25 Things you should know about arthritis

Sari Harrah with additions by Lucy Wildman

This painful joint disease is actually a collection of many ailments. The first line of defence: Educate yourself

Arthritis. If the word makes you think about older folks with creaky knees and jumbo bottles of ibuprofen, you need an update. This painful joint disease is widespread and comes in many forms.

By far the most common type, currently affecting 40 million people across Europe, is osteoarthritis. The UK-based Rheumatology journal reports a lifetime risk of 45 per cent for knee and 25 per cent for hip osteoarthritis. It’s the fastest growing cause of disability worldwide.

Other types of arthritis, including gout, psoriatic arthritis, and rheumatoid arthritis, add to the misery. Gout affects from about one percent to two and a half per cent of the population, depending on the country, psoriatic arthritis less than half of one per cent and rheumatoid arthritis about one per cent.

All told, rheumatic conditions and other musculoskeletal diseases (including such diseases as fibromyalgia, tendinitis and carpal tunnel syndrome) will strike one in four Europeans—more than 120 million people—at some point in their lives, reports the European League Against Rheumatism (EULAR).

There’s no cure for any form of arthritis, but science has made several breakthroughs in understanding how to treat the inflammation and pain that come with it, as well as how to halt the underlying joint damage.

 

OSTEOARTHRITIS (OA): Wear and tear of the cartilage cushion between joints that can often cause—and in some cases result from—chronic inflammation.

1. Old-fashioned X-rays are the best diagnostic tool. A Washington University study noted that X-rays can diagnose OA as accurately as MRI scans—and they do it faster and more cheaply. Identifying arthritis early gives you time to turn to lifestyle changes (more on those below) before irreversible damage is done to your knees (the most common pain point) or other joints.

2. The most common treatment for OA doesn’t repair joints. Up to 85 per cent of sufferers try nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Though they can be effective at getting you through the day, says Kelli Allen, a researcher at the Thurston Arthritis Research Centre at the University of North Carolina, they don’t protect joints from progressive damage and may have serious side effects.

3. When people with osteoarthritis used NSAID gels, drops, or patches, half said their pain fell by 50 per cent or more over 12 weeks. Because these versions are rubbed onto your skin, less of the drug gets into your blood, reducing the risk of gastrointestinal bleeding, heart problems, and other side effects. That said, don’t use these topical treatments if you have kidney disease or are taking oral NSAIDs.

4. A 2018 study of 240 osteoarthritis patients showed that those who took opioids were in slightly more pain after a year than those who took non-opioid medication. Researchers aren’t sure why, but as these drugs can be very addictive, they recommend against opioids.

5. Arthritis hurts your heart by contributing to chronic inflammation, reducing physical activity, and increasing NSAID use—all factors in cardiovascular risk. All told, researchers estimate that OA boosts your odds for heart disease by 24 per cent. (Psoriatic and rheumatoid arthritis raise the odds even higher.)

6. Australian researchers who reviewed the evidence for 20 top-selling herbs and dietary supplements used to treat OA concluded that three—Boswellia serrata extract, pine bark extract, and curcumin—are most effective in reducing inflammation and pain short term.

7. Cortisone injections don’t help long term. “A single shot can ease pain,” says Dr Timothy McAlindon, chief of rheumatology at Tufts Medical Centre in Boston. But a recent study found that repeated shots of cortisone, a steroid, not only didn’t control pain but actually led to more joint damage.

8. Insomnia is an often undertreated side effect of arthritis, but there are fixes. Lack of sleep can intensify sensitivity to pain, a problem for OA patients, according to a study at Johns Hopkins University in Baltimore. Cognitive behavioural therapy, which helps people change distorted thinking that can worsen pain levels, has been shown to increase the amount of time OA sufferers slept—and decreased their pain.

9. A new device called Coolief uses specialised electrodes to send water-cooled radio waves into the tissue around your knee, which temporarily deactivates nerves. Patients reported longer-lasting pain relief (up to 12 months) with Coolief than with cortisone injections.

 

RHEUMATOID ARTHRITIS (RA): The immune system attacks the fluid that lubricates joints, causing inflammation and destroying cartilage.

10. Vitamin D could help prevent RA. In a study, researchers found that people with low blood levels of vitamin D, which boosts immune function, were at higher risk for RA. (One great free source of vitamin D: sunshine.)

11. Menopause worsens symptoms of rheumatoid arthritis. A 2018 study of 8,189 women in the journal Rheumatology confirmed that joint degeneration speeds up after menopause. Early menopause can trigger the disease too.

12. Rheumatoid arthritis can raise your risk for certain types of cancer. Lung cancer, lymphoma, and multiple myeloma are more common in people with RA, partly due to inflammation and partly because RA drugs suppress the immune system.

