which further increases coordination and provides proprioceptive feedback to the user. In turn creating a subconscious awareness of the joint which provides support.
Closing Statement
There are numerous types of arthritis and ways to diagnose, treat and manage their symptoms. The ways these are managed are specific to the type of arthritis and will require different types of treatments including self-management, rehab, bracing, medicines, and medical approaches.
It’s important for us to widen our knowledge and understanding on arthritis especially when considering the damage it causes, which can lead to life changing disability and irreversible damage. We need to support awareness of the condition, be aware of how each type presents, and how we can help the suffer to get the quickest diagnosis, treatment and support available.
Continual research and education is needed to support arthritis suffers, develop ongoing treatment pathways, and to build up medical and social support networks to assist in future care and management.
There are numerous online resources and charitable organisations which can be called upon to assist with arthritis and many local events and specialists which help with mobility, pain management and rehabilitation. Taking all this into mind it’s worth considering your body weight and general health, and try to exercise and keep fit and healthy. This is well documented as the best way to manage arthritis, most certainly in load bearing joints.
Understand your body and learn about the presentations. If weight loss goals are difficult to achieve due to joint pains and discomforts, consider managing your mobility via assistive devices such as orthotics, which will help to give you confidence and might assist you in taking the further steps needed to support your wellbeing.