13. Patients getting disease-modifying antirheumatic drugs (DMARDs) should understand that one DMARD doesn’t fit all. “DMARDs can put RA into remission, but a drug may stop working after several years. Some people have to try several before they find the one that works best,” says Dr. David Daikh, president of the American College of Rheumatology.

14. Tumour necrosis factor (TNF) is an inflammatory protein responsible for pain and cartilage degeneration in RA, and drugs called TNF inhibitors can sometimes block it. And if one TNF inhibitor—such as etanercept (Enbrel) and adalimumab (Humira)—doesn’t work, try another. In a recent study, 43 per cent of patients who didn’t respond to one type of TNF inhibitor responded positively to a different one.

15. Biologic drugs—such as etanercept (Enbrel), golimumab (Simponi), and adalimumab (Humira)—are engineered from human genes. They work by targeting specific parts of the inflammation process rather than suppressing the immune system in general (as older DMARDs do), so they tend to have fewer side effects.

16. Genetic profiling could soon pinpoint which drug classes or individual drugs will work for you. In a new study published last May in the US-based journal Arthritis & Rheumatology, researchers analysed joint tissue from 41 rheumatoid arthritis patients to determine which gene variations each individual had and how they responded to each type of drug. Next they hope to predict which patients will respond best to specific drugs based on their genetics, saving time and money.

 

PSORIATIC ARTHRITIS (PsA): An autoimmune disease in which the immune system attacks healthy joint tissue, PsA affects about 30 per cent of people with psoriasis, a condition marked by red, scaly patches on the skin or scalp.

17. PsA is not RA. Psoriatic arthritis is often misdiagnosed as rheumatoid arthritis, but the cause and many treatments are different. Until 2013, the medications to treat psoriatic arthritis were RA drugs. Since then, new treatments for those with PsA have become available.

18. A timely diagnosis can prevent permanent joint damage. “In PsA, erosive joint changes can begin within six months of first symptoms,” says rheumatologist Dr. Sergio Schwartzman. “But many people have a five-year delay in receiving a diagnosis.”

19. Psoriatic arthritis sufferers are six times more likely to have the inflammatory bowel disease (IBD) known as Crohn’s disease, according to a study of more than 174,000 women. Chronic inflammation underlies both Crohn’s and PsA, and some medications used to treat arthritis may exacerbate IBD symptoms. People with PsA are also at higher risk for diabetes, osteoporosis, kidney disease, other autoimmune diseases, and many other conditions.

 

GOUT Caused by uric acid crystals in joints (most often in the big toe).

20. Cases of gout have increased steadily in recent years, particularly here in the UK, where about one in 40 people suffer from it, according to the London-based Annals of the Rheumatic Diseases. The number of UK cases rose nearly 30 per cent between 1997 and 2012. In Sweden, too, a research article reported that the incidence of gout rose steadily from 2005 to 2012, increasing by almost 50 per cent among the Swedish population. The use of certain medications for high blood pressure—especially loop and thiazide diuretics—are among the top reasons for the increase. Foods and drinks rich in compounds called purines (such as alcohol, bacon, and sweets) also contribute to the formation of uric acid crystals, as does being overweight and sedentary.

21. Tomatoes could be a gout trigger for some people, a study from 2015 found. Tomatoes, which can increase uric acid levels, were the fourth most common food trigger after seafood, alcohol, and red meat. Cherries, however, can lower risk of an attack. In a 2012 study, researchers followed people with gout for a year and found that those who ate fresh cherries or took cherry extract throughout the year were 37 per cent less likely to have recurrent attacks.

22. Gout drugs can be effective, but they can also have drawbacks. In a 2018 study of more than 6,000 people with gout, those who took febuxostat were 34 per cent more likely to die from heart disease than people who took allopurinol, another common gout drug. But allopurinol can cause liver problems, while another older gout drug, colchicine, can cause severe diarrhea.

 

HEALTHY CHOICES New research has proven that old-time remedies really work. While most studies have been done with osteoarthritis or rheumatoid patients, experts say these strategies will help almost all kinds of arthritis.

23. In a study of 640 overweight and obese people, those who lost just five per cent of their body weight over two years had lower rates of cartilage degeneration.

24. Fiber and fish can reduce pain. People who ate 22 to 28 grams of fiber per day had a 30 to 61 percent lower risk for OA-related knee pain. One study showed that RA patients who ate fish at least twice a week had fewer swollen, tender joints than those who rarely did.

25. And so can exercise and physical therapy. Just 45 minutes a week of walking or easy exercise helped people with OA reduce pain and improve joint function in knees, hips, and ankles by 80 per cent. And a review of 21 complementary therapies found that acupuncture, massage, yoga, and tai chi were all effective in easing pain.

Arthritis Action is the UK’s charity focused on self-management. We empower people to take control of their arthritis by sharing tools, advice and information they need to manage the physical and mental aspects of their condition.